Evaluation of the effectiveness of electroencephalographic training with neurofeedback (EEG-NFB) for a patient with dysexecutive syndrome after neurosurgery of two brain aneurysms detected after COVID-19 disease

The purpose of this study is to evaluate the effectiveness of functional neuromarker- based electroencephalographic training with neurofeedback (EEG-NFB) for a patient with dysexecutive syndrome following neurosurgical operation of two brain aneurysms of the left and right middle cerebral artery (MCA) detected after COVID-19 disease. A right-handed, 56-years-old, not vaccinated, patient, became infected with SARS- CoV-2 and contracted COVID-19 with the manifestation of respiratory symptoms, high fever, dyspnea and low saturation of 79% Sa02. She was hospitalized at the Infectious Disease Unit, where a positive RT PCR test for COVID-19 was confirmed. The acute phase of COVID-19, during which oxygen therapy was administered, lasted two weeks and was complicated by brain fog and transient hypertension (175/100). There were no signs of focal damage to the central nervous system. She was discharged home in a good general and neurological condition. After returning home, the patient was unable to cope with daily functioning, as she said her brain fog continued to persist, manifesting itself as executive dysfunction. Eight weeks after the infection, the patient's neuropsychiatric condition worsened. On CT and MRI examination of the cerebral vessels, she was diagnosed with the presence of two aneurysms located on the left and right middle cerebral arteries (MCA). She was operated on at the Department of Neurosurgery and Neurotraumatology, where a pterional craniotomy and clipping of both brain aneurysms was performed. The Yasargil titanium clip was placed on the aneurysm neck. During the surgery procedures, performed two months apart, there were no signs of a history of subarachnoid haemorrhage and the post-operative period was uneventful, except for a drooping right-eye eyelid (after the second surgery) with a tendency to improve. Each time, the patient was mobilized and walked independently and was discharged home in a good general condition, with no neurological symptoms, except for executive dysfunction. Approximately five months after the SARS-CoV-2 infection (four weeks after the second surgery), her executive dysfunction worsened. Neuropsychological testing using Mindstreams™ Interaction Computer Tests revealed moderate Dysexecutive Syndrome (DES), while neurophysiological testing using qEEGs, ERPs and sLORETA tomography, a functional neuromarker of frontotemporal area dysfunction. The EEG pattern was characterized by excessive, slow (about 6 Hz) activity in frontotemporal areas, which indicated the progressive loss of cognitive control over time. The patient was offered an electroencephalographic training protocol with neurofeedback (EEG-NFB) based on the detected functional neuromarker, which reduced DES. The improvement achieved during therapy was statistically significant [compared to the normative database (Human Brain Index, HBI)]. In effect, the patient's quality of life improved, as she herself pointed out. Her symptoms of brain fog and DES disappeared and she returned to her previous work as a waitress. The Human Brain Index (HBI) methodology can be successfully used in the neurodiagnosis and implementation of individualized electroencephalographic training with neurofeedback (EEG-NFT) for patients with executive dysfunction after contracting longCOVID.