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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

Historical Archives: The Beginning of Neurofeedback . . .

PART I – The Beginning – from the latest issue of the Journal of Neurotherapy introduces a new feature of the journal, the Historical Archives. In any profession it is important to be aware of the historical origins of the field. The field of neurofeedback was conceptualized a long time ago, and in this section we want to share some of the first works so the interested reader can get an idea of where our field came from and how it all started. As with most psychiatric treatments, the field of neurofeedback started as serendipity . . . .

In the early 1940s several studies already demonstrated that the human EEG could be classically conditioned (Jasper & Shagass, 1941a; Knott & Henry, 1941). These studies investigated in great detail the occipital alpha-blocking response and whether alpha blocking with visual stimulation could be conditioned to an auditory stimulus. In addition a range of classical conditioning principles have been successfully applied, and all of the Pavlovian types of conditioned responses could be demonstrated (Jasper & Shagass, 1941a). In a follow-up study, Jasper and Shagass (1941b) investigated further whether participants could also exert voluntary control over this alpha-blocking response. In this study they had participants press a button, which would turn the lights on and off, and use subvocal verbal commands when pressing the button (e.g., ‘‘Block’’ when pressing the button and ‘‘Stop’’ when releasing the button).

New Findings on PTSD and Brain Activity

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on November 1, 2010

Researchers have discovered a correlation between increased activity among brain circuits and flashbacks among individuals with post-traumatic stress disorder (PTSD).

University of Minnesota investigators learned that an increased circuit activity in the right side of the brain is associated with the debilitating, involuntary flashbacks that often characterized PTSD.

The ability to objectively diagnose PTSD through concrete evidence of neural activity, its impact and its manifestation is the first step toward effectively helping those afflicted with this severe anxiety disorder.

PTSD often stems from war, but also can be a result of exposure to any psychologically traumatic event. The disorder can manifest itself in flashbacks, recurring nightmares, anger or hypervigilance.

Using a technique called Magnetoencephalography (MEG), a noninvasive measurement of magnetic fields in the brain, researchers found differences between signals in the temporal and parieto-occipital right hemispheric areas of the brain among those with PTSD.

The temporal cortex, in accordance with earlier findings on the effects of its electrical stimulation during brain surgery, is thought to be responsible for the reliving of past experiences.

The American Academy of Neurology (AAN) Position Statement On Sports Concussion

The American Academy of Neurology (AAN)—an association of more than 22,500 neurologists and neuroscience professionals dedicated to providing the best possible care for patients with neurological disorders—is an advocate for policy measures that promote high quality, safe care of individuals participating in contact sports.

Concussion is a common consequence of trauma to the head in contact sports, estimated by the Centers for Disease Control and Prevention to occur three million times in the United States each year. Among people aged 15 to 24 years, sports are now second only to motor vehicle accidents as the leading cause of traumatic brain injury. While the majority of concussions are self-limited injuries, catastrophic results can occur and the long-term effects of multiple concussions are unknown.

Members of the AAN specialize in treating disorders of the brain and nervous system, and some members have particular interest and experience caring for athletes and are best qualified to develop and disseminate guidelines for managing athletes with sports-related concussion. Based on the clinical experience of these experts, the AAN supports the implementation of policy that supports the following recommendations:

Recommendations

Any athlete who is suspected to have suffered a concussion should be removed from participation until he or she is evaluated by a physician with training in the evaluation and management of sports concussions
No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion.
Following a concussion, a neurologist or physician with proper training should be consulted prior to clearing the athlete for return to participation.
A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion.
Education efforts should be maximized to improve the understanding of concussion by all athletes, parents, and coaches.

Position Statement History
Approved by the AAN Sports Neurology Section, Practice Committee, and Board of Directors
October 2010 (AAN Policy 2010-36).

VA Eases PTSD Claims Process

The Veterans Affairs Department has published a final regulation intended to ease the claims process and improve access to health care for veterans with post-traumatic stress disorder. Under the new rule, VA no longer will require substantiation of a stressor tied to fear of hostile military or terrorist activity if a VA psychiatrist or psychologist can confirm that the experience recalled by a veteran supports a PTSD diagnosis and the veteran’s symptoms are related to the stressor. The Veterans Affairs Department has posted a fact sheet including questions and answers about the new rule governing PTSD claims on the VA website or call VA’s toll free benefits number at 800-827-1000

International Society for Neurofeedback & Research (ISNR) 18th Annual Conference

International Society for Neurofeedback & Research (ISNR) 18th Annual Conference
Denver, Colorado Sept 30-Oct 3, 2010

ISNR invites you to their 18th Annual Conference for Health Professionals, Education Professionals, Researchers & Students. This conference offers workshops by the leading clinicians and researchers in the field of neuroscience. There will be many workshops and keynote talks on clinical as well as theoretical applications in the neuroscience field.

Consciousness: An Emergent Property Of Mind-Brain Interaction

Consciousness: An Emergent Property Of Mind-Brain Interaction – presented by Jay Gunkelman

A model of consciousness will be illustrated with physiological data from EEG and Event related potentials. Using millisecond level time resolution, a working model of the interaction between the mind and the brain will be constructed.

The Slow Cortical Potentials generated by Glial activity and the faster gamma activity reflecting activity of bound neural networks will be used to illustrate this model. The physiological correlates of concepts like intention, attention, memory, perception, awareness, sensory differentiation and conscious awareness will all be discussed within the framework of this model. Advanced concepts like neural network binding, nested rhythms, cross-spectral correlation, and the bispectrum will be discussed.

The DC potentials cause an instantaneous phase resetting and binding of a neural network, which can initiate synchronous activity within these neural networks. Current work using this model in clinical work on severe disorders of consciousness, including work by the International Brain Research Foundation on recovery of consciousness in coma cases will be reviewed. The simplest expression of the model: when the DC potentials reflecting activity of the mind interact with gamma activity reflecting neural activity in the brain, the emergent property of this interaction is consciousness.

[youtube]http://www.youtube.com/watch?v=Pv-msnzTk7o[/youtube]

From The Society for Scientific Exploration (SSE)

How EEG can Show an Epileptogenic Process

This is the first of a few posts with a variety of ways the EEG can show an epileptogenic process. The morphology of the underlying process are quite dramatically varied.

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.

Epilepsy and EEG

Epilepsy and EEG have been inextricably linked since the 1930s, when Frederick and Erna Gibbs discovered that epileptic events were visible in the EEG. The evolution of other medical imaging in the 1970s and 1980s provided a better way to localize tumors, and the clinical use tapered off in areas other than epilepsy and encephalopathies. Even with the multiplicity of other methods, the EEG remains the gold standard for identification of epilepsy.

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.