Neuromodulation as Treatment for Chemotherapy

A Story by Dr Sarah Prinsloo / MD Anderson

Chemotherapy-induced peripheral neuropathy (CIPN) is often a side effect of cancer treatment and can diminish a patient’s quality of life (QOL) by affecting everyday activities such as driving a car, putting on clothing, using utensils and walking. By using technology that measures the electrical activity of the brain, Dr. Prinsloo and her team tested a treatment called neurofeedback for CIPN that is customized to the individual, relatively inexpensive, non-invasive, and provided alongside conventional medicine.

Patients completed assessments that determined the brain activity related to their pain, mental health, and QOL. They were randomized to one of three groups:
1) neurofeedback, 2) placebo control or 3) wait-list.
The neurofeedback group had a minimum of two sessions of neurofeedback training each week for 10 weeks where their brain activity was monitored by electroencephalogram while the patients played a computer game. The game rewarded the participants when they successfully modified their brainwave activity in a targeted area. Over time, the patient learned to modify that activity without the game. Patients in the placebo condition received the same treatment although they were not taught to modify their brain activity. Follow-up measures were collected at the end of the neurofeedback sessions and one month later.

Dr. Prinsloo and her team found that patients can learn to control activity in brain areas that are associated with CIPN, leading to QOL improvements such as restoration of normal exercise and recreational activities. They also examined the brain activity of patients with CIPN before neurofeedback and again after and compared that to the brain activity of patients who received a placebo intervention.
 

Rising Tide is currently contributing to the next step of this research, a phase III trial using neurofeedback to augment the limited effects of the only medication approved to treat CIPN (duloxetine).


The objective is to determine the least number of sessions required to achieve the most benefit from neurofeedback.  They will recruit 400 cancer survivors with CIPN, one of the locations will be a clinic for underserved populations. Participants will receive either 15 sessions of neurofeedback (over 5 weeks) or duloxetine for five weeks. 

They will also examine baseline patterns of brain activity and pair that activity with whether the participant benefitted from NFB or from duloxetine. Then they will determine who will respond to treatment, and who will need an increased number of neurofeedback sessions. Another component of this research will ask participants about their overall quality of life during and after varying numbers of neurofeedback sessions, cancer related symptoms, and physical functioning. Participants will be assessed at the end of treatment, at 6 months, and then a year after the conclusion of treatment. Assessments will include an EEG, functional performance, questionnaires of CIPN-symptoms, QOL, and mental health.

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