What's New in Neurofeedback

• Tactile Input Affects What We Hear

• Uniform Method to Interpret Autism Spectrum Disorders

• Two Sides of the Same Coin: Speech and Gesture Mutually Interact to Enhance Comprehension

• Before or After Birth, Gene Linked to Mental Health Has Different Effects

• Acute Stress Leaves Epigenetic Marks on the Hippocampus

• Alzheimer's: How Amyloid Beta Reduces Plasticity Related to Synaptic Signaling

Links at http://www.sciencedaily.com/news/mind_brain

 

The first published report of human EEG was in 1929, from data collected in part as early as 1924. The initial reports were quantitative in terms of measuring frequencies. Berger (1929) compared his son's EEG against a steady signal marking time. Spectral analysis to determine the exact amount of each frequency was performed soon after (Dietsch, 1932; Berger, 1932). We have been analyzing EEG activity quantitatively in every decade, 20s, 30s, 40s, 50s, 60s, 70s, 80s, 90s, 00s, and now 10s, and there are more than 120,000 papers on EEG analysis, 115K in Medline, with Molly Brazier providing a list of pre-1950 publications in the now-defunct journal, EEG and Clinical Neurophysiology. That is a long time to be studying a single phenomenon, even if it is of our own creation, a correlate of human thought. The 17th century poet Alexander Pope once said "The proper study of mankind is Man" and much of modern science has followed his prescription, expanding our definition of humanity to include our inner workings and our outer garb (i.e., environment).

As the world changed across the decades, EEG science has reflected these changes. One way to get a feel for these changes is the list of presidential addresses of the ACNS, an early professional society for EEG analysis. The 1950s in America were full of promise and expanding our way of life to the planet, and this is reflected in the 1956 address by the current society president, titled "New Dimensions in Electroencephalography." With expansion comes responsibility and search for greater laws such as Liberson's "Functional EEG, the Law of 3.5 and the Hippocampus" in which he proposed that brain frequencies are organized along multiples of 3.5 Hz at every level of investigation, micro and macro, a number very near pi. By 1962 Americans were eager to prove that we had the right stuff between our ears, and Charles Henry's address spoke to this drive, "EEG in Relation to Space Travel." The 1970s, my generation, were about spiritual renewel and spiritual hubris in the West, and this is reflected in addresses like that given by John Barlow, "The Electroencephalogram — Window on the Universe?" and Stevens' self-centered title "All that Spikes is not Fits: Opus Two, Sunlight and the Third Eye." (Did we miss Opus One?)

Science is on guard about error creeping into portfolio of understanding (though this is lost on some of us), and we see this reflected in Gloor's address, "When Reading an EEG, Do We Really Know What We Are Looking At?" Finally, by the 1980s we have a modern, almost mocking relationship to our studies, in Gabor's "If EEG is the Answer, What is the Question?" By 1990 the nostalgia movement and futurist movements were full-throttled, as reflected by Pedley's "Facing 21st Century Realities," Engel's "Investigating Human Cerebral Function: Past, Present and Future," and Aminoff's "The Clinical Neurophysiology of Cortical Sensorimtor Function: Yesterday, Today, and Tomorrow." Finally technology gains dominance in our analysis, as witnessed by Emerson in 2005, "Brain Waves and Moore's Law: The Shape of Things to Come," referring to the process of crowding more and more silicon angels onto the head of a pin.

The utility of EEG analysis is without question -- in staging sleep, detecting nonconvulsive seizures, and monitoring mental operations and their shortcomings. One of the first applications with this new signal and technology was trying to alter the signal volitionally, and Lord Adrian attempted this in 1934 according to his self-report. Training of the EEG signal has progressed through human and animal trials ever since, under various monikers such as neurotherapy, EEG biofeedback, brain-computer interface, and brain training. Early research in alpha training is not yet included in this summary, as we pick up the story with SMR training over the motor strip in the late 1960s which provided a means of increasing neural inhibition in a variety of conditions. PubMed lists 5,565 neurofeedback papers in its index, which is limited to biomedical journals, ignoring a large fraction of psychology and engineering journals. (Medline recently included biofeedback as part of the neurofeedback search else articles would number around 400 for purely CNS feedback.) Google Scholar has 5,340 neurofeedback articles published since 1991 in its more extensive database of peer-reviewed journals, including all of Psychology, Engineering, and Neuroscience. Medline is older, going back to 1950, but smaller in size.

