The two images below show the referential and sequential montage display of an active right temporal-parietal spike and slow wave focus, seen in a child clinically diagnosed with an attachment disorder. There was no history of convulsion, nor any suspicion of the actual underlying pathophysiological basis for the behavioral presentation.

The focus cortical area is normally involved in comprehension of facial expression and body language, as well as the prosodic (emotive) aspects of language. Any disturbance in that cortical area’s function generally has social contextual implications for behavior due to “prosodic blindness”. (see: Van Bloem, L. QEEG in Children with Reactive Attachment Disorder,

Journal of Neurotherapy, 4(4), 2001.

The implications for treatment option with this pathophysiological source for the behavioral presentation which could really only be discovered through the EEG are enormous. The use of an anticonvulsant or an approach with one of the proven efficacious applications of Neurofeedback in treating epilepsy can be used to target the underlying cause, rather than trying to effect some symptomatic control with antipsychotic or antidepressant medications so commonly used in these situations of severe attachment disorder. (see a review of SMR applied to epilepsy by Dr. M. Barry Sterman, Professor Emeritus, UCLA, from 2000 in Clinical Electroencephalography’s special edition on Neurofeedback)

In these images the referential focus is seen associated with the largest waveform, though in the sequential data the 180 degree phase reversal points to the focus.

EEG & Epilepsy - Referential Montage Display

EEG & Epilepsy - Sequential Montage Display

In modern neuroscience centers, the EEG is still the tool of choice in evaluation of convulsive epilepsy, as well as some other non-convulsive forms, such as staring episodes seen in “absence epilepsy” typically as a 3/second spike and wave dominant anteriorly, or temporal lobe epilepsy, which is seen as a “notched” slow wave discharge fronto-temporally.

The EEG can now be processed through algorithms, such as spike dipole localization software, to identify the “seizure focus” cortically, or spectral averaging to look for changes in the underlying EEG rhythmicity due to the disorder.

One of the difficulty with the two later categories is that they are not always identified as forms of epilepsy, and thus can be mis-diagnosed based on behavior alone as some other disorders, including ADD/ADHD in absence epilepsy “spells” where the attentional process is disturbed by the discharge taking segments of time out of the cognitive streaming of perception, or from discharge in sensory areas.  These segments being removed do not have any conscious awareness of the event for the person experiencing the blips missing from their cognitive process, and they will have trouble tracking on-going events, like driving or listening to a speech or lecture.  Imagine missing a few here and there, to tens of seconds from your awareness, and see if you don’t have “attentional deficits”.

The other major areas of misdiagnosis are of a “schizophrenic” or “psychotic” nature.  This occurs when the discharges are frontal or temporal and disturbing local cortical function, and may be seen as a range of presentations from hallucinations or emotional outbursts of rage, or even “fits of laughter” in “Gelastic seizures”.   Temporal Lobe Epilepsy (TLE) is a particularly difficult one to properly diagnose in the absence of the EEG.

The importance of these missed-diagnoses can be quite severe, with the use of medications to treat the symptoms often being contra-indicated by the epilepsy.  One example of this is TLE that is assumed to be psychosis, since antipsychotic medications lower the seizure threshold, and make the person worse, which can then be responded to with more antipsychotics, spiraling the person into a progressively worsened condition.  The use of stimulants in epilepsy is a controversial area, as the effect of stimulants for inattention in known and treated epileptics may be acceptable, though throwing a stimulant at an undiagnosed epileptic can have severe negative consequences.

The real issue is that IF YOU DO NOT LOOK, YOU WILL NOT SEE… and in epilepsy, looking requires the EEG, as the gold standard.

In surgical approaches, the EEG is used to identify whether there are multiple foci, which generally will preclude a good outcome (you remove the brain tissue and the seizures do not change).

I will post some images of the WIDE variety of morphologic presentation that epilepsy can take, so that some understanding of the task of the Electroencephalographer and Epileptologist can be better appreciated by those who think it is straight-forward.

Thanks for your attention to these obscure issues.

Jay

This may not surprise too many old-time NF practitioners, except that it is now being proven with well done studies in the traditional neuroscience literature!  Neurofeedback can induce changes in brain plasticity!

Jay

First Direct Evidence of Neuroplastic Changes Following Brainwave Training

ScienceDaily (Mar. 12, 2010) — Significant changes in brain plasticity have been observed following alpha brainwave training.

A pioneering collaboration between two laboratories from the University of London has provided the first evidence of neuroplastic changes occurring directly after natural brainwave training. Researchers from Goldsmiths and the Institute of Neurology have demonstrated that half an hour of voluntary control of brain rhythms is sufficient to induce a lasting shift in cortical excitability and intracortical function.

Remarkably, these after-effects are comparable in magnitude to those observed following interventions with artificial forms of brain stimulation involving magnetic or electrical pulses. The novel finding may have important implications for future non-pharmacological therapies of the brain and calls for a serious re-examination and stronger backing of research on neurofeedback, a technique which may be promising tool to modulate cerebral plasticity in a safe, painless, and natural way.

