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(R)=Research, (T)=Theoretical, (C)=Clinical Application
KEYNOTE PRESENTATION
Developmental Changes in the EEG of People with AD/HD: Results from an Initial Investigation
Adam Clarke, Ph.D., University of Wollongong, aclarke@uow.edu.au
(R)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: 1
Level of Difficulty: Beginner to Intermediate
Introduction
Attention-deficit/Hyperactivity Disorder (AD/HD) is one of the most common disorders of childhood, and research is finding that as many as 60% of childhood sufferers will continue to have the disorder as adults. Research has further shown that the symptom profile of people with AD/HD continues to change as they get older, with the hyperactivity commonly seen in childhood reducing, but the impulsive and inattentive components remaining. In addition to the maturational changes in the core symptoms, the profile of other comorbid problems also changes. The aim of this study was to investigate changes in the EEG from childhood to adulthood.
Methods
Forty subjects were initially assessed as children (8-12yrs old) and reassessed as adults (22-26 years old), with a clinical interview being performed and an eyes-closed resting EEG being recorded at both assessments. From these assessments, EEG abnormalities in the adult population, and changes in the EEG profiles from child to adult were evaluated.
Results
The results indicated the existence of some EEG power and coherence abnormalities in children with AD/HD which continued into adulthood. Differences in the EEG were also evident between those that outgrew the disorder and those that continued to be symptomatic into adulthood.
Discussion
These results have important implications for our understanding of developmental changes in the disorder, which will be discussed in this presentation.
Learning Objective
Identify common EEG and coherence abnormalities in children and adults with ADHD.
Outline
Developmental aspects of AD/HD (15 minutes)
Adult AD/HD (15 minutes)
EEG abnormalities in AD/HD (30 minutes)
Financial Interest: This study was funded by Novartis Australia. Data was recorded on a Lexicor NRS-24. Dr. Clarke provides consultancy services to Lexicor Medical Technologies.
KEYNOTE PRESENTATION
A Proposal for Combining Measures of Electric, Magnetic, and Chemical Gradients to Optimize Brain Imaging of Large-Scale Activity
Walter Freeman, M.D., Ph.D., University of California MC, mdfreeman@berkeley.edu
(R & T)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: 1
Level of Difficulty: Intermediate
Abstract
The common factor that underlies several techniques for brain imaging is the electric current by which dendrites express the magnitudes of their responses to synaptic inputs, sum them, and transmit their sum to the trigger zones of axons for transmission without attenuation locally and to the far reaches of the central nervous system. The high current densities in parallel dendritic shafts support magnetic field gradients of sufficient intensity to be detectable several cm from the scalp in the MEG. The broad distributions of the loop currents outside the dendrites manifest electric field gradients observed in potential differences in the scalp EEG. The prodigious demands for the energy that is required to drive the dendritic currents are met by metabolic and hemodynamic responses (inclusively "chemical gradients") that are observed with PET, BOLD, fMRI and related techniques. For all three of these state variables the relationships between the intensities of neural electric current density and the electric, magnetic, and chemical gradients are complex and far from proportionate. The observable state variables are complementary because the information they convey comes from differing sources, so that efforts to cross-validate localization of neural activity relating to specified cognitive behaviors have been disappointing. A more appropriate use for the three methods in combination is proposed through the non-invasive study of large-scale, high-resolution spatial patterns of neural oscillatory activity in the beta and gamma ranges. This approach would use multivariate statistics to classify and evaluate nonlocal macroscopic brain activity patterns that simultaneously occupy both gyri and sulci in the cerebral hemispheres. To the extent that various sensors obtain samples over comparable time segments, this approach may support cross-validation of the techniques and provide for better modeling of the multifactorial nonlinear relations between each observable state variable and the underlying neural activity.
Learning Objective
Search EEG and ECoG for spatiotemporal patterns correlated with cognition and mental states.
Outline
Hierarchical structure of brain dynamics - micro, meso, macro, corresponding to microelectrode recording, ECoG and LFP recording, and imaging with EEG, MEG, fMRI, BOLD, etc. (60 minutes)
High spatial and temporal resolution ECoG and EEG for pattern analysis (60 minutes)
Use of nonequilibrium thermodynamics to combine measure at all three levels in deriving neural correlates of cognition and consciousness (60 minutes)
Financial Interest: No financial interest.