There are few things associated with EEG as much as epilepsy, a term which encompasses a range of brain breakdowns that manifest by loss or change of consciousness with or without convulsions. We’ve known about epilepsy since we’ve known about ourselves; seizures are described in the earliest medical writings we have. In fact few conditions have attracted so much attention and generated so much controversy as epilepsy. The maladies of epilepsy and aphasia were the dysfunctional engine that propelled behavioral and clinical sciences into the modern era.

People have been describing seizures for thousands of years (Stol, 1993). The Code of Hammurabi of the 2nd millenia BC even mentions epilepsy in slave sale contracts, a buyer-beware notice. The Babylonians believed all diseases had supernatural causes, as did the Sumerians, whose name for epilepsy was "what has fallen from heaven," a word akin to meteorite. Epilepsy was called bennu in ancient Babylonia and "apasmara" (loss of consciousness) or "rupa" in Ayurvedic (Indian) texts. An ancient medical treatise from China, the The Yellow Emperor's Inner Canon (or Classic of Internal Medicine), included epileptic symptomalogy. Plato believed epilepsy was caused by phlegm mixing with black bile which confused the divine circles of the head (Eadie & Bladin, 2001; Scott, 1993). A 4th century account of a generalized tonic-clonic seizure belongs in a modern-day textbook: "After various premonitory signs the patient falls down, stretched out or twisted, and in this condition he remains for some time. After these tonic convulsions he passes into the stage of clonic convulsions and a condition where he appears to be sleeping. The attack is followed by complete amnesia." (Temkin, 1945).

The ancients considered diseases to be invasion by the gods. With the emergence of monotheism, this idea was transformed to lesser agents, but the idea of invasion (or possession) still held sway for millenia. Hippocrates called epilepsy the "great disease" which in Latin became "morbus maior" which translated into French is "grand mal," now the label for one form of epileptic fit. The Romans called epilepsy "morbus comitialis" as fits ruined the assembly (comitia) of the people. The term "aura" was coined not by a physician but by a patient who described how an uncanny feeling would emerg in his leg and climb through his body like a "cold breeze" or breath. Epilepsy was not prominent in any animal but man, outside of a rapid dog and the quail, a bird known since Roman times to stutter and fail. (Seizures in dogs are actually common but misinterpreted.) As early as the 4th century the three primary responses or remedies to epileptic fits have been dietary, surgical, and pharmacological, with the dietary or lifestyle approach being the most effective. Pharmocological approaches included drinking the blood of stabbed gladiators and other nonsense. Neurofeedback may be considered as lifestyle, coaching the brain to be calm and self-regulated.

The Middle Ages considered epilepsy to be a sign of possession or witchcraft. As many as 200,000 women were put to death because they had seizures and thus were deemed practitioners of black magic. Renaissance ushered in new ideas about epilepsy. Paracelsus (16th century) believed that epilepsy was present in all of nature including plants: "Earthquakes and falling sickness have the same causes," he was known to say. English anatomist Thomas Willis (1667) believed that "(e)pilepsy is caused by contractions of the membrances around the brain compressing and constricting its substance and preventing the proper and equable expansion of the (animal) spirits..." -- an explosion of 'animal spirits' in the brain that resembles the internal combustion engine. As the concept of animal spirits died in neuroscience, the role of electricity in epileptogenesis grew, especially after Galvani (1780) demonstrated electrical activation in his frog preparations, until we reach the semblance of modern-day thinking on this topic.

By the 1870s the modern era of epilepsy research and treatment had begun with John Hughlings Jackson and his fellow neurologists. However we were not yet free of the stigma of epilepsy. Eugenics came on the scene in the early 20th century and 33 states enacted laws that allowed for the sterilization of epileptics, specifically those under the care of state institutions (e.g., Virginia Sterilization Act of 1925). Many states also enacted laws that forbade people with epilepsy to marry. Only when Congress passed the Americans with Disabilities Act of 1990 were these laws overturned in their entirety.

Today there remains still a lack of understanding about seizure disorders including the notion of an epileptogenic focus. A third of all patients who undergo surgery for intractable epilepsy continue to have seizures postoperatively (e.g., Kim et al., 2008). Brain areas are removed and the patient is no better off. That the supposed starting point for a seizure is removed and convulsions continue reflects how little we actually do know about epilepsy. It may be that the entire brain runs fast in such cases, making EEG training the best option. As many as 50,000 Americans die each year from seizures and related causes (e.g., drownings, car accidents) and 1 in 10 people will suffer a seizure during their lifetime. The mortality rate is 2 to 3 times higher and the risk of sudden death is 24 times greater than that of the general population, yet research funding lags far behind many other neurological afflictions, with $35 a patient for epilepsy compared to $129 for Alzheimer's and $280 for multiple sclerosis (Meacham, 2009).

