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Tourette Syndrome

by Siegfried Othmer | January 12th, 2011

The following case report was provided from a child psychiatry practice in Norway.We have worked for many years with Tourette Syndrome, with very equivocal results. It is clearly a heterogeneous condition that does not lend itself readily to a narrow diagnostic description. Mild expressions of the condition may respond readily to a variety of neurofeedback protocols, but more extreme presentations may be more resistant to most approaches. The following case report was provided from a child psychiatry practice in Norway.

Bodil Solberg, MD is a specialist in Child and Youth Psychiatry and in General Medicine, specialized in diagnosing and treating neuropsychiatric disorders. Dr. Solberg also teaches and supervises cognitive behavioral therapy. Her clinic is part of the Norwegian public health care system.

Erlend Solberg has been a Neurofeedback therapist since 2005. He was educated through EEG Info and more lately also in QEEG and ERP analysis. He has experience in supervising other Neurofeedback therapists from Norway and Sweden.

The clinic’s niche is neuropsychiatric investigations, cognitive therapy and Neurofeedback. The most common diagnostic groups are various spectra of ADHD/ADD, Tourette Syndrome, Bipolar affective disorder, etc. Neurofeedback has been offered at the clinic since 2005. The following case was selected because more than one-year follow-up was available to demonstrate that the benefits of training held over the longer term.

A Case of Tourette Syndrome
by Erlend Solberg
(Note: Client is referred to as “A.” in this article)
A. came into the world in 1993. Currently he still lives with his parents, sister and a little brother, who is the foster child in the family. He was referred to us from the family unit of Child and Youth Psychiatric Clinic at the local hospital here in Norway, since he was not helped by traditional treatments. He was diagnosed there as a youth with depression, dyslexia, and Oppositional Defiant Disorder. He was unmanageable by his parents and was aggressive towards adult authority figures, parents and fellow pupils. He was assigned special resources and placed in a special school for youths at risk. As his condition continued to worsen rapidly, we agreed to give him a try with neurofeedback.

His desperate mother told us on the first visit about her own brother, who had similar problems that he had been struggling with throughout his life. She was totally scared of seeing the same development in her son, as he was attracted to unhealthy social environments. Many of his earlier friends had withdrawn, and now he had only the younger ones left that he could lead and impress and dominate. There were good relations within the family, and there was no suspicion of drug use. He was somatically healthy except for a pollen allergy in springtime and gastro-intestinal reflux.

He was described as a boy who had always been unusually active. He was dominant and intense in play. He had a low frustration threshold, and was extremely rigid and detailed in everything he did. He had frequent mood swings, was persistent, argumentative and unable to withdraw in conflicts. He was impulsive, with little inclination or ability to think about consequences. Even with minimal provocation he could become threatening and even violent. There were problems with focus and concentration in all arenas. He had low empathy when he was angry, but on the other hand he could be caring when he had calmed down. Underneath he had always been anxious about a variety of things, and was perceptually hyper-sensitive to certain sounds and visual stimuli.

At our first meeting, we encountered an immature boy with poor emotional and social abilities. He resisted any support and denied having any problems. He blamed others for his failures. At the end of the conversation, however, he agreed to give neurofeedback a try. The initial interview and testing revealed that he met the criteria for Tourette Syndrome, ADHD and dyslexia.

We started the neurofeedback training in March 2008, looking for the Optimal Reward Frequency (ORF), according to the Othmer Method. We scanned frequencies at T3-T4 between 1.5 Hertz and 0.05 Hz (the then-standard procedure). Training too high in frequency caused him to become stressed mentally and active motorically. Training too low in frequency made him sleepy and sloppy. At the time we did not have access to the infra-low frequencies that we use currently, so we ended up with an ORF at 0.15 Hz. His initial reactions after the first sessions were very positive. His mood improved and he seemed calmer and more in harmony with himself.

After that he became more tired and sluggish, irritated, anxious and lower in mood. We tried out slightly higher frequencies, 0.2 Hz-0.5 Hz. During the session he became more awake and his mood improved, but afterwards he became even more irritated and oppositional. There were a lot of tics; the hyperactivity was worse, and he also had problems with insomnia.

Over sessions 4-13 we used an ORF 0.2 Hz, where he calmed down and functioning started to improve. We introduced T4-P4 for sensory integration and general calming of body and mind. T3-Fp1 was used for improved ability to focus, for better impulse control, and to reduce his tics. During this time his allergy also caused irritation and stress in his brain, which could be seen both in his general performance and in his EEG.

A. was a poor reporter, so most evaluations of training effect between sessions had to be done via his parents. They told us that now A. was stable for approximately two to three days after a session, and then the effect gradually faded. He still had days of increased irritability and oppositional behavior. We had a rebound of symptoms and a lot of allergy-related problems during sessions up to nineteen. Because of that we lowered the frequency back to 0.15 Hz.

