Archive for the ‘Efficacy’ Category

The Medical Treatment of Epilepsy

Friday, August 28th, 2009

An informal survey taken on a public website dealing with epilepsy has found a notable trend in the prescribing of anti-convulsant medication. Most people being treated for epilepsy have been tried on a significant number of different medications.An informal survey taken on a public website dealing with epilepsy has found a notable trend in the prescribing of anti-convulsant medication. Most people being treated for epilepsy have been tried on a significant number of different medications. The survey results are shown in Figure 1. Shown is the percentage of respondents who have taken the indicated number of medications over their treatment history. The bin labeled ’10’ includes everyone who has been prescribed at least ten different anti-epileptic drugs. The modal value is ’10,’ so those diagnosed with epilepsy are more likely to have been prescribed ten or more medications than any lesser value. The total number of participants in the survey was 177.

No doubt each of these medications required several visits to the neurologist, plus some blood work and perhaps an EEG every now and then. Also we may assume that most of the ten or more medications will have been abandoned along the way because it is unusual for someone to be on more than three AEDs at a time. So one may judge that at least 70% of the ten or more medications were not worth keeping in the mix. That indicates a fairly low hit rate on the medications.


Neurofeedback for the Aging Brain

Wednesday, July 29th, 2009

The movement toward healthy aging not only promises to increase the return on that investment, but it also gives hope of making inroads into the cost of health maintenance itself.The near-win of Tom Watson at the British Open Golf Tournament at the age of 59 gives us the impetus to address the issue of healthy aging. Everywhere the elderly are sticking around, in careers, in positions of power, and even in sports where youthful eyeballs, strength, and stamina confer an advantage. The present concern about the looming health care crisis, however, focuses us ever on the other part of the spectrum, the gradually deteriorating health status of the elderly. Our present system of health care seems to do well at keeping people alive, but often with very little quality of life. With an ever growing contingent of the elderly, the costs keep creeping up, but the return on our societal investment keeps diminishing. The movement toward healthy aging not only promises to increase the return on that investment, but it also gives hope of making inroads into the cost of health maintenance itself. Read on.

In our current orientation in medicine, the tendency is to regard certain symptoms as a natural part of aging and then to adopt a policy of “watchful waiting,” particularly when we don’t have a ready remedy in any event. The same passivity, however, afflicts the research community. As the cartoon says, “Not only is there no cure, but there isn’t even a race for a cure.” This might be defensible if it weren’t for the fact that ignoring some issues just sets the table for worse to come. Further, some emerging health problems are quite optional, as we shall see.


Wired to Heal with Neurofeedback

Thursday, July 16th, 2009

Wired to Heal with Neurofeedback with Siegfried Othmer, Ph.DDr. Siegfried Othmer the Chief Scientist for the EEG Institute goes onlinewithandrea to discuss Neurofeedback and how it is used to help conditions such as Anxiety, Autism, Cerebral Palsy, Depression, Seizures, Post Traumatic Syndrome, ADD/ADHD, Sleep Disorders, and many others.

Hosted by Andrea R. Garrison
This interview is approximately 2.5 hours in length.

To listen to this interview:
Click on the image of the multimedia player below to be taken to the website.

Dr. Siegfried Othmer the Chief Scientist for the EEG Institute discusses Neurofeedback with Andrea R. Garrison

Recovery from PTSD: A Vietnam Veteran

Thursday, February 19th, 2009

We have just experienced a remarkably quick recovery from PTSD symptoms in a Vietnam veteran. The case is illustrative of the more rapid pace of recovery that is achievable with the latest neurofeedback techniques that encompass the infra-low range of EEG frequencies. The veteran has had a forty-year history of PTSD, and was rescued from homelessness by the Salvation Army here in Los Angeles. He came to our offices for intensive neurofeedback training through the auspices of the Salvation Army. In exchange for our providing services at no cost, the veteran has allowed us to make his case history available for the benefit of other clinicians.

For scientific purposes, the veteran has agreed to undergo pre-post quantitative EEG analysis (courtesy of QMetrx) and SPECT imaging (courtesy of the Amen Clinics). As the training is still on-going, these pre-post comparisons are not yet available. However, we do have initial symptom-tracking data that already tell quite a story. Symptoms are assessed on the basis of self-report at typically three-session intervals. Severity is rated on a ten-point scale. Results for the first eighteen training sessions are shown in Figure 1. Overall symptom reduction reached 50% by session ten, and was more than 80% by session eighteen. The symptom list was broadly inclusive, and covered a number of areas not considered to be classically associated with PTSD. Eleven out of the twenty major symptoms were rated at zero by session 18. None were rated higher than 4 out of ten by session 18. The picture is one of broad improvement in self-regulatory capacity.

