QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated. . . . Clinicians, including the authors, have had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

Preface by By James Neubrander, MD

Parents of children with autism know me (JN) as a physician who uses various biomedical treatments to help children move toward recovery. Several years ago, I was introduced to the powerful modality of QEEG-guided neurofeedback. This treatment uses EEG biofeedback, also known as neurofeedback, guided by the QEEG, or quantitative electroencephalogram. Neurofeedback has since become an important addition to my practice because it offers therapeutic options that are not possible through biomedical treatments alone.

To date, I have obtained QEEGs on hundreds of children with autism and have watched the neurofeedback process help them take one or more steps forward on their roads to recovery. That is why it pleases me to have been asked by Autism Science Digest to write this article to introduce QEEG and QEEG-guided neurofeedback for children with autism as one more important treatment option for parents to consider.

Although I have prescribed many neurofeedback sessions for my clients, I cannot claim to be an expert in QEEG interpretation. In that regard, I defer to those who evaluate my patients’ EEg tracings and subsequently recommend appropriate neurofeedback protocols that my neurofeedback technicians then implement. My coauthors (Ml, Jg, and Ck), whose biographies speak for themselves, are some of the most respected names in the field of QEEG and QEEG-guided neurofeedback. In this paper, they provide an overview of the science behind the process, a theoretical platform, and an outline of the benefits this treatment can offer to the many children who have attention-deficit or attention-deficit/hyperactivity disorder (ADD/ADHD), Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), or autism spectrum disorder (ASD).

“I have obtained QEEGs on hundreds of children with autism and have watched the
neurofeedback process help them take one or more steps forward on their roads to recovery.”

Download or Read the full PDF here.

AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE – ISSUE 03

This paper brings into clear question the commonly taught model of short and long distance connectivity which has been taught as a “cortical-cortical connectivity” issue, when many have pointed to the logical fallacy to this theory seen in the International Federation of Clinical Neurophysiology position paper (Basic Mechanisms of Cerebral Rhythmic Activities) on EEG generators, which showed that cutting cortical-cortical connections did not alter coherence (making the theory false).

I have presented this to the people in the field in an effort to correct the “cortical-cortical connectivity” theory – that has been promoted.

I hope the two compartmental cortical-cortical connectivity theory will fade away, especially as publications like this and the IFCN position paper point in a different direction.

Jay

More Reading: Control of Spatiotemporal Coherence of a Thalamic Oscillation by Corticothalamic Feedback Science 1 November 1996:Vol. 274 no. 5288 pp. 771-774 DOI: 10.1126/science.274.5288.771

Movement during brain scans may lead to spurious patterns from Simons Foundation Autism Research Initiative (SFARI)

Last Friday he defended his PhD titled: “Personalized Medicine in ADHD and Depression: A quest for EEG treatment predictors” with success!

For those of you interested, you can download a PDF of his 282 page PhD on http://www.brainclinics.com/page/5/course-calendar.html on the bottom of the page. You can also register under ‘Community’, where you can access all PDF’s of the articles and powerpoint presentations: http://www.brainclinics.com/page/11/community.html

Martijn’s dissertation far exceeds the quantity of work seen in PhD dissertations, covering a breadth and depth generally not seen from any less qualified than a full professor. His review of the literature, providing of a meta-analysis of the use of NF in ADHD lays the basis for the current level of acceptance NF in ADHD has achieved within the Neurosciences. His work also includes the prediction of medication response in ADHD and Depression, as well as the application of rTMS to depression, and an investigation into personalizing the rTMS stimulation paradigm. Seldom is such a breadth or depth of work seen in a PhD dissertation, as it generally would be too much work to finalize such an endeavor.

Martijn went back into the historic EEG literature far enough to gain insight into some of the reductionistic errors that the early days of qEEG created in our ability to understand the very nature of some of the pathologies we are currently studying. His dissertation disentangles the presence of slowed alpha from true theta rhythm, and also tests prospectively the EEG Phenotype model, integrating it with the European Vigilance model, and postulating biomarkers that predict clinical approaches.

It is easy to see why Martijn has gained such prominence in the neuromodulation field at such a young age (compared to me he is very young… but so is almost everyone else!)

By: James Neubrander MD, Michael Liden PhD, Jay Gunkleman QEEGD, and Cynthia Kerson PhD.

QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of  neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated …. Clinicians, including the authors, hove had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

PREFACE

Parents of children with autism know me (JN) as a physician who uses various biomedical treatments to help children move toward recovery. Several years ago. I was introduced to the powerful modality of QEEG-guided neurofeedback. This treatment uses EEG biofeedback, also known as neurofeedback, guided by the QEEG, or quantitative electroencephalogram. Neurofeedback has since become an important addition to my practice because it offers therapeutic options that are not possible through biomedical treatments alone.