Continued at http://www.sciencedaily.com/releases/2010/03/100310114936.htm

It’ll be the first Neuroscience Multidisciplinary Meeting hosted by the Brainmech Foundation in Spain after the last conference held in Holland in 2007. This is a unique oppurtunity for professionals to learn today what investigators and scientists on neuroscience are preparing for the future.

It’ll be the meeting point for Psychiatrists, Psychologists, Neurologists and Pediatricians that will have the chance to learn from the authors about the last investigations and researches on the human brain, new methods of diagnosis, new diagnosis criteria on mental disorders proposed for the DSM-V, neurobiologist database of the ADHD, bipolar disorder, as well as the new treatments and therapy for neurological illness and psychiatric malfunctions.

This video was recently shown again on CBS 60 Minutes. It is a great video talking about using brain controlled interfaces.

Neurofeedback is a treatment where real-time feedback is provided for specific brain activity (most often EEG) in order to learn the brain to suppress or produce specific brain activity. This method was initially discovered for the treatment of Epilepsy and from 1976 investigated further for the treatment of ADHD. This technique has become more popular by clinicians worldwide, and is currently provided for the treatment of several disorders. Critics have often questioned the efficacy of Neurofeedback and whether it can be considered an Evidence Based treatment or not.

In collaboration with researchers from Tübingen University (Germany), Radboud University (Nijmegen, the Netherlands), Brainclinics and EEG Resource Institute a so-called meta-analysis was conducted on all published research about Neurofeedback treatment in ADHD. This meta-analysis included 15 studies and 1194 ADHD patients. Based on this study – which will be published in the July issue of EEG and Clinical Neuroscience – it could be concluded that Neurofeedback can indeed be considered an Evidence-Based treatment for ADHD. The results show that neurofeedback treatment has large and clinically significant effects on Impulsivity and Inattention and a modest improvement of Hyperactivity.

These findings apply to Neurofeedback treatment for ADHD, but do not automatically imply that Neurofeedback can be considered evidence based for any disorder. The efficacy of Neurofeedback has to be assessed separately for each disorder. For example, a meta-analysis of EEG biofeedback in Epilepsy is published in the same issue of EEG and Clinical Neuroscience demonstrating clinical efficacy in the treatment of epilepsy.

Interested clients are advised to make an informed choice regarding Neurofeedback therapists, since there is a large heterogeneity in neurofeedback treatment approaches and clinicians. It is advised to look for psychologists or physicians who are at least a member of a professional organization such as the International Society for  Neurofeedback and Research (ISNR: www.isnr.org) or other professional organizations and who use investigated methods.

Literature Arns, M., de Ridder, S., Strehl, U., Breteler, M. & Coenen, A. Efficacy of Neurofeedback Treatment in ADHD: The effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis. EEG and Clinical Neuroscience; 40(3), 180-189.

The Boy with the Incredible Brain

This is the breathtaking story of Daniel Tammet. A twenty-something with extraordinary mental abilities, Daniel is one of the world’s few savants. He can do calculations to 100 decimal places in his head, and learn a language in a week. This documentary follows Daniel as he travels to America to meet the scientists who are convinced he may hold the key to unlocking similar abilities in everyone.


Secrets of the Mind

Click here to view the embedded video.

Phantoms in the Brain: V. S. Ramchandran from T.E.D.

This is a 25 minute video of Ramchandran’s talk presented at TED.

Phantoms in the Brain Part 1 Full Documentary


Phantoms in the Brain Part 2

From Taboo. this clip is about a man who wants to get rid of his own leg. Eventually trying to do it at home.

The Foundation gives an award to the author(s) of the publication which has
“contributed the most to furthering the field of neurofeedback” during the
past year. Past recipients have included Drs Rob Coben, John Gruzelier, as
well as Johan Levesque and Mario Beauregard.

This year the Foundation has chosen Professor Dr. Juri Kropotov as recipient
of this years award, based on his book and the body of work Juri has
contributed over the years.

This award selection was announced recently at the EEG Spectrum Clinical
Interchange Conference in Los Angeles.  The award includes a gorgeous plaque
as well as an honorarium.

We salute both the Foundation for helping promote the fiend of NF, as well
as all the award recipients for their publications and the substantial
contributions they all have given to our field.

Our organization needs to provide information regarding the types of training/treatment that has been proven  over and over to help clients that have severe impediments to their lives.  If you feel similarly and would like to either sign this letter or write your own, it may cause some movement in APA and the Monitor to recognize the services we provide.