KEYNOTE PRESENTATION
Time-Frequency Components of Brain Connectivity: Methods and Examples
Roberto Pascual-Marqui, Ph.D., The KEY Institute for Brain-Mind Research, pascualm@key.uzh.ch
(R & T)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: 1
Level of Difficulty: Intermediate
Abstract
Measures of linear dependence (coherence) and nonlinear dependence (phase synchronization) between any number of multivariate time series are defined. The measures are expressed as the sum of lagged ependence and instantaneous dependence. The measures are non-negative, and take the value zero only when there is independence of the pertinent type. These measures are defined in the frequency domain and are applicable to stationary and non-stationary time series. One important field of application is neurophysiology, where the time series consist of electric neuronal activity at several brain locations. Coherence and phase synchronization are interpreted as "connectivity" between locations. However, any measure of dependence is highly contaminated with an instantaneous, non-physiological contribution due to volume conduction and low spatial resolution. The new techniques remove this confounding factor considerably. Moreover, the measures of dependence can be applied to any number of brain areas jointly, i.e. distributed cortical networks, whose activity can be estimated with eLORETA (exact low resolution brain electromagnetic tomography). A time-frequency analysis of single-trial ERP data during word processing is presented.
Learning Objective
Explain concepts of brain connectivity mediated by different oscillatory phenomena, which can change dynamically over time.
Outline
Concepts of localization of brain function based on EEG recordings (10minutes)
Concepts of brain connectivity, problems and limitations (10 minutes)
Optimal estimation of brain connectivity based on estimated electric neuronal activity (10 minutes)
Concepts of time-varying spectra (10 minutes)
Example: time-varying analysis of brain connectivity in a word processing experiment (10 minutes)
Conclusions (5 minutes)
Discussion (5 minutes)
Financial Interest: No financial interests.
INVITED PRESENTATION
Effect of Psychoneurotherapy Upon Brain Electromagnetic Tomography in Individuals with Major Depressive Disorder
Mario Beauregard, Ph.D., University of Montreal, mario.beauregard@umontreal.ca
(R & C)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Beginner to Advanced
Context Recent advances in quantitative electroencephalography (QEEG) and brain computer interface (BCI) technology provide unique and powerful tools that may significantly contribute to the development of psychoneurotherapies. Objective: The main goal of the present study was to test the effect of a QEEG-guided psychoneurotherapy (PNT) upon brain electromagnetic tomography in individuals with major depressive disorder (MDD). The central objective of this treatment was to teach depressed patients to change their negative thoughts and emotions while learning to modify the underlying brain activity through a BCI. We predicted that the treatment would significantly reduce depressive symptoms and QEEG abnormalities.
Methods
Twenty-seven subjects (22 female and 5 males; age range: 27-58) participated in this study. The severity of depressive symptoms was assessed by the Beck Depression Inventory-Second Edition (BDI-II). EEG was recorded (Deymed Diagnostic, TruScan 32) before and approximately one month after the PNT from 19 scalp locations. Based on the results of spectral analyses, subjects were taught during the PNT to modify their negative thoughts and emotional states while learning to reduce high-beta (18-30Hz) activity in right fronto-temporal/paralimbic regions. Subjects met the therapist two times per week for 20 1-hour session. Brain changes were measured through standardized low resolution brain electromagnetic tomography (sLORETA).
Results
Following treatment, there was a significant reduction of BDI-II scores (P < .001), and 20 out of 27 (74%) subjects did not meet the DSM-IV criteria for MDD. In addition, absolute power of high-beta (18-30Hz) activity showed a significant reduction in the right lateral prefrontal cortex, right orbitofrontal cortex, right insula, right subgenual cingulate cortex and right anterior temporal pole. It is noteworthy that these brain regions play a key role in executive functions, emotion or emotional self-regulation.
Conclusions
These findings suggest that the proposed PNT used in this study can significantly improve brain activity and reduce depressive symptoms in individuals with MDD.
Learning Objective
Discuss new information about the effect of neurofeedback and psychoneurotherapy in major depressive disorder.
Outline
Effect of psychoneurotherapy in major depressive disorder (40 minutes)
Financial Interest: No financial interest.
