What's New in Neurofeedback

A Monthly Summary of News and Events

Vol. 11 No. 4 - April 2008

This newsletter is sponsored by EEG Spectrum International, Inc.,
the leader in providing neurotherapeutic services and training professionals.

Past issues are available at start.eegspectrum.com/Newsletter/
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Opinions in this newsletter reflect those of the author only.
Copyright (c) 2008 by ESII or David Kaiser, Ph.D. All rights reserved.

Announcements - News In the Spotlight - Frontal Lobe Facts News & Reviews - Books & journal papers Events & Locations - Conferences, Courses Last Word - Task-QEEG Assessment

Announcements

In the Spotlight

Frontal Lobe Facts

None of us can say we understand the endless show of days

This morning, as I was chatting up the cute barista at Jitters, a local coffee spot, it came out that she wanted to work with animals and didn't know where to start or what to study. Having worked with dolphins briefly, I broke into a story about those days, providing her an alternative to feeding seals at the local zoo. In the summer of 1989 I went off to Hawaii under the pretense of studying cerebral laterality of Tursiops truncatus, which, as it turns out, never happened. The post-doc and I never got around to running any new experiments, but it was a great time so I didn't care. I slept in the lab, which was adjacent to Waikiki Beach, and split my time between four bulbous-headed sign-language-trained dolphins and an equal number of bikini-clad lab assistants. Life at 24 was good, to say the least. I considered leaving UCLA for the greener (or bluer) pastures of Oahu as part of my 24-year-old's quest for more Mind. Here, in the middle of the Pacific, were the largest brains currently in communication with humans -- if we discounted stories of alien abduction.

Hollywood had brought me to this very spot. I had followed a blueprint laid out by two movies from my youth, Day of the Dolphin (1973) and Altered States (1980), both inspired by the life and work of John Lilly, MD, a neurophysiologist from my father's generation, who I would not meet until the following summer. Lilly lived in Malibu and lectured on how large-brained dolphins possessed higher consciousness; but I was not so easily taken in by cetacean neuroanatomy and looked for behavioral clues of divine incarnation. Within moments of my first eye-to-eye meeting with this kind I realized my mistake, that these aquatic aliens were not philosopher-kings but mindful wolves, ocean-adapted, but nothing to set a shrine to. They acted like Romper Room kids, raking the backs of each other with their teeth as they vied for attention from the trainer, as far removed mentally from Plato and Aristotle as my future 5 year old. I would soon retreat back to studying humans -- well, as close as I could get back to studying humans as my return was to L.A., and even if Lilly was right and God was more instantiated in these large brains, whatever vision we might possessed of the Infinite could be enacted outwards through our hands for all to see, and not trapped in a long pointy whistling skull.

Getting back to Lilly, he suggested (1967) that the sperm whale possessed the most advanced mind on the planet because of its brain size; this, despite a relatively low brain-to-body weight ratio: 37,000 kg-to-7.8 kg (Ridgway, 1986). Here are the other contenders, ranked by maximum brain size in grams for each species:

1700 g -Tursiops truncatus [Bottlenose dolphin] (Lilly, 1958)
2850 g -Homo sapien [Human, mentally-retarded, epileptic]
6075 g -Proboscidae [Elephant] (Tower, 1954)
7200 g -Balaenoptera phipalus [Fin whale] (Jansen, 1952)
9200 g -Physeter catadon [Sperm whale] (Kojima, 1951)

The relationship between brain and mind is never simple nor obvious. As humans, we now consider connectivity most important, with special attention focusing on our frontal lobes, but even with such an anatomical index, too much of a good thing is bad, and too many axonal connections leaves the individual dumbfounded. Our brains create more axons than we need and if we do not prune back the growth, we are in for a long confused stay on Earth. (This process is called neural Darwinism: exuberance and elimination.) Our focus on the frontal lobes is relatively new; in past years we called it the silent lobe, unable to grasp its role except perhaps as head ballast, even though our cortex is more frontal lobe (35-38%, estimates vary) than anything else (parietal 20, temporal 18, occipital 16, limbic 9%, plus a bit of insula).

Frontal lobe functions began to undergo scrutiny 150 years ago, in response to events that took place in Vermont. Phineas Gage was foreman of a crew working for the Rutland and Burlington Railroad in New England and he would soon possess the most famous brain in science. One day, while working on the cutting outside of town, gunpowder was prematurely ignited and a meter-long tapping iron he was using suddenly rocketed out of his hands and into and through the left side of his skull. What followed after this incident is well known to neuroscientists: Gage recovered, miraculously, but according to friends "Gage was no longer Gage." He regressed, became childlike, impulsive, given to profanity and drinking. He lost his railroad job, worked in a livery stable, went down to South America on speculation. Twelve years after he lost much of his frontal lobes, he lost his life during a series of violent epileptic convulsions.

