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Data absent from claim that video game benefits MS patients

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IMAGE: AXIAL STATISTICAL MAPS SHOW AREAS OF REDUCED THALAMIC FUNCTIONAL CONNECTIVITY IN PATIENTS WITH MS COMPARED WITH THAT IN HEALTHY SUBJECTS. PATIENTS EXHIBITED SIGNIFICANTLY LOWER FC IN CLUSTERS LOCATED IN THE… view more

CREDIT: RADIOLOGICAL SOCIETY OF NORTH AMERICA

OAK BROOK, Ill. – Playing “brain-training” video games may help improve some cognitive abilities of people with multiple sclerosis (MS) by strengthening neural connections in an important part of their brains, according to a new study published online in the journal Radiology.

MS is a disease of the central nervous system that results in damage to the protective covering of nerve fibers. Symptoms include weakness, muscle stiffness and difficulty thinking–a phenomenon often referred to as “brain fog.” MS affects an estimated 2.5 million people worldwide, according to the Multiple Sclerosis Foundation.

Damage to the thalamus, a structure in the middle of the brain that acts as a kind of information hub, and its connections with other parts of the brain play an important role in the cognitive dysfunction many MS patients experience.

Researchers led by Laura De Giglio, M.D., Ph.D., from the Department of Neurology and Psychiatry at Sapienza University in Rome, recently studied the effects of a video game-based cognitive rehabilitation program on the thalamus in patients with MS. They used a collection of video games from the Nintendo Corporation, called Dr. Kawashima’s Brain Training, which train the brain using puzzles, word memory and other mental challenges. The games are based on the work of Japanese neuroscientist Ryuta Kawashima, M.D.

Twenty-four MS patients with cognitive impairment were randomly assigned to either take part in an eight-week, home-based rehabilitation program–consisting of 30-minute gaming sessions, five days per week–or be put on a wait list, serving as the control group. Patients were evaluated by cognitive tests and by 3-Tesla resting state functional MRI (RS-fMRI) at baseline and after the eight-week period. Functional imaging when the brain is in its resting state, or not focused on a particular task, provides important information on neural connectivity.

“Functional MRI allows you to study which brain areas are simultaneously active and gives information on the participation of certain areas with specific brain circuits,” Dr. De Giglio said. “When we talk about increased connectivity, we mean that these circuits have been modified, increasing the extension of areas that work simultaneously.”

At follow-up, the 12 patients in the video-game group had significant increases in thalamic functional connectivity in brain areas corresponding to the posterior component of the default mode network, which is one of the most important brain networks involved in cognition. The results provide an example of the brain’s plasticity, or ability to form new connections throughout life.

“This increased connectivity reflects the fact that video gaming experience changed the mode of operation of certain brain structures,” Dr. De Giglio said. “This means that even a widespread and common use tool like video games can promote brain plasticity and can aid in cognitive rehabilitation for people with neurological diseases, such as multiple sclerosis.”

The modifications in functional connectivity shown in the video game group after training corresponded to significant improvements in test scores assessing sustained attention and executive function, the higher-level cognitive skills that help organize our lives and regulate our behavior.

The results suggest that video-game-based brain training is an effective option to improve cognitive abilities of patients with MS.

In the future, the researchers hope to study whether the plasticity induced by video games in MS patients is also related to improvements in other aspects of their daily lives. They also plan to look at how the video game can be integrated into a rehabilitation program together with other rehabilitative techniques.

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“Multiple Sclerosis: Changes in Thalamic Resting-State Functional Connectivity Induced by a Home-based Cognitive Rehabilitation Program.” Collaborating with Dr. De Giglio were Francesca Tona, M.D., Francesca De Luca, Psy.D., Nikolaos Petsas, M.D., Ph.D., Luca Prosperini, M.D., Ph.D., Valentina Bianchi, Psy.D., Carlo Pozzilli, M.D., Ph.D., and Patrizia Pantano, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)

RSNA is an association of more than 54,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

For patient-friendly information on brain fMRI, visit RadiologyInfo.org.