Merlyn Hurd PhD;BCIAC/EEG Fellow
Editor of NeuroConnections the ISNR/AAPB Neurofeedback division

Letter to APA regarding qEEG – March 09 2009

James H Bray PhD, President APA
Rhea K. Farberman, Executive Editor Monitor on Psychology
750 First Street, N.E.
Washington, DC 20002-4242

Dear Drs. Bray and Farberman,

Imagine the excitement of seeing “Brain Imaging” on the front of the Monitor for the March 2009 edition.  Finally, the APA is writing about QEEGs (quantitative electroencephalograms) and the types of work that is being done by thousands of psychologists in the neurofeedback world.

No, the first article is “A pacemaker for your brain?” which reviews the effect of deep brain stimulation (DBS) for the treatment of depression.  The second article “From the Research Lab” informed us about implanting electrodes on the surface of the brain to pinpoint where to surgically remove parts of the brain to correct the disorder from which the client was suffering.  The instrument discussed is fMRI. Perhaps I have not been keeping up with the areas of scope of practice for psychologists but this falls under medical procedures and few psychologists can afford an fMRI machine in their private office.  Yes, many psychologists work with fMRI’s in hospital settings, still it is a small number compared to the number of psychologists/neurofeedback therapists in the United States.

It is time the APA and the Monitor recognize the value of the thousands of psychologists around the world and approximately 3000 in the USA who use non invasive imaging techniques and treatments/training to reduce/eliminate epilepsy, traumatic brain injury; depression; ADHD;  and a host of other disorders.  As you probably know, early on, neurofeedback was, studied and researched in psychology laboratories,and is based on the principles of operant conditioning, which is a major area of development and focus for psychologists (beginning with its founder, psychologist B.F. Skinner) Some of the most seminal research in brain imaging and neurofeedback was and is conducted by psychologists ( for example Barry Sterman, Ph.D whose research led to the validity of neurofeedback, Joel Lubar, Ph.D. and Robert Thatcher, Ph.D.)Also early studies by Steven S. Fox, Ph.D. ( Univ. of Iowa, dept of psychology) with his 1967-1971 EEG/EP operant conditioning studies in cats and humans as well as Peter Rosenfeld, Ph.D. and Alan Rudell, Ph.D. who also published rigorous scientific studies on EEG/EP biofeedback in the late 1960s and early 1970s need to be recognized.

Do not be persuaded by the American Neurolog ical Academy’s viewpoint that QEEGs are not valid.  Recently, in a court case in NY State the QEEG was admitted as meeting Daubert criteria. This is one of many in the United States courts that have admitted QEEG’S as part of the defense.   It submitted thousands of studies using QEEG to verify its validity. The criterion used to locate the studies were computerized analysis of QEEG results. Also do not be persuaded that the Neurofeedback training is not valid, especially, when hundreds of studies have shown excellent outcomes.  These studies have been published in numerous journals.

Furthermore, Carl U. Weitman, Phd., F. BCIA-EEG chaired a liaison task force from 1995-97 between APA and AAPB that resulted in the APA practice directorate and APA council recognizing neurofeedback and QEEG as proficiencies within the scope of psychology; applied psychophysiology and biofeedback.  Among the results, state boards aligned their views with those of the practice directorate. In the interim, the practice code  90876 came to be “Psychophysiological Psychotherapy.
Perhaps you could see to having an edition that looks at Brain Imaging that employs the techniques that psychologists use and the training that they employ guided by those images and interpretations which are against normative databases.

Please log on to isnr. org; aapb.org; skiltopo.com and appliedneuroscience.com to review the studies, member’s lists and activities of these professional organizations.

Thank you for your kind attention to this letter.

Sincerely,

Merlyn Hurd PhD; BCIAC/EEG Fellow
Editor of NeuroConnections.. ISNR/AAPB Neurofeedback division Newsletter
Gerald Gluck Ph.D     Marvin H. Berman Ph.D.       Laurence R. Lewis Ph.D.
Alfred Collins Ph.D.  BCIA-EEG     Anne Ward Steven Ph.D.    David Cantor Ph.D.

Merlyn Hurd PhD; BCIAC/EEG Fellow
88 University Place, 8th Floor
New York, New York 10003
133526162
NYState Lic 7301
Tel: 212 807 8690

For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition.

Methods: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation (‘placebo’) scales were applied to control for parental expectations and satisfaction with the treatment. Results: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. Conclusions: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD. Keywords: Neurofeedback, attention deficit/hyperactivity disorder (ADHD), slow cortical potentials (SCPs), theta/beta training, randomised controlled trial (RCT), EEG.

Read the full PDF here.

Holger Gevensleben,1 Birgit Holl,3 Bjo¨rn Albrecht,1 Claudia Vogel, Dieter Schlamp,3 Oliver Kratz,2 Petra Studer,2 Aribert Rothenberger, Gunther H. Moll,2 and Hartmut Heinrich2,3 1Child & Adolescent Psychiatry, University of Go¨ttingen, Germany; 2Child & Adolescent Psychiatry, University of Erlangen-Nu¨rnberg, Germany; 3Heckscher-Klinikum, Mu¨nchen, Germany