To date, I have obtained QEEGs on hundreds of children with autism and have watched the neurofeedback process help them take one or more steps forward on their roads co recovery. That is why it pleases me to have been asked by Autism Science Digest to write this article to introduce QEEG and QEEG-guided neurofeedback for children with autism as one more important treatment option for parents to consider.

Although I have prescribed many neurofeedback sessions for my clients. I cannot claim to be an expert in QEEG interpretation. In that regard, I defer to those who evaluate my patients’ EEG tracings and subsequently recommend appropriate neurofeedback protocols that my neurofeedback technicians then implement. My coauthors (ML, JG, and CK), whose biographies speak for themselves, are some of the most respected names in the field of QEEG and QEEG-guided neurofeedback. In this paper, they provide an overview of the science behind the process, a theoretical platform, and an outline of the benefits this treatment can offer to the many children who have attention-deficit or attention-deficit/hyperactivity disorder (ADD/ADHD), Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), or autism spectrum disorder (ASD).

Read the rest of the article [PDF File]

Real the full article here – Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

(The Journal of Neuropsychiatry and Clinical Neurosciences 2008; 20:7?22)

This ERP technology is ready for prime time in TBI. The peer review and publication process is how science moves forward, and the use of ERP for TBI evaluations is now accepted by the peer review process, but not the EEG/qEEG yet fully, and definitely not EEG based discriminants for TBI, which are now counseled against in the peer reviewed literature.

Jay

ABSTRACT

Traumatic brain injuries are often associated with damage to sensory and cognitive processing pathways. Because evoked potentials (EPs) and event-related potentials (ERPs) are generated by neuronal activity, they are useful for assessing the integrity of neural processing capabilities in patients with traumatic brain injury (TBI). This review of somatosensory, auditory and visual ERPs in assessments of TBI patients is provided with the hope that it will be of interest to clinicians and researchers who conduct or interpret electrophysiological evaluations of this population. Because this article reviews ERP studies conducted in three different sensory modalities, involving patients with a wide range of TBI severity ratings and circumstances, it is dif!cult to provide a coherent summary of !ndings. However, some general trends emerge that give rise to the following observations and recommendations:

1) bilateral absence of somatosensory evoked potentials (SEPs) is often associated with poor clinical prognosis and outcome;

2) the presence of normal ERPs does not guarantee favorable outcome;

3) ERPs evoked by a variety of sensory stimuli should be used to evaluate TBI patients, especially those with severe injuries;

4) time since onset of injury should be taken into account when conducting ERP evaluations of TBI patients or interpreting results;

5) because sensory de!cits (e.g., vision impairment or hearing loss) affect ERP results, tests of peripheral sensory integrity should be conducted in conjunction with ERP recordings; and

6) patients’ state of consciousness, physical and cognitive abilities to respond and follow directions should be considered when conducting or interpreting ERP evaluations.

1. Introduction
Event-related potentials (ERPs) are types of electroencephalographic (EEG) recordings used to evaluate patients who experienced traumatic brain injury (TBI). “Potential” refers to the electrical potential difference (or voltage) between two points, de!ned as the electrical force that would drive an electric current between those points. In the case of ERPs and EEG, the “two points” are electrodes attached to the patient’s head that record voltages generated by neural activity from populations of neurons within a sensory pathway. These voltage changes result from movement of ions (e.g., K+, Ca++, Na+, and Cl?) and other charged particles within and between neurons in the brain. Evoked potentials (EPs), a subset of ERPs, are elicited by presenting stimuli (for example, light “ashes, sounds,electric shocks, images, words, odors or “avors) to the patient, then using a computer to average the EEG activity that is time-locked to the stimuli.

Traumatic brain injuries are often associated with damage to sensory organs and pathways. Because EPs are generated by neuronal activity, they are useful for assessing neural processing capabilities in TBI patients. Furthermore, EPs can provide information about the integrity of sensory pathways, including their ef!ciency for conducting input from the periphery to the central nervous system (CNS), the ability of CNS structures to process sensory input, and the ability of speci!c sensory systems to perceive and integrate stimuli. EPs and ERPs can also provide information about higher-order CNS processing, such as classi!cation and categorization of multi-modality stimuli, and decoding/interpretation of language, images and other complex stimuli. For TBI patients, EPs can provide valuable information related to the severity of injury and its impact on neuronal pathways. ERPs can
also provide information about patients’ states of consciousness and cognitive functions. In fact, one of the driving interests of using ERPs in TBI research is the possibility of predicting outcomes of these patients.