INVITED PRESENTATION
Executive Functions: A New Perspective (T)
Guillermo van Wielink, M.D., Private Practice, neurociencia@prodigy.net.mx
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Beginner to Advanced
Abstract:
Although there is growing evidence for the efficacy of neurofeedback training, there is still some skepticism due to the methodological issues in studies published so far, and the doubt of how this method might operate changes in EEG and clinical symptomatology. This lecture examines the executive functions (EF) and correlates the neuroanatomy of the prefrontal region, to these abilities. This knowledge will help us to develop better models to treat conditions where the EF are affected. An open discussion for surface targets and/or methods for neurofeedback training is expected by the speaker.
Learning Objective
Explain the new findings in prefrontal cortex and its relationship to executive functions.
Outline
Introduction (10 minutes)
Executive functions, the prefrontal region and neurofeedback (20 minutes)
Questions (10 minutes)
Financial Interest: No financial interest.
INVITED PRESENTATION
An Evolutionary Approach to Brain Rhythms and its Clinical Implications for Brain Modulation
Dirk De Ridder, M.D., Ph.D., University Hospital Antwerp, dirk.de.ridder@uza.be
(R, C & T)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Intermediate to Advanced
Introduction
Evolutionary approach to functional anatomy: We have a brain because we need one. Evolution has created the brain that fits the environment. Looking at the evolutionary stages, a phylogenetically old automatic autonomic archencephalic reflex can be modified by an evolutionary more recent paleencephalic brain structure, dimming or increasing the response. This modulated response can, at a later stage of evolution, become integrated into a neencephalic plan, and ultimately result in a controlled execution of the planned response.
Motor/autonomic responses require some cost/benefit (C/B) instructions, deciding about the allocation of responses in relation to various reinforcers. The nucleus accumbens, being a cost / benefit instructor might instruct the ventral and dorsal striatum to form conditioned responses (both Pavlovian and operant) to the stimulus that released a burst in the VTA with resultant dopamine boost in the nucleus accumbens and prefrontal cortex.
Evolutionary approach to brain functioning: extending the polyvagal theory Steven Porges has described the polyvagal theory, based on a phylogenetic approach. Based on dopamine lateralization in controllable and uncontrollable stress and based on the lateralization studies of the autonomic system performed by Oppenheimer the polyvagal system can be heuristically extended to a five step mechanism. At rest the myelinated vagus, controlled by the left insula is predominantly active (rest and digest). When a stimulus arrives that needs to be responded to (controllable stressor) the right insula is co-activated adding some sympathetic drive to the parasympathetic activity. When stress becomes uncontrollable the left insula shuts down vagal nerve activity and only right insular sympathetic activity prevails, and when stressors become life-threatening the activity shifts back to the left insula activating the unmyelinated vagus resulting in extreme rest (death feighning).
Evolutionary approach to brain waves: Primitive species, requiring little information processing suffice with slow oscillations, whereas phylogenetically more recent species such as humans have enormous processing going on, demanding more of the fast oscillations.
The frequency of paleencephalic emotional pathways in the brain might be theta band activity, whereas the phylogenetically more recent cognitive activity might be alpha based.
The frequency of the spontaneous oscillations in the EEG and the level of consciousness are correlated: the higher the frequency and the lower the amplitude of the EEG, the higher the level of consciousness. Data from multiple sensory systems suggest that gamma waves (30-80 Hz) are a prerequisite for conscious perception of a sensory stimulus. Thus sensory awareness is correlated to gamma band activity in the sensory thalamocortical system. Synchronization of separate gamma-band activities, present in different thalamocortical columns, is proposed to bind distributed neural gamma activity into one coherent sensory percept.
However studies in the olfactory system suggest that gamma activity is nothing more than a carrier wave and that the information transmitted occurs via amplitude modulation of the gamma carrier wave. One way of retrieving the information content is to decompose the gamma band activity via ICA (independent component analysis). If the other frequency bands are also carrier waves one message can be processed simultaneously by separate circuits, e.g. limbic at delta/beta and cognitive at theta/gamma.
Bringing it all together: a hypothetical tinnitus model: At rest the auditory cortex oscillates at alpha frequencies (8-12 Hz). When there is hearing loss, the deafferented cells will initially oscillate at lower frequencies (4-7 Hz) because there is less information to be processed. Due to decrease in lateral inhibition there will be an associated halo of gamma band activity (30-80 Hz). This is called thalamocortical dysrhythmia.