Reconstruction of his skull reveal how the metal bar disconnected and/or destroyed much of his left frontal lobe, especially the orbitofrontal area. This part of cortex provides cortical constraint over the hypothalamus, among other functions. The hypothalamus is in some sense the first CPU, evolutionarily speaking, sitting atop the brainstem, the first interpreter of sound and sight with its main program being survival, finding food and mates. Gage underwent an accidental frontal lobotomy (removal of gray matter) as well as a partial leucotomy (cutting of the white matter). "The most that the Gage case indicated was that radical operations on the brain were possible." (Macmillan, 1996).

The history of frontal lobotomy begins with Gage's accident in 1848 and extends into the present. Forty years later, in 1890, Friederich Golz discovered he could calm dogs by cutting away parts of the cortex. Not to be outdone, Gottlieb Burkhardt (1892) removed what could only be considered in hindsight random bits of neocortex in 6 schizophrenics, killing two in the process. He was roundly criticized for his hubris by his colleagues and that ended experimental human psychosurgery for decades. But never underestimate our arrogance to destroy other members of our species. In 1935 Carlyle Jacobson at Yale damaged chimp's prefrontal cortex, which calmed the previously aggressive animal down without compromising its memory or intelligence. The next year his colleague at Yale John Fulton replicated the work and would go on to present it at a conference in London attended by Antonio Egaz Moniz and Walter Freeman. Moniz, a Portugese surgeon, extended the process into treating human maladies. He cut the frontal lobes of 20 of his psychiatric patients and reported a similar "calming" effect. He developed the leucotomy, white matter disconnection of the frontal lobe from the rest of the brain, and won the Nobel Prize for his efforts (he was later shot by a ex-patient and paralyzed). Walter Freeman, an American, would introduce the frontal lobe leucotomy to US markets, refining it into a famous transorbital "icepick" technique. By pushing an icepick into the brain via the eye sockets and slicing back and forth to cut the white matter, thousands could be (mis)treated in minutes time for conditions as mild as depression and ADHD in children (in Japan). It also was an effective way to render political opponents impotent and to calm unruly in-laws, truthfully. The frontal leucotomy, still used in extreme pain cases, did not even lose favor when its clinical efficacy was evaluated and it was found entirely lacking any: 1/3 of patients got better, 1/3 got worse, 1/3rd stayed the same -- the same had patients been left to their own devices. It only lost popularity when antipsychotic drugs like Thorazine and the other miracle drugs for schizophrenia became popular.

In terms of function, the frontal lobes are divided into three main areas, a dorsolateral region serving executive functions, an orbitofrontal area involved in emotional regulation and related processes, and motor programming areas for speech and eye movements. This last division is excluded when we speak of prefronal cortex. Executive functions are those involved in planning behavior, initiating behavior and in the cessation of behavior, as well as evaluating behavior and changing a behavioral approach or mind set.

When prefrontal cortex is damaged, here are the major problems that can arise:

Impaired abstract reasoning

failure to maintain goal-directed behavior

inability to perform abstract reasoning

failure to generalize experiences into rules/general principles

reduced mental flexibility and increased distractibility

Personality disturbances

lack of originality and creativity

inappropriate emotions and behavior, with little awareness of it

difficulty initiating behavior or stopping when started (perseveration).

Impaired language production

Rare initiation of conversation, even to the point of mutism

Impaired social behavior

deficits in maintaining appropriate social responses

loss of spontaneous behavior

confabulation (lying), tendency to fabricate quick, impulsive answers to questions.

Impaired motor function and reflexes

problems with highly controlled, volitional components of motor control (apraxias)

perseveration, incoordination, motor impersistence, including reflexes

There are a number of tests used to assess frontal lobe function, including the BRIEF battery. My experience is with the Stroop task, which forces a person to inhibit an automatic process (reading) to attain the correct answer, the Tower of Hanoi, which assesses strategy and planning, and the Wisconsin Card Sorting Task, which evaluates perseveration.

One of the most critical survival functions is also served by the frontal lobes: detection of deception. The right frontal lobe serves this important function and some say that consciousness itself is but the output of a deception detection module. We are self-aware as a protection against lies, separating false linguistic depictions of reality from our own. In a way, as we read or listen to anyone, we engage our right frontal lobe and ask, is the author lying to me right now? How much? How can I tell?

-DK

Upcoming Courses

Arlington VA, Jun 19-22
Albuquerque NM, Jul 10-13
Glendale CA, Aug 7-10

Our course is a hands-on experience right from the start. Attendees consistently say this format is a very good way to learn neurofeedback.