Read Full article – Electrophysiological assessments of cognition and sensory processing in TBI: Applications for diagnosis, prognosis and rehabilitation

Folmer, R.L., et al., Electrophysiological assessments of cognition and sensory processing in TBI: Applications for
diagnosis, prognosis and rehabilitation, Int. J. Psychophysiol. (2011), doi:10.1016/j.ijpsycho.2011.03.005

Robert L. Folmer a,b,!, Curtis J. Billings a,b, Anna C. Diedesch-Rouse a, Frederick J. Gallun a,b, Henry L. Lew c,d

a National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR, USA
b Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
c Defense and Veterans Brain Injury Center (DVBIC), USA
d Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University (VCU) School of Medicine, Richmond, VA, USA

Article history:
Received 29 September 2010
Received in revised form 4 March 2011
Accepted 8 March 2011

International Journal of Psychophysiology
journal homepage: www.el sevier.com/ locate/ i jpsycho

It is no surprise when insurance companies find ways to restrict what they will cover as a service for their clients, whether flood insurance liability insurance, or any other branch of this financial industry.  This is especially true for medical insurance companies, which are always finding reasons to restrict payments.

This decision restricts the payment for a qEEG to be an extension of the analysis of an EEG analysis, which makes the qEEG a medical procedure requiring licensure adequate to provide credentials to do a medical EEG interpretation. If further restricts the payments to applications that match the American Academy of Neurology position paper, which approves the technique in vascular cases, encephalopathies such as dementia cases, or for epilepsy, as well as longer term EEG monitoring, where quantitative analysis allows the selection of segments for review visually, assisting the electroencephalographer in eliminating long time segments from detailed analysis.

Specifically restricted from payment are these applications:

• Alcoholism
• Asperger’s syndrome and other autism spectrum disorders
• Attention disorders
• Depression
• Drug abuse
• Fibromyalgia
• Hypoxic ischemic encephalopathy
• Insomnia
• Learning disability
• Mild or moderate head injury
• Panic disorder
• Post-concussion syndrome
• Predicting response to psychotropic medication
• Schizophrenia
• Tinnitus

The list above is not an appropriate reason to do an EEG medically… at least not on the surface. In many of these cases the clinical decision may include ruling our an encephalopathy, a a vascular or epileptic process. As an example of this, approximately 30% of those with autism have undiscovered epileptiform discharges in the EEG, and respond well to anticonvulsants. An EEG is the only way to rule out epilepsy in such a case, and this may be allowed under the coverage listed, if the testing is ordered appropriately and the chart supports the order for the testing.

This is generally the same for TBI, where a post-traumatic vascular issue or epileptiform response to the TBI may be suspected, such as with contusion or post traumatic edema/ischemia.
In atypical clinical presentation, an alcoholic can be evaluated for dementia (Korsakov’s syndrome), as well as epilepsy (PLEDS are a common withdrawal pattern in chronic alcoholics). The chart needs to support the evaluation diagnostically for ruling out any of these covered categories.

The report can comment on medication implications, even if the testing was not done for that purpose diagnostically.

Attentional and affective disorders will not be covered, but if the physician is trying to rule out epilepsy (absence can mimic ADD) or an encephalopathy or dementia as the etiology of the psychiatric changes, then the insurance may cover the EEG and subsequent qEEG examination.

The important thing is to have the documentation in the chart to support the diagnostic/treatment question being posed with the testing.

The fact that they cover any of the qEEG at all is only due to the AAN position paper’s support for these areas. As the neuroscience is done to support more applications, then the carriers will have to amend their coverage statements. It is up to us to do the hard work to open these other areas up to payment…. and to argue for some other licenses to be covered for payment.

HOUSTON – A Houston doctor is working on something that could help the many service members who return from the battle field suffering from post-traumatic-stress disorder.

By its own admission, The Veterans Administration has had little success treating people who are suffering from both traumatic brain injury and post traumatic stress disorder.

“They end up not having any cognitive strategies to manage the therapy, and they’ll either get out of therapy, or end their lives and that’s what’s happening,” said Dr. Ron Swatzyna, a psychotherapist, neuro-therapist, and biofeedback therapist for Houston’s Tarnow Center. “I’ve been working on this issue for about four years now.”

He said resetting the brain, lining it back up through stimulation, is the key.  And by mapping the brain, he believes he can tell when the patient is ready for therapy.

“Not at the beginning. If you push them too quick that’s a problem. If they are pushed into therapy too quick,” he said.

Swatzyna said the defense department and the VA both realize more research is needed, and if he can get funding, and cooperation from a group in the Texas Medical Center, he would like to open up a research center in Houston.

Vietnam veteran Billy Miller, who one of Swatzyna’s patients, is now helping him pull it off.