The picture is actually even more dramatic when data are segregated for the symptoms commonly associated with PTSD. These are shown in Figure 2. With regard to PTSD symptoms, overall improvement reached 50% within three sessions, and reached 93% in 18 sessions. Even more significantly, nightmares, flashbacks, suicidal thoughts, and binging and purging were all eliminated within three sessions. These were the most troublesome PTSD-related symptoms. The most persistent symptoms related to the quality of sleep. At the first QEEG session it became obvious that the veteran was suffering from sleep apnea. He was unable to stay awake for the QEEG assessment. This was a problem during the early neurofeedback sessions as well. By session 18, he was getting through entire alpha-theta sessions without falling asleep. Other persistent symptoms relate to motor function and mobility. Currently the veteran remains confined to a wheelchair. The improvement in hypertension is not entirely attributable to neurofeedback: as a result of the training, the veteran was motivated to be more consistent in taking his blood pressure medication. (more…)

The Ongoing Saga of Infra-low Frequency Training

Wednesday, December 17th, 2008

Our infra-low frequency training is sending ripples through the field of neurofeedback because it appears to represent such a fundamental departure from prevailing models. It is at such a bifurcation point that a professional community is tested in its assumptions, in its procedures, in its processes for finding accommodation, and indeed in its humanity. Unfortunately, the field of neurofeedback already has a history of fragmentation behind it. Therefore history does not augur for a benign accommodation to our new findings. More than likely we will just be in for continuing Balkanization of our field.

The first response has been skepticism, much of it animated by the thought that this new approach has just suddenly sprung upon the scene without sufficient research and scientific support. In fact, of course, the infra-low training is just the culmination of a long development process that goes back more than ten years. There have been many milestones along the way, each of which was well-established both clinically and scientifically before we moved on. In particular, our march to probe the low-frequency training has taken place in five distinct epochs over that period of time. We have now been exploring the domain below 1.5 Hz for more than two years, and the domain below 0.05 Hz for more than one year.

Our new findings present the greatest “affront” to the classical QEEG perspective, namely that the guide to neurofeedback protocol is to be found in the stationary deviations in QEEG variables from established norms. The hope has been that the QEEG formalism would give neurofeedback the necessary rigor, predictability, and reproducibility to finally achieve respectability in polite circles. This has not yet happened. Under the pressure of rejection, the response has been to adhere to the model with ever greater rigor, all the while critiquing other neurofeedback modalities that were not compliant. Unfortunately, the QEEG perspective has the propensity to become a kind of closed system that confers validity on its own data preferentially. Because the belief system was the prime mover here, there has been a tendency to recognize data that supports the model and to dismiss data that contradicts it. (more…)

Implications of Personalized Medicine for Research

Tuesday, December 18th, 2007

Much proposed research on neurofeedback has faltered over the years on the issue of uniformity of approach. The protocol to be investigated needs to be narrowly constrained or the research will be criticized for a lack of specificity. We have had a number conversations over the years with researchers who were willing to give Neurofeedback research a go, provided we would give them a fixed protocol to work with. In recent years, we have been increasingly unwilling to do this, and by now the point has been reached where such fixed protocols are plainly inappropriate.

The best neurofeedback requires one to react to how the client is reacting to the training, and to make appropriate adjustments. The moment we know this, it becomes ethically questionable to proceed in a manner that sweeps such particularity under the carpet. As it happens, however, the way we proceed in practice is not very different from the way a psychiatrist might proceed in optimizing medication. The choice of medication is often driven more by side effects than by bare-bones efficacy, particularly in the case of the most common medications, the antidepressants. And in many instances medications are combined in various ways. Research by classical methods is not of help when it comes to polypharmacy, and it is not of help with regard to handling side effects. To some degree, therefore, ‘Personalized Medicine’ has already emerged in pharmacotherapy, but this has not yet succeeded in feeding back to rewrite the rules for research. A recent analysis of the status of the science at the FDA, requested by FDA Commissioner Andrew von Eschenbach, came up with the recommendation that the FDA could help to define personalized medicine. “This is the science that the FDA can really take a lead on.” [Science, 318, p.1537, 7 Dec 2007] In neurofeedback, we are in the same boat. (more…)


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