Rarely do neurofeedback therapist see individuals who have not tried any psychiatric medicines. Normally, by the time most patients consider neurofeedback, they have failed multiple medication trials and non-medication treatments and are frustrated with the trial-and-error method. A 2015 a study linked psychiatric medication failure to four EEG phenotypes: focal slowing, spindling excessive beta, encephalopathy (EN), and isolated epileptiform discharges (IEDs). The significance of the focal or diffuse slowing and spindling excessive beta is easily discerned in qEEG brain mapping. However, IEDs are either artifacted out or averaged out in qEEG processing. Only neurologists, through visual interpretation of the EEG, can diagnose EN or identify the presence IEDs. This is beyond the scope of practice for PhD or masters level clinicians.
Encephalopathy is a term for any diffuse disease of the brain that alters brain function or structure. EN may be caused by infectious agent (bacteria, virus, or prion), metabolic or mitochondrial dysfunction, brain tumor, or increased pressure in the skull, prolonged exposure to toxic elements (including solvents, drugs, radiation, paints, industrial chemicals, and certain metals), chronic progressive trauma, poor nutrition, or lack of oxygen or blood flow to the brain. Symptoms include progressive loss of memory and cognitive abilities, over time subtle personality change, inability to concentrate, and fatigue. How to differentiate encephalopathic features from drowsy and sleep states including case examples of encephalopathies, metabolic, neurodegenerative, and structural disorders will be discussed.
Isolated Epileptiform Discharges refers to spike and wave or sharp and slow activity in nonepileptic individuals. Various terms have been used to describe epileptiform activity such as IEDs, subclinical epileptiform activity, epileptiform discharges, and interictal epileptiform discharges. The importance of differentiating normal features of EEG from epileptiform features will be discussed as well as the ever- present danger of over interpretation or under interpretation of EEG abnormalities, with multiple examples of both errors.
This workshop with cover the early work on phenotypes and vigilance modeling, including the trait and state of the four primary categories that predict treatment failure. We will discuss the vital nature of identifying EN and IEDs and how the EEG can be useful to guide neurotherapy protocol development. The ethical considerations for the neurotherapist will be delineated with an emphasis on the importance of collaboration among ourselves, neurologist, psychiatrists, and other mental health providers. Lastly, we will discuss how to collect and categorize clinical electrographic data for the purpose of joining an international collaborative effort to further the research in our field.
Presented by: Joe Castellano, Ron Swatzyna, Harry Kerasidis & Robert “Rusty” Turner