"Neurofeedback should be viewed as one of the three essential or primary forms of intervention - psychotherapy, psychopharmacology, and neurofeedback. In my experience, neurofeedback is every bit as important and powerful as the other two forms of treatment." - Dr. Laurence Hirshberg, Brown University Medical School, psychologist specializing in Developmental Disorders and Autism.

Contact Karie Kramer, our training coordinator, for more information 818-789-3456 ext 847 or see www.eegspectrum.com/Training

* EEG Spectrum International, Inc. is approved by the APA to offer continuing education to psychologists. ESII maintains responsibility for the program.

Conferences for Neurofeedback Clinicians & Researchers

CONFERENCE LOCATION DATES

ISNR - www.isnr.org San Antonio, TX Aug 28-Sep 1

Conferences for Neurofeedback Clinicians & Researchers
CONFERENCE	LOCATION	DATES
ISNR - www.isnr.org	San Antonio, TX	Aug 28-Sep 1

Last Word

Task-QEEG Assessment

Neurotherapists attempt to restore impaired collaborations within and between brain areas by momentarily adjusting EEG toward a preconceived ideal based on a client�s age or maturational state. Mental fitness is conceived as a healthy blend of EEG rhythms and synchronies. By analyzing EEG synchronization between electrode sites, we evaluate the likelihood that cortical networks are functional enough to manage age-appropriate challenges, especially self-regulation. Does a specific challenge such as reading or rest have anticipated psychophysiology? To what extent is the dominant frequency present? Is there age-appropriate hyperpolarization? Are sufficient fast frequencies present or do slow rhythms dominate? Are faster frequencies synchronized with slower ones or acting independently?

The larger the range of mental behaviors we assess, the more likely we will attain a reasonable estimation of a person's range of functioning. Ten years ago Sterman-Kaiser Imaging Laboratory, Inc., introduced task-QEEG assessment and were largely criticized for such innovation. Some in the field expressed the opinion that the EEG is destabilized or corrupted by the use of recordings obtained during cognitive task conditions (Thatcher, 1998) despite many careful studies reporting just the opposite. McEvoy et al. (2000), for instance, demonstrated greater stability in quantitative EEG values collected during cognitive task conditions (r = 0.9) than during the eyes closed condition (r = 0.7). This fact is obvious to anyone with any experience in task EEG recordings. Cognitive challenge focuses attention and reduces variability in the mental state, and the good news is that many of us are now using task-QEEG evaluations to understand client impairments without such unfounded criticisms biting at our heels.

While important in all contexts, the utility of task conditions in the QEEG evaluation of Attention Deficit Disorder is particularly relevant. Evidence of EEG abnormality as a possible marker for ADD has existed for many years. Using labels such as "Minimal Brain Damage" and "Childhood Behavior Disorder", neurologists in the early part of the 20th century described a syndrome that included hyperactive behavior, short attention span, frequent mood shifts, and various minor perceptual disturbances. The possibility of a physiological disturbance was recognized almost at the outset by the discovery of a high incidence of unusually slow EEG brain wave patterns in these children (Lindsley & Cutts, 1940; Solomon, Bradley & Jasper 1938). In fact, this finding originally suggested that these children were under-aroused, and contributed to the initial exploration of stimulants and other centrally acting medications as a therapy (Lindsley & Henry, 1937; Walker & Kirkpatric, 1947). By mid-century, however, lack of evidence for gross neurological damage or deficits associated with this syndrome led to a change in accepted terminology, and adoption of the new label "Minimal Cerebral Dysfunction" (MCD). EEG studies during this period also found that a high percentage of children with a diagnosis of MCD showed diffuse abnormal EEG slow activity (Capute et al, 1968; Klinkerfuss et al, 1965; Small & Milstein, 1978). This diagnosis became ADD with the DMS II.

Today, using quantitative methods, a growing number of comprehensive scientific reports strongly support the importance of EEG markers in ADD. As many as 90%-plus of those with ADD show QEEG disturbances in terms of neurophysiological regulation (e.g., Chabot et al., 1996; 1999; Clarke and Barry's work for the past decade - check Medline for numerous papers on ADHD and EEG by this Australian team). Collectively, these studies have illuminated two important facts. First, that there are a number of different patterns of disturbance seen in this population, and second, that these disturbances are reliably increased during cognitive challenge.

On a related front, the Mayo Clinic recently researched the effect of psychostimulant therapy for ADHD children. Coauthor of the study, Professor William Pelham of U Buffalo, concludes the following: "The children had a substantial decrease in their rate of growth so they weren�t growing as much as other kids both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects � none." "In the short run [medication] will help the child behave better, in the long run it won�t."