At rest the limbic system oscillates at theta frequencies (4-7 Hz). When there is a deafferentation of limbic input associated with a sensory deafferentation (via the non-topographic pathways) the deafferented limbic cells will initially oscillate at lower frequencies (1-3 Hz) because there is less information to be processed. Due to decrease in lateral inhibition there will be an associated halo of beta band activity (13-30 Hz). This is what is noted in distressed tinnitus patients in a right sided 'distress network', consisting of the amygdala, anterior cingulate, anterior insula and BA10 (prefrontal cortex). By analogy this could be called limbic dysrhythmia.
Synchronization of the thalamocortical dysrhythmia and limbic dysrhythmia by e.g. phase synchrony could then result in tinnitus distress.
Based on this evolutionary heuristic model the following suggestions/predictions can be made: NFB as a form of operant conditioning can be most powerfully performed using implanted electrodes in the VTA or nucleus accumbens. NFB might be strengthened by dopaminergic medication targeting D1 receptors. NFB at different targets should focus on restoring normal FFT activity of the dysfunctional circuit involved, e.g. alpha for tinnitus intensity, theta for tinnitus distress. NFB should aim at treating spectrally filtered and subsequently ICA decomposed activity. NFB should consider lateralization for modulation of limbic/autonomic activity
Learning Objective
Discuss the different brain wave patterns as a dynamic system to improve feedback treatment.
Outline
Theoretical model of brain functioning (20 minutes)
Implications for brain modulation (20 minutes)
Financial Interest: The author has no financial benefit from anything mentioned in the abstract nor has any financial ties to any company mentioned in the abstract.
INVITED PRESENTATION
Neurological Aspects of the Tomatis Audio-Psycho-Phonology APP) as Deduced from QEEG Brain Mapping and Auditory Evoked Potentials (AEP)
Martien J.A. deVoigt, Ph.D., Centre of Listening Therapy, m.j.a.de.voight@tue.nl
(R & C)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Advanced
Introduction
The sounds provided in the Tomatis APP Listening therapy cause neurophysiological stimulation. The physiological stimulation is due to the movements of the ossicles, and of the membranes, i.e. the eardrum, the oval and circular membranes and thereby training the antagonistic muscles of the middle ear. The neurological stimulation besides the brain concerns also the hearing, the equilibrium, the vagus nerve and the recurrent nerves. The recurrent nerve for the left ear has a longer pathway to the larynx than for the right ear which, combined with the localization of the Broca motor center of speech only in the left hemisphere, results in a retardation of speech by about 0.03 seconds when the feedback is dominated by the left ear (Tomatis, 1991). This fact and the dominance of the left hemisphere for logics, abstract thinking, language, reading, writing and calculus stimulated Tomatis to emphasize training of the right ear. The neural stimulation by sound of all organs and muscles of the body is largely accomplished by means of the vagus nerve, which branches from the eardrum and from the outer hearing channel via the spinal marrow to all those peripheries in the body. In general, changes due to the therapy are well visible in the measured QEEG-brain maps and in the AEP's. They can be correlated with changes in the Listening tests and with the observed improvements in the problems of the individual subjects.
In recent years, auditory evoked response techniques have been utilized to objectively assess integrity of the central auditory system in children with learning disabilities, autism, language and attention deficit disorders (Van den Bergh, 1998). Many hundreds of individuals have been treated in this way at the Atlantis Institute. At the conference the method will be illustrated by the treatment of a man, called Eugen, who suffered a severe stroke, with lack of speech and bad walking.
Method
Eugen has received the Listening Therapy at the Atlantis Institute during 2 years with in total 424 sessions of hr. with eight intermissions of 2 to 9 months. The QEEG and AEP data were taken with the Sirius, ESAOTE BIOMEDICA equipment, along with the Listening tests (audiograms) before, during and after the Tomatis APP therapy. The QEEG data are processed quantitatively, in contrast to the classical EEG, as to reconstruct a map of responses over the brain surface, called the brain map. AEP's are measured at the Atlantis institute, with 19 electrodes on the skull using the International System of Electrode Placement. Auditory clicks or tones are presented mostly into the left ear and the measurements are registered (Van den Bergh 1998). With the cognitive auditory potentials, the mental processing mechanisms of the auditory perception (attention mechanisms) are explored. Wearing the headphones, 150 tones are presented to the subject; 120 of them are frequent, "standard", low-pitched and 30 are "rare", high-pitched tones. This test is performed under both the attention (to the rare tones) and non-attention condition. Those cognitive potentials are in many cases disturbed in individuals with cognitive immaturity, attention deficit disorders and learning disabilities.