From session twenty on we added T4-Fp2 and had an immediate and significant positive effect. He now started to talk instead of fighting with his parents and teachers. Violent behavior decreased to zero and he started to make new friends that even his parents thought were acceptable. He was a happier boy and was looking forward to the next neurofeedback session.

He became more reflective, and began to put words to his thoughts and feelings. He made improvements at school and became willing to accept correction from adults. He was no longer troubled by gastro-intestinal reflux, and no longer needed any medication.

From session twenty-five to forty the effect of the neurofeedback training lasted longer and longer, to the point where his condition became stable between sessions. The family climate was now much like in any other family with teenagers, and his mom describes a relaxed atmosphere at home. The plan is for A. to return to a normal school setting, and he clearly wishes to be like everybody else. He is still described as an energetic person, but much better regulated. According to his teachers, he has developed a talent for solving problems and conflicts in class verbally—-as opposed to causing them, as was the case before. The tics have been reduced to less than 50% of what they were before, and are now mainly seen when A. is under stress.

When we run into his mother these days in our small-town environment, she reports that A. is still functioning appropriately for his age both at home and at school. He spends his free time with sound friends and activities. In overall summary, according to her A. is today just like any other energetic teenage boy.

Siegfried Othmer, PhD
drothmer.com

5 Responses to “Tourette Syndrome”

  1. Robert Barrett says:

    Hello,
    At the age of 25 years old, I was discharged from the Marine Corps.
    I had developed “panic attacks” . I went to my local VA Hospital.
    It was then that I learned about “Biofeedback”. I put on the head phone
    and listened to alpha-wave sound feedback. After a few sessions, I no
    longer had the panic attacks. I t was under control.
    I am almost certain that biofeedback can help me with Tourette Syndrome .
    The problem is the VA does not have that service anymore.
    Can anyone assist me in finding biofeedback help?
    Thank you
    Robert Barrett

  2. Go to http://www.eegdirectory.com and enter your zip code. See if there is a practitioner from our network near you. If not, get in touch with our office. See http://www.eeginstitute.com

  3. Can you forward me any information regarding neurofeedback and tourettes syndrome

  4. Caroline Bryan says:

    I would also like to receive any information regarding Neurofeedback and Tourette Syndrome. I am working on a research project/proposal. Would you let me know how I can get more information? I cannot find any recent research on this topic. Thank you!

  5. Here’s an update from Erlend Solberg, writing on our professional list on his recent experience:

    We have performed NF with Tourette clients since 2005 with good results. The results dramatically improved when Infra-Low Frequency Training (ILF) was introduced. We have now used the ILF HD module since March 2013 and the results have further improved. It is more calming and the effects are more specific, stronger and clearer. We also have the possibility to train at even lower frequencies. These clients have a wide variety of symptoms where tics are only “the tip of the ice berg.” Therefore we concentrate on the overall picture. Tics will usually be decreased by at least 50%, but can re-occur in a milder form under stress. Even more importantly NF is usually highly effective for the behavioral issues, and it reduces anxiety and rigidity.

    From an older post:
    In our Child and Adolescent Psychiatry Clinic about 50% of the kids have tics in various degrees. We find tics to be sensitive to frequency and site. Training too low or too high can trigger tics and even change their nature. I interpret increase or changed tics as a symptom among all other symptoms guiding me to find the optimum response frequency (ORF). We view OCD as a symptom that often is closely related to Tourette Syndrome, a kind of mental tic. These kids seldom have only tics or OCD, but always have many other issues as well. For example: anger, rage, and oppositionality; sensory hypersensitivity (touch, sound, light, smell, taste etc..); extreme rigidity, sense of right and wrong, black-and-white thinking; sleep problems; anxiety and fear; distractibility; poor muscle tonus, etc.). They often have various learning disabilities and dyslexia.
    I regard tics as the tip of the iceberg. We don’t usually try to target tics directly, but rather concentrate on the total symptom presentation. Some kind of detailed symptom tracking is very useful. Tics are a good indicator of whether the ORF has been identified because they will typically not decrease significantly except when training at the ORF. In fact, they will tend to increase at the wrong site or frequency.
    All our Tourette clients train at very low frequencies, but need careful fine tuning as they have a reactive CNS. We usually concentrate on right-side training to start with. Primarily T4-P4 and later T4-Fp2 (if well tolerated). T3-Fp1 can later be added if well tolerated. Other sites according to symptoms.
    Our overall experience is that tics will be reduced by at least 50% in the long run as their arousal level settles down. Even more important, their total picture of symptoms will usually greatly improve.

    Erlend Solberg

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