Most commonly, patients may feel fatigued during or after a session. More rarely, treatment can lead to a headache, distractibility, dizziness or difficulty falling asleep. Such symptoms may arise from a long training session and will often pass a within a few hours after the session has completed. If you tell your doctor or technician about these symptoms, the protocol can be altered to reduce or eliminate these side mild effects. More rare side effects result from working with poorly trained, uncertified therapists who do not utilize individualized treatment protocols which should be unique for each patient. For example, if trying to reduce seizures or address issues resulting from attention deficit hyperactivity disorder (ADHD), specific regions of the brain need to be targeted for training. Our group of board-certified neurologists, registered nurses and AAPB certified technologists are trained to create individualized programs for each patient for safe and effective treatment. References: 1. Hammond DC. What is Neurofeedback: An Update. J Neurother. 2011;15(4):305-336. doi:10.1080/10874208.2011.623090

1. Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up (2013) Design: Randomized control trial comparing neurofeedback to stimulant medication (methylphenidate) in children with ADHD. Results: Significant academic performance improvement in neurofeedback group. Both groups had reduction in functional impairment and symptoms as rated by parents and teachers. 2. Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (2007) Design: Trial comparing neurofeedback group to group therapy. Parents and teachers rated executive function and neuropsychological testing was done before and after treatment. Results: Neurofeedback was superior to group therapy in attention and cognitive related domains

1. A Randomized Controlled Study of Neurofeedback for Chronic PTSD (2016) Design: Randomized control trial comparing neurofeedback treatment (n=28) to waitlist group (n=24) Results: Group treated with neurofeedback had significant symptom improvement in chronic PTSD

1. Effects of Increase in Amplitude of Occipital Alpha & Theta Brain Waves on Global Functioning Level of Patients with Generalized Anxiety Disorder (2015) Design: 28 patients with generalized anxiety disorder, 14 of whom received training with neurofeedback and 14 were on waitlist. Results: Group treated with neurofeedback had improvement in their global functioning level and reduction of symptoms of anxiety not observed in the waiting list group.

1. Efficacy of bio- and neurofeedback for depression: a meta-analysis (2022) Design: Meta-analysis of neurofeedback and biofeedback (heart rate variability) in treatment of symptoms of depression Results: The analysis found reduction in self-reported symptoms of depression from both mechanisms of biofeedback not seen in control groups.

1. Neurofeedback Intervention in Fibromyalgia Syndrome; a Randomized, Controlled, Rater Blind Clinical Trial (2010) Design: Randomized controlled, rater blinded trial comparing neurofeedback to SSRI treatment Results: While both treatment groups showed improvement, neurofeedback group showed significantly greater benefit (p<0.05) with improved pain, anxiety, depression and quality of life.

1. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study (2010) Design: 37 migraine patients treated with 40 neurofeedback sessions, 3x weekly over 6 months and followed for 14.5 Results: 70% of patients had 50% reduction in headaches which was sustained 14.5 months after the end of neurofeedback treatment 2. QEEG-guided neurofeedback for recurrent migraine headaches (2011) Design: Neurofeedback with medication vs medication alone in patients with migraine with aura. Results: 54% in the neurofeedback group had complete cessation of migraine and 39% had frequency reduction of >50%. In contrast, 68% in medication only group had no change in migraine frequency, 20% had reduction to <50% and only 8% had a reduction of >50%.

1. The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients with Multiple Sclerosis (2017) Design: 10 patients underwent treatment with EEG biofeedback, and 10 patients served as control. Depression and quality of life were analyzed Results: EEG biofeedback reduced depression and improved quality of life in patients with multiple sclerosis. 2. MRI correlates of cognitive improvement after home-based EEG neurofeedback training in patients with multiple sclerosis: a pilot study (2021) Design: 14 patients underwent EEG neurofeedback training, followed by tractography and fMRI. Results: successful neurofeedback training may not only lead to cognitive improvement, but also to increases in brain microstructure and functional connectivity.