“Everyone I had been to before, all 25 doctors had never had military experience, they didn’t know what I was going through,” Miller said.

Swatzyna was a captain in the Air Force, and now many believe he is the best in the country at understanding veterans.

Army soldier Joel Brasier, who suffers from TBI and PTSD, believes Swatzyna is on the right track and is hoping research will lead to better, faster treatment.

“It’s an ongoing process, but eventually they are going to make a breakthrough and get us the help we need,” Brasier said.

Full story from khou.com

No traditional structural neuroimaging was able to see this damage (like CT or routine MRI). The NY Times recently reported on soldiers injuries evading the M.R.I and CT Scans

The brain areas involved included the orbital surfaces of the frontal lobe and the temporal areas.

These results point to the need for a clinical diagnosis, not a reliance on any given technology to answer the clinical question.

The endocrine changes from supposed pituitary injury, and the presence of micro-emboli due to pressure wave impact on the thorax that are reported in blast injury is not at all dismissible with these findings.

Chronic Traumatic Encephalopathy(CTE) is associated with repeated head traumas — concussions or sub-concussive hits — that are not allowed to properly heal. It is a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury. A variant of the condition, dementia pugilistica, is primarily associated with boxing. CTE has been most commonly found in professional athletes participating in gridiron football, ice hockey, professional wrestling and other contact sports, who have experienced head trauma, resulting in characteristic degeneration of brain tissue and the accumulation of tau protein. Individuals with Chronic Traumatic Encephalopathy may show symptoms of dementia such as memory loss, aggression, confusion and depression which may appear within months of the trauma or many decades later.

A number of athletes have been affected by the condition with serious consequences. Recently a former NFL lineman committed suicide after serious mental decline. His wife said it started with the nightmares and progressively got worse.

Bob Probert’s brain was examined after his early passing at the age and was found to have CTE (read more here).

A couple of years back with the Chris Benoit tragedy the issue of CTE and it’s effects were put on the map and other athletes began to take notice.

Other players are worried and should be about the possible effects of concussions not only during their playing career but also long after they have retired. CTE is a serious medical condition that should not be taken lightly. A brain injury that goes untreated can have serious long term consequences. We should applaud efforts by the NHL and the NFL to address vicious hits to the head but they need to go farther. Teams need to be proactive in helping to identify possible head injuries.

Often athletes and coaches will push to play even when there may be some lingering effects of a head injury. Athletes have long tried to play through injuries and in certain sports it is almost a crime to take yourself out of a game. Teams and / or the league need to mandate some sort of criteria for athletes they suspect may have head injuries. This can hopefully help prevent or lessen the possibility of CTE. While we may not be able to prevent CTE – following certain procedures (such as a qEEG and ERP) after an “event” may lessen the likelihood of CTE occurring in the first place.

The Pittsburgh Penguins forward Sidney Crosby recently has been out almost three months with post-concussion symptoms.  This is a great loss for hockey fans when you have one of the sports top performers not playing due to a head injury. A recent study shows that more players are losing playing time due to concussions (see the full story on ESPN.com) The NHL is finally addressing this issue. One big step is pulling players out of the game for at least 15 minutes for a concussion test. The new Concussion Removal Protocol is designed to keep players with head injuries out of the game.

It was great to hear that the Pittsburgh Penguins, as part of a new initiative, will offer free baseline concussion testing and educational programs to youth hockey players in the region. “Heads Up Pittsburgh” is a combination effort with the Pittsburgh Penguins Foundation and UPMC Sports Medicine, aimed at making more hockey families aware of concussions in the sport.  Hopefully more teams will follow suit.

more relevant links..

-NHL governors discuss player safety – PEBBLE BEACH, Calif. — NHL Commissioner Gary Bettman said Tuesday that there was not enough data yet to draw conclusions about the link between concussions and a degenerative brain ailment that has been found in four dead hockey players….(full story)

-CTE found in Lew Carpenter’s brain – (full story)

-Head injuries: A growing issue in hockey – ONALASKA, Wis. — Concussions have been a hot topic and a cause for concern in the sport of hockey recently. Head injuries have had serious effects on many NHL players including the face of the league, Sidney Crosby. (full story)

-Report: Derek Boogaard had CTE – NEW YORK — Rangers enforcer Derek Boogaard suffered from chronic traumatic encephalopathy, a degenerative brain ailment related to Alzheimer’s disease that is caused by repeated blows to the head, the New York Times reported…(full story)

- Concussions in Sports from ESPN

- A simple way to curb concussions from SI.com

- Former NFL players sue league over head injuries - Men accuse league of misleading them, failing to take action to reduce head injuries… (full story)