Results
Eugen has experienced a significant recovery of his speech and motor system. He only moves somewhat slowly with the right leg. In most other cases learning abilities were improved with better concentration, speech and communication. Lasting improvements have been reported by several institutes, with an average score of about 80%, see www.tomatis.com.
In general our results were verified by other institutes or doctors, as was the case by e.g. the University Clinic at Giessen & Marburg, Germany, where different diagnostic tools were applied, also including EEG measurements. Placebo groups or shams have been followed at several other institutes, see e.g.www.tomatis.com and by Tomatis (Tomatis, 1991). Those investigations all show clearly net effects of the method.
Conclusions
It can be concluded that the Listening tests are replicated by the QEEG-brain-map data, thus independently correlating the results of those tests. In most cases attention and concentration problems were observed during the Listening test by the high and often descending bone conduction results at low frequencies with respect to the air conduction test results. This correlated strongly with large activity frontal and pre-frontal and with the absence or weak activity, mostly occipital, in the corresponding brain maps and with weak N200 and P300 amplitudes in the oddball paradigm AEP's, both indicating little alertness. After the Listening therapy those aspects were improved in the Listening tests, as well as in the brain maps and AEP's. Generally a correlation was also observed in the case of language disorders between the diminished sensitivity in the middle frequency region of about 1000-3000 Hz in the Listening tests and the diminished activity at the temporal lobes in the brain maps. Therefore Listening tests can be used as reliable evidence to support the results of the Listening therapy as they are replicated by the QEEG data. It may be noticed that several neurological aspects of the Tomatis method are similar to those of the Neurofeedback.
References
Van den Bergh, W. (1998). Die Neurologischen Basis der Audio-Psycho-Phonolgischen Therapie bei Sprachentwicklungsst rungen und Legasthenie. In Vervoort, J&MJ (Eds) Wissen Sie warum Sie zwei Ohren haben: Atlantis Institut, Sint-Truiden, Belgium.
Tomatis, A.A. (1991). The conscious ear. Thompson, B.M. (Ed). Station Hill Press Inc, Barrytown, New York 12507, ISBN 0-88268-108-7.
Keywords: Listening Therapy, Tomatis Method, QEEG Brain Mapping, AEP, Brain Damage, Speech Retardation, Motor Dysfunction.
Learning Objective
Discuss the neurophysiological background of the Audio-Psycho-Fonology training, according to Tomatis.
Outline
Neurological introduction (10 minutes)
Method of QEEG brain maps and Tomatis listening test (20 minutes)
Results of a case study (10 minutes)
Financial Interest: The authors declare that there is no financial agreement with any company or other body and the work is not supported by any external organization.
INVITED PRESENTATION
The SMR Story: Sleep, Motor Regulation, and Memory
M. Barry Sterman, Ph.D., University of California, Los Angeles, msterman@ucla.edu
(R & C)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Intermediate
Abstract
The discovery of an EEG rhythmic pattern in the sensorimotor area of cortex in alert but motionless cats, dubbed the Sensorimotor Rhythm, or SMR, was of particular interest because of its similarity to the unique "spindle-burst" pattern seen in the EEG of cats and humans during quiet sleep (Sterman & Wyrwicka, Brain Research, 1967). Both were in the 12-15 Hz frequency range over this general region and both were associated with the absence of spontaneous motor behavior. Additionally, the SMR appeared when animals were trained to suppress a learned motor response. To test the possibility that the changes in motor regulation in both states were related, a study was carried out in which cats were trained to produce the SMR directly in an operant conditioning paradigm, and sleep EEG and structure were measured before and after this training (Sterman et al., Science, 1970). When compared to an alternate EEG training condition in a counterbalanced, crossover design, sleep spindle density was significantly increased and the duration of sleep periods prolonged only following the SMR training condition. A follow-up study with random assignment and double-crossover design provided SMR and control EEG training conditions to human subjects. Sleep studies obtained before and after these training periods revealed a significant and unique increase in sleep spindle density specifically following SMR training. Collectively, these finding suggested a functional link between the SMR and sleep-spindle EEG patterns that was subsequently investigated by others. Hauri (Arch. of Gen. Psychiatry, 1981) found that SMR neurofeedback training significantly improved the sleep of so-called "idiopathic" insomniacs who were not suffering from stress or transient tension. More recently Verstraeten, in a blinded, randomized, placebo controlled study, found that SMR training sessions prior to sleep significantly improved sleep latency, sleep stability, and sleep efficiency in a group of healthy adults, while Shabus and Hoedlmoser obtained similar results in a randomized, controlled study of SMR training and sleep but also demonstrated a significant increase in sleep SMR frequency and spindle number. Further they found significant improvements in memory performance in SMR-trained subjects after sleep (papers submitted, 2008). The involvement of SMR training in motor regulation and learning potentiation appears to mediate these outcomes.