The story of the treatment of epilepsy with neurofeedback begins in the 1960s, when Mercury astronauts claimed they saw Polynesian natives waving at them as they flew over the Pacific. The neurotoxicity of the capsule's rocket fuel was to blame, and in testing the mixture, Barry Sterman seredipitously discovered that SMR training countered its effect, a behavioral anticonvulsant. Neurofeedback now has a 40-year history for treating seizures (Sterman et al., 1969; Tan et al., 2009) and this technology and approach (operant conditioning) has since been adapted to treat an astounding array of human frailties including mood and sleep problems, attention and learning difficulties, as well as brain injury and drug abuse. The mysteries of brain function still remain, but with neurofeedback we’ve added an extremely powerful tool to resolving one of its chief disorders.

References

Eadie MJ & Bladin PF (2001). A Disease Once Sacred: A History of The Medical Understanding of Epilepsy. Eastleigh: John Libbey.

Kim SK, Wang KC, Hwang YS, Kim KJ, Chae JH, Kim IO, & Cho BK (2008). Epilepsy surgery in children: outcomes and complications. Journal of Neurosurgery.Pediatrics, 1, 277-83.

Meacham J (2009). A storm in the brain. Newsweek, Apr 11, 2009.

Scott DF (1993).The History of Epileptic Therapy: An Account of How Medication was Developed. London: Informa Healthcare.

Sterman MB, Wyrwicka W, & Howe R (1969). Behavioral and neurophysiological studies of the sensorimotor rhythm in the cat. Electroencephalography & Clinical Neurophysiology, 27, 678-9.

Stol M (1993), Epilepsy in Babylonia, Cuneiform Monographs 2, Groningen, Styx Publications

Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, & Kaiser DA (2009). Meta-analysis of EEG biofeedback in treating epilepsy. Clinical and EEG Neuroscience, 40, 173-9.

Temkin O (1945). The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology. Baltimore: Johns Hopkins Press (2nd edition, 1971).

Recent neurofeedback papers on epilepsy

1. Walker JE (in press). Using QEEG-Guided Neurofeedback for Epilepsy Versus Standardized Protocols: Enhanced Effectiveness? Applied Psychophysiology and Biofeedback.
2. Shelley BP & Trimble MR (2009). "All that spikes is not fits", mistaking the woods for the trees: the interictal spikes--an "EEG chameleon" in the interface disorders of brain and mind: a critical review. Clinical and EEG Neuroscience, 40, 245-61.
3. McElroy-Cox C (2009). Alternative approaches to epilepsy treatment. Current neurology and neuroscience reports, 9, 313-8. Review.
4. Fell J, Fritz NE, Burr W, Ludowig E, Axmacher N, Elger CE, & Helmstaedter C (2007). Human neocortical and hippocampal near-DC shifts are interconnected. Hippocampus, 17, 413-9.
5. Zhao L, Liang Z, Hu G, & Wu W (2005). Nonlinear analysis in treatment of intractable epilepsy with EEG biofeedback. IEEE Engineering in Medicine and Biology Society Conference, 5, 4568-71.
6. Strehl U, Trevorrow T, Veit R, Hinterberger T, Kotchoubey B, Erb M, & Birbaumer N (2006). Deactivation of brain areas during self-regulation of slow cortical potentials in seizure patients. Applied Psychophysiology and Biofeedback, 31, 85-94.
7. Sterman MB, & Egner T (2006). Foundation and practice of neurofeedback for the treatment of epilepsy. Applied Psychophysiology and Biofeedback, 31, 21-35.
8. Egner T, & Sterman MB (2006). Neurofeedback treatment of epilepsy: from basic rationale to practical application. Expert Review of Neurotherapeutics, 6, 247-57.
9. Sheth RD, Stafstrom CE, & Hsu D (2005). Nonpharmacological treatment options for epilepsy. Seminars in Pediatric Neurology, 12, 106-13.
10. Strehl U, Kotchoubey B, Trevorrow T, & Birbaumer N (2005). Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy. Epilepsy and Behavior, 6, 156-66.
11. Walker JE, & Kozlowski GP (2005). Neurofeedback treatment of epilepsy. Child and Adolescent Psychiatric Clinics of North American, 14, 163-76.
12. Kirlangic ME, Holetschek J, Krause C, & Ivanova G (2004). A database for therapy evaluation in neurological disorders: application in epilepsy. IEEE Transactions of Information Technology in Biomedicine, 8, 321-32.
13. Bhatia MS (2004). Pseudoseizures. Indian Pediatrics, 41, 673-9.
14. Monderer RS, Harrison DM, & Haut SR (2002). Neurofeedback and epilepsy. Epilepsy and Behavior, 3, 214-218.
15. Kotchoubey B, Strehl U, Uhlmann C, Holzapfel S, König M, Fröscher W, Blankenhorn V, & Birbaumer N (2001). Modification of slow cortical potentials in patients with refractory epilepsy: a controlled outcome study. Epilepsia, 42, 406-16.
16. Uhlmann C, Fröscher W (2001). Biofeedback treatment in patients with refractory epilepsy: changes in depression and control orientation. Seizure, 10, 34-8.
17. Duffy FH (2000). The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor's opinion. Clinical Electroencephalography, 31, V-VII.
18. Kotchoubey B, Strehl U, Holzapfel S, Schneider D, Blankenhorn V, & Birbaumer N (1999). Control of cortical excitability in epilepsy. Advances in Neurology, 81, 281-90.

