Brain Science – Page 3 – qEEGsupport.com

Coherence Models and artifacts – Prior published findings in Autism are artifactual.

The following link to the article “Movement during brain scans may lead to spurious patterns” contains peer reviewed hard evidence of a clear cut case of poor deartifacting and excessively short recording times combining to create artifactual findings… findings that had high reliability within the data set, but which had results which were determined by artifact (movement). Even bad data can be repeatable.

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)

Congratulations Martijn Arns on your Phd

Dr Arns is a great friend of Bio-Medical & qEEGSupport.com and we would like to wish him congrats on his Phd!

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!)

Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

Subclinical electroencephalographic epileptiform discharges in neurobehavioral disorders are not uncommon. The clinical significance and behavioral, diagnostic, and therapeutic implications of this EEG cerebral dysrhythmia have not been fully examined. Currently the only connotation for distinctive epileptiform electroencephalographic patterns is epileptic seizures. Given the prevailing dogma of not treating EEGs, these potential aberrations are either disregarded as irrelevant or are misattributed to indicate epilepsy. This article reappraises the literature on paroxysmal EEG dysrhythmia in normative studies of the healthy nonepileptic general populations, neuropsychiatry,
and in neurobehavioral disorders. These EEG aberrations may be reflective of underlying morpho-functional brain abnormalities that underpin various neurobehavioral disturbances.

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)

In Memory of Hershel Toomim Sc.D

Hershel Toomim passed away at 4 am Tuesday July 19, 2011. Hershel had just turned 95 on June 19, 2011. He will be dearly missed by everyone who knew him. He was a great friend who was always willing to listen and offer his advice.

If you would like to write a remembrance of Hershel, please feel free to do so here. If you would like to send something private to the family please contact Bob Marsh bob@biocompresearch.org and he will be sure the family receives it. Please leave Hershel Toomim in the subject line.

HISTORY OF BIOFEEDBACK AND NEUROFEEDBACK – The Hershel Toomim Story from AAPB Magazine Summer of 2008

The RC Hall of Fame Web site features a narrative about Hershel’s contributions in that area on their site.

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

This article from the International Journal of Psychophysiology shows the full acceptance of the use of EP and ERP testing to evaluate TBI. The paper is co-authored from the Defence Veterans Brain Injury Center (DVBIC), and this paper shows none of the quibbling or caveats about a lack of specificity or sensitivity in TBI. It is a paper that looks at full adoption for use, not a call for plenty of more studies and funding!

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.

Clinical Policy Bulletin: Quantitative EEG (Brain Mapping) from Aetna

Recently Released Clinical Policy Bulletin: Quantitative EEG (Brain Mapping) from Aetna

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:

Houston’s Tarnow Center offers solution for service members with PTSD

A friend of qEEGsupport.com ( Dr. Ron Swatzyna) was recently featured on a local news station in the Houston area.

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

Current Research Regarding Blast Injuries in Veterans

This current research from the New England Journal of Medicine – Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel – shows that Blast Injury is not at all like mild traumatic brain injury, since the mTBI does not involve white matter injuries. The research does show white matter changes during the medical evacuation, done in Germany using Diffusion Tensor Imaging, and also that the white matter changes continue to evolve. They also show that not all symptomatic blast injuries are seen with this technique.

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.

Sports Related Brain Injury aka Chronic Traumatic Encephalopathy(CTE)

It is now almost common to hear about athletes who suffered a number of concussions over their careers having some difficulties later in life. The damage can be very serious.

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).

What Happened to the Reporter at the Grammys?

Recently during a post-Grammy interview, the on-air report had some serious difficulties in getting her words out. You can read about it and see the video here .

The reporter in this article likely had a TIA… a Transient Ischemic Attack… the temporary insufficiency of vascular flow dynamics to a cortical area providing insufficient local glucose and oxygen for function. This can happen from just flow dynamics due to vasoconstriction, such as seen in hyperventilation or gross over-arousal. This can also happen when blood consistency is not appropriate to allow flow, such as seen with hyperglycemia in diabetics when their blood sugar rises too high.

You may think “what does this have to do with EEG?”… well it is an important EEG area, and not without controversy.

The mid-temporal sharp-slow transients that are seen in EEG are considered neurologically non-specific, and many neurologists do not even comment on them. This is a mistake, as these nonspecific changes are a harbinger of vascular issues, including ischemia (as seen in migraine ischemia and the current discussion of TIAs), or vascular insufficiency, commonly in the vertebro-basillar artery and posterior vascular distributions supplying the hippo-campus (which has a huge metabolic demand load).

No less than Ernst Neidermayer chastises the neurologists doing EEG interpretations for under-reading of these findings. He clearly shows in his paper that these non-specific findings are important.

Recently I had a client who sent in the EEG of his wife, who had experience some word-finding and fluency issues, and it had these “nonspecific” temporal findings on the left… we suggested an MRA (magnetic resonance angiography), and though they had already done the MRI (which was normal), the MRA was done. The MRA showed a 9 millimeter AV malformation, and surgery was done to patch this area so it didn’t burst, saving her life.

These are the sort of waveform distortions that require an experienced EEG interpretation, and preferably an expert with Board qualification in EEG, not just someone licensed to read EEGs. These controversial findings make all the difference, and it is exactly these areas that provide the large difference between interpretation in studies looking at inter-reader visual EEG reliability.

Jay