Learning Objective
Appreciate the potential for SMR neurofeedback therapy in the treatment of sleep disturbances and the facilitation of memory function related to sleep.
Outline
EEG characteristics of sleep. Relation to waking SMR and the common characteristics between SMR and spindles (15 minutes)
Enhancement of sleep spindles, sleep efficiency, and memory with SMR training - animal and human studies (15 minutes)
Underlying physiological mechanisms and implications for treatment (10 minutes)
Financial Interest: No financial interest.
INVITED PRESENTATION
How Modulating Hemispheric Specialization and Interhemispheric Interaction Enable Skilled Behavior
Eran Zaidel, PhD
(R & C)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .66
Level of Difficulty: Intermediate
Hemispheric specialization for higher cognitive function in the human brain permits the acquisition and maintenance of highly skilled performance. There is a special role for the right hemisphere in the initial stages of skill acquisition, where conceptual labels are missing or tentative. As the conceptual structure of the domain becomes more elaborate, the analytic role of the left hemisphere becomes more dominant. Further, skilled behavior is made possible by different modes of hemispheric interaction. One mode is the specialization by one hemisphere for efficient processing in a particular cognitive domain. For example, the left hemisphere is specialized for phonetic perception and the right hemisphere is specialized for emotional prosody during auditory language comprehension. A second mode is parallel processing in the two hemispheres when the task is complex and the cognitive domain is within the repertoire of both sides. In that case, shielding the hemispheres from each other is beneficial. A third mode is error monitoring by one side of performance in the other. An example is left hemisphere specialization for visual word recognition (reading) but right hemisphere specialization for detecting errors in reading. These modes are made possible by selective activation and deactivation of one hemisphere or of different channels of the corpus callosum. Those channels therefore provide a target for EEG biofeedback as a means of achieving skilled behavior.
INVITED PRESENTATION
Nninvasive Brain Stimulation as a neuromodulatory Approach: Review on the Clinical and Neurophysiological Effects
Filipe Fregni, MD, PhD, Harvard, ffregni@bidmc.harvard.edu
(R & C)
Credits: CME, American Psychological Association, NBCC, ASWB AND TX MFT CE Credits and BCIA recertification credits: .86
Level of Difficulty: Beginner to Advanced
Abstract
In neurology and psychiatry, like in all of medicine, symptoms of disease and the resulting burden of illness and disability are not simply the consequence of the injury, inflammation or dysfunction of a given organ. Instead they are ultimately the consequences of the nervous system's attempt to adapt to the insult. This plastic response includes compensatory changes that prove adaptive for the individual, as well as changes that contribute to functional disability and are thus maladaptive. In this context brain stimulation techniques tailored to guide individual plastic changes associated with neurological and psychiatric diseases might enhance clinical benefits and minimize adverse effects. For this lecture, I discuss the application of two noninvasive brain stimulation techniques, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), to modulate activity in the targeted cortex or in a dysfunctional network; restore an adaptive equilibrium in a disrupted network for best behavioral outcome; and suppress plastic changes for functional advantage. I therefore review the mechanisms of these two techniques of noninvasive brain stimulation and their potential clinical utility in psychiatry and neurology.
Learning Objective
Discuss the benefits of rTMS and tDCS in psychiatry and neurology.
Financial Interest: No financial interest.