-DK

Reviews NEW &/OR USEFUL BOOKS

Children and Behavioural Problems Anxiety, Aggression, Depression and ADHD: A Biopsychological Model with Guidelines for Diagnostics and Treatment M Delfos
Guidance on diagnosis, treatment, and social support for childhood behavioral problems including anxiety, aggression, mood, and attention.

Atypical Cognitive Deficits in Developmental Disorders: Implications for Brain Function Sarah H. Broman, Jordan Grafman (Editors)
Research of autism, William's, and Turner syndromes which clarifies localization of cognitive function and developmental trajectories of atypical cognitive profiles.

Social Brain: Evolution and Pathology M Brune
Discusses development of social cognition in humans and psychiatric implications of disturbances to this development.

Theories of Theories of Mind P Carruthers & PK Smith (Eds)
Surveys major topics in the philosophy of mind, developmental psych, autism, and primatology.

Man Who Tasted Shapes R Cytowic
A review of synesthesia.

Emotional Expression Among the Cree Indians N Ferrara
A dissertation on pictorial representations in the assessment of mental operations.

Autism, Mind and Brain U Frith & Hill
Clinical research and therapies for autism.

Social Behavior Mapping: Connecting Behavior, Emotions and Consequences Across the Day M Garcia Winner
The SBM is a cognitive behavior flow chart used to teach individuals how their behaviors impact others and vice versa.

Bipolar disorder and ADHD: Clinical concerns.
Studies implicate common brain regions and neural circuits subserving bipolar and ADHD disorders
http://www.ncbi.nlm.nih.gov/pubmed/19773717

PTSD and TBI in veterans
Nearly a fifth of veterans with PTSD screened positive for MTBI
http://www.ncbi.nlm.nih.gov/pubmed/19829203

Normal metabolite levels in the left dorsolateral prefrontal cortex of unmedicated major depressive disorder patients
MDD shows normal neurochemistry in the left frontal lobe (DLPFC).
http://www.ncbi.nlm.nih.gov/pubmed/19910168

Electroencephalographic correlates of Chronic Fatigue Syndrome.
CFS may be the result of impaired sleep homeostasis
http://www.ncbi.nlm.nih.gov/pubmed/19807920

New horizons for therapeutics in drug and alcohol abuse.
Suggests use of drugs to disrupt drug abuse problem.
http://www.ncbi.nlm.nih.gov/pubmed/19917308

"It's not an easy life, but then, what is?"

This was Uncle Hubert's comment when I told him I was entering the ministry. Hubert was the youngest son of a rural minister who had known poverty, unemployment, hunger, difficulty with the law, infidelity, divorce court, the death of a son, a heart attack, and two automobile accidents that left him hospitalized and almost fully blind. Yet he retained a positive outlook on life which is why his comments have stuck in my mind all these years.

"It's not an easy life, but then what is?"

Life is never easy for any of us. How often do we feel that no one really understands our particular problems, not even God. We know the age-old platitude that "God is Love" but what does it mean in terms of everyday living? Does God really care about me and my troubles?

Jesus said yes, God does care. He lives with us, through us, within us. We are his body, his mind, his soul. Our struggles are His struggles, our worries His worries, our heartaches His as well. God's Love is not abstract or general, but personal, unique and without end. As a high school boy in my youth group said, "If God is like Jesus, then I trust Him."