Video games improve brain connections in multiple sclerosis patients

Our Review Summary

Video gameThis release describes a comparative study in a very small number of patients with MS who either used a video game program or not. The research study reports that the control group received no comparative treatment during the 8-week study period. The study reports changes in brain imaging and test scores that suggest benefit at the end of the study period. While encouraging, the release alludes to the need for considerable additional studies. We found that the release ignored some criteria we consider important, including cost, harms, alternative therapies and acknowledgement of the study funders or any potential conflict of interest. It would have been helpful for the release to emphasize more clearly what this study doesn’t do and next steps needed before this is something that patients with MS, who may be desperate for new therapies, should embrace.

 

Why This Matters

MS is a degenerative brain disease that often affects individuals in the prime of life. For some, the course may be mild and managed with current therapy. However, for others it is a terrifying disease with rapid declines in function that can come without warning and only partially be reversed with treatment. In this context, therapies that help “train” the brain to function better within the limits of the disease make sense. And there are a range of rehabilitative programs that are available to MS patients and it is in this context that any new treatments, such as video game training should be considered. If proven effective, this approach of using a home-based, readily available video game/training program might improve the quality of life for MS patients whose prospects for improvement are often slim.

However, the size of the study population is far too small to extrapolate findings to MS patients overall, and neither the release nor the study itself demonstrate an actual clinical improvement in these patients, although the lead paragraph of the release suggests that such is the case.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release makes no mention of the cost of this video game/training program although that would be a key immediate question in the minds of both MS patients and their families. Moreover, this cost may not be covered by health insurance whereas other forms of cognitive training, for example performed by occupational therapist, may be. The release also fails to mention the cost of other equipment required to play the video game. Together, the game and player can cost hundreds of dollars, depending on the model purchased, and while that cost may not be overly prohibitive, readers deserve to know it when considering the value of this study’s information.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release says that the research showed “significant increases in thalamic functional connectivity” but fails to quantify the extent of those increases. Nor does it show that increased connectivity improves the patients’ quality of life, although it certainly suggests that outcome. More important for patients, the release states, “The modifications in functional connectivity shown in the video game group after training corresponded to significant improvements in test scores assessing sustained attention and executive function…” This improvement is not quantified, nor is it put into a perspective where the patient can know what this may or may not mean in terms of life functioning (see quality of evidence section).

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

While there are no obvious harms that would come from playing the video game/training program used in the study we think addressing harms is applicable for this news release, and there was no mention. It is possible that focusing on training in one part of brain function may lead to lack of attention in other parts, and this imbalance may result in relative gains and losses in brain activity that may have negative impacts in certain cognitive or functional areas. It may also be worth noting that harm may come from overuse. In a controlled setting like this study, overuse may be preventable. But what if this was available at home and the person could use it 24/7?

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The news release adequately frames the trial and its findings and describes how outcomes were measured through cognitive and imaging tests. But the release could have gone further in providing the specific outcome data, which we addressed in the benefits section above. This was a very small study using only two dozen patients, half of which were controls. While the release states that brain scans showed increased connectivity in game-playing patients, it fails to offer evidence of improvements in the patients’ disease or in their ability to cope with it.

Does the news release commit disease-mongering?

Satisfactory

The combination in the release of information about the incurable disease of MS, plus the appeal of video games potentially playing a therapeutic role, makes this a release that should trigger broad interest, but that does not seem to reach the level of disease-mongering.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release doesn’t share any information on how the research was funded, while in fairness, neither does the original research paper. Neither does it discuss any potential conflict of interest, although the research paper suggests there is none. Given the mention of the use of a commercial game, information about funding and conflict of interest is relevant.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The release fails to mention any alternatives to the use of the video game/training program which might produce equivalent improvement in connectivity within this region of the brain. As previously mentioned, there are other forms of therapy for patients with MS and it isn’t clear how this new therapy compares. At least a mention of this would have been appropriate. The last line of the release says this new treatment could be combined with existing rehabilitation therapy, but we think this is too little, too late.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The release does identify the specific video game used in the study and its manufacturer, Nintendo, allowing readers to do a quick web search showing both it and accompanying equipment are readily available on the market.

Does the news release establish the true novelty of the approach?

Satisfactory

A study showing that a video game used regularly in a home environment might improve the condition of MS patients, if confirmed, is certainly novel enough to warrant a news release, although the lack of substantive findings from the research weaken its value to readers.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release does not appear to use unjustifiable language.

Total Score: 5 of 10 Satisfactory

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