This last year we lost an old friend, Bill Hudspeth…. William J Hudspeth, PhD. He scientifically contributed to understanding the EEG of maturation, and his multivariate connectivity eigenvector work is still ahead of many others in modeling brain function. We lost a real contributor.
In his later years he was treated for hypertension with Reserpine. I recall Bill’s dehydration in Arizona at an ISNR meeting when I carried him out of the hall during a syncopal spell. He was not well conmtrolled on his diuretic. Reserpine is rarely used in the management of hypertension today, as it is a second-line adjunct agent for patients who are poorly controlled on a diuretic, when cost is an issue. It is an inexpensive and effective antihypertensive, though not without a substantial potential for side-effects, which has it banned in England.
Martijn Arns • Wilhelmus Drinkenburg • J. Leon Kenemans
Abstract In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with EEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment.
This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.
by James Neubrander, MD, Michael Linden, PHD, Jay Gunkelman, 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, 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.
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.
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!)
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.
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.
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.
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:
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.