Jesus said, "Come to me, all you that are weary and are carrying heavy burdens and I will give you rest. Take my yoke upon you and learn from me; for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light (Matthew 11:28-30). This is the very core of Love. But what does a yoke, even an easy one, have to do with Love?

When I was a kid my Sunday school teacher often read this text to us, "My yoke is easy?" she would ask, "Who in this class can tell me what a yoke is?" I remember answering that it is something that they put on the necks of animal. Then the teacher asked, "Then what is the meant by God's yoke?" A young boy next to me said "It is God putting His arms around our neck."

Love lies at the heart of the Universe; it is why we are here. But Love can only comfort us when we accept it. If we reject it, rebuff it, we lose our greatest resource. This can be seen by various responses people can make to God's Love. One response is to say in effect, "God does not really care for the individual," as did a young mother who was facing the death of her child and finding it impossible to reconcile this with a loving Creator. Turning to her pastor with steel in her eyes she said bitterly, "I suppose this is the will of God and I will just have to accept it."

Unfortunately that which passes for religious faith is often nothing more than a rebellious acceptance of the inevitable. In the young mother's words there was no element of trust, but only a surrender to a power greater than she. She acknowledged that she was outmatched and resigned herself sullenly to that which could not be helped or changed. She could discern no trace of love in the heart of a Being who would allow the death of an innocent, and she completely doubted His vision for her. Had she the power of God, her child would be alive now. As it was, she felt helpless in the hands of one whom she loved not and trusted not.

We can think of God as an embodiment of Infinite Love, protective and caring, a Heavenly Father, as Jesus did. Abba, Dad in Heaven. In this view if Infinite Love inflicts an apparent wound on us, it must serve a holy and loving purpose.

Can we put ourselves wholly in God's hands and trust wholly in Love? This was what Joe Scriven finally did. Joe grew up in Dublin, Ireland, and he never trusted anybody growing up. Some said that he was born with a glint of suspicion in his eyes and from his earliest schooldays he was a loner, wary. What was wrong with Joe? Perhaps his parents were soured on life and warned the boy against putting his faith in anyone or anything. In any case Joe became dissatisfied with Dublin and sought his fortunes elsewhere and eventually ended up in Canada. The new surroundings intensified his loneliness until finally he broke down, and the man who was afraid of making friends fell in love with a young woman. Soon they were engaged and he forgot his past ways.

On the night before their wedding, his soon-to-be-wife went across the bay to buy her wedding gown. As she was returning, a sudden storm capsized the ferry she was on and everyone aboard was drowned. Joe Scriven stood alone in the world once again. He had tried to make sure that life could not hurt him, but now he was devastated, plunged into anguish. The pain of it was too great to be borne alone, yet to whom could he turn? The only friend that he had ever made was now gone.

Alone in his room he fell on his knees and cried to God for a friend.

Hours passed before he weakly climbed to his feet. He started down the stairs of his boardinghouse, not knowing where he was going, but he was stopped short by the group of people waiting for him in the hall. There was the young clerk who lived in the room next to his, and the schoolteacher with the lady from the library, along with the boardinghouse mistress. They held out their hands to Joe and told him to have courage. Even the old clergyman was there and he took Joe by the arm and led him to the parsonage for dinner with the pastor's family. Joe was amazed to find how much sympathy and friendliness there was in the world.

No one had ever thought of Joe as religious, nor musical for that matter. Certaintly no one had ever thought of him as one who would be able to bring comfort to people. Yet this is exactly what happened. Joe Scriven was transformed by his loss; and in the solitude of his room one night he wrote a hymn that is sung in uncounted churches around the world and has brought comfort to millions, "What a Friend We Have in Jesus."

Consider this: when they uncovered the ruins of Pompeii years ago in Italy, a team of workers found a body of an invalid boy, apparently lame since birth -- but the body was not alone. His mother was with him. She could have saved herself, but she had gone back to rescue this helpless, deformed boy or stayed with him as the volcanic ash overwhelmed the city. For nearly two thousand years the mother's arm lay underneath the child she died to save. If our parents in their imperfection are capable of love and self-sacrifice, then how boundless the Love of our Heavenly Father must be. God's arms are wrapped around us, like the boy said. His everlasting arms are always underneath us, and He is with us in our pain, our struggle, and our folly, for we are the Children of Love.

-BFK