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.
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.
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.
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.
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 – 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.
This is three sets of data from the same underlying EEG, all with varying coherence results, and with the weighted average showing the alpha hypercoherent pattern with better fidelity than any other for this data.
AAPB is traveling to San Diego, California for its 41st Annual Meeting. Mark your calendars for March 24-27, 2010 to attend this gathering of experts in biofeedback, neurofeedback, and applied psychophysiology. You won’t want to miss this educational event and the networking opportunities available!
We are honored to welcome several high-profile speakers, including:
Personalized Medicine in the Age of Technology–Vilayanur S. Ramachandran, MD, PhD; Director of the Center for Brain and Cognition and Professor with the Psychology Department and Neurosciences Program at the University of California, San Diego, and Adjunct Professor of Biology at the Salk Institute
Regeneration and Stress at Work: Strategies for Improved Employee Health – Tores Theorell, MD, PhD; Professor Emeritus at the University of Stockholm, Sweden
An Overview of Mind Body Healing – C. Norman Shealy, MD, PhD; founder of the American Holistic Medical Association, and past president of the International Society for the Study of Subtle Energies and Energy Medicine
Neurotherapy in the Treatment of Traumatic Brain Injury: A Physiological Hypothesis – Paul Rapp, PhD; Professor in the Department of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences
There is a generally reciprocal effect between alpha and beta, as brain stem stimulation desynchronizes the alpha generators, beta is seen. During states of under-arousal, this relationship is not seen, as when the subject is alerted, when both alpha and beta increase.
The point is that the arousal level changes the EEG responses expected, as when a stimulant is given to an under-aroused subject, increasing alpha. In a normally aroused subject, stimulants decrease alpha, and in an anxious (low voltage fast EEG variant) subject alpha will not be seen as changed by a stimulant.
Though there is a response stereotype for each medication, there are also individual responses, which vary. Mixtures of medications become too complex to evaluate each individual medication’s contribution, not to speak of synergistic effects not seen with any single medication, which may be seen in polytherapy.
The following pages represent a summary of many articles, papers, reviews and books on medications and the CNS function, and finally nearly 30 years of experience in clinical and research EEG. The difficulty in this area is the definitions of bands varies, the methods of analysis range from visual inspection of the raw EEG to quantitative measures, not all of which are clearly defined… and thus the need for a brief summary which puts this into a concise form for reference.