1. Meta-analysis of EEG biofeedback in treating epilepsy (2009) Design: 10 studies employing EEG biofeedback in medication refractory epilepsy patients Results: 74% of patients showed fewer weekly seizures which is particularly of note given these patients were refractory to medication.

1. A meta-analysis of neurofeedback for treating substance used isorders (2023) “A meta-analysis was conducted to assess the efficacy of neurofeedback (NFB) in the treatment of individuals with substance use disorder (SUD) in between-group studies." "This meta-analysis provides strong evidence for the efficacy of neurofeedback in treating substance use disorder while also highlighting the value of holistic client care in substance use disorder treatment.”

1. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist) (2020) Design: Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field. Results: This checklist is intended to encourage robust experimental design and clear reporting for clinical and cognitive-behavioral neurofeedback experiments. Widespread adoption of this checklist will help advance scientific understanding of how neurofeedback affects brain function and behavior.

Bidaki R, Sepehri F, Sadr Mohammadi R, Kamali O, Babaei Zarch M, Mirhoseini H. The Effect of EEG Biofeedback on Depression and Improve the Quality of Life of Patients with Multiple Sclerosis (MS). Focus Sci. 2017;3(3):1-5. doi:10.21859/focsci-03031417 Dadashi M, Birashak B, Taremian F, Asgarnejad AA, Momtazi S. Effect of increase in amplitude of occipital alpha &amp; theta brain waves on global functioning level of patients with GAD. Basic Clin Neurosci. 2015;6(1):14-20. Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen HC, Brandeis D. 1Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD). Behav Brain Funct. 2007;3(1):35. doi:10.1186/1744-9081-3-35 Fernández-Alvarez J, Grassi M, Colombo D, et al. Efficacy of bio- and neurofeedback for depression: a meta-analysis. Psychol Med. 2022;52(2):201-216. doi:10.1017/S0033291721004396 Kayıran S, Dursun E, Dursun N, Ermutlu N, Karamürsel S. Neurofeedback Intervention in Fibromyalgia Syndrome; a Randomized, Controlled, Rater Blind Clinical Trial. Appl Psychophysiol Biofeedback. 2010;35(4):293-302. doi:10.1007/s10484-010-9135-9 Meisel V, Servera M, Garcia-Banda G, Cardo E, Moreno I. Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up. Biol Psychol. 2013;94(1):12-21. doi:10.1016/j.biopsycho.2013.04.015 Pinter D, Kober SE, Fruhwirth V, et al. MRI correlates of cognitive improvement after home-based EEG neurofeedback training in patients with multiple sclerosis: a pilot study. J Neurol. 2021;268(10):3808-3816. doi:10.1007/s00415-021-10530-9 Ros T, Enriquez-Geppert S, Zotev V, et al. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist). Brain. 2020;143(6):1674-1685. doi:10.1093/brain/awaa009 Stokes DA, Lappin MS. Neurofeedback and biofeedback with 37 migraineurs: A clinical outcome study. Behav Brain Funct. 2010;6. doi:10.1186/1744-9081-6-9 Tan G, Thornby J, Hammond DC, et al. Meta-analysis of EEG biofeedback in treating epilepsy. Clin EEG Neurosci. 2009;40(3):173-179. doi:10.1177/155005940904000310 van der Kolk BA, Hodgdon H, Gapen M, et al. A Randomized Controlled Study of Neurofeedback for Chronic PTSD. Matsuoka YJ, ed. PLoS One. 2016;11(12):e0166752. doi:10.1371/journal.pone.0166752 Walker JE. QEEG-guided neurofeedback for recurrent migraine headaches. Clin EEG Neurosci. 2011;42(1):59-61. doi:10.1177/155005941104200112 Russo GM, Smith S, Sperandio KR. A meta-analysis of neurofeedback for treating substanceusedisorders. J Couns Dev. 2023;101(2):143-156.