Traumatic Brain Injury/Seizures
Mapping and Reconditioning the Brain
In recent years, the consequences of brain injuries have been recognized. Usually, persons with a head injury have CAT scans or MRI’s, which often don’t reveal organic damage since they look at the structure of the brain and not how the brain functions. As a result, accident victims were often not taken seriously and accused of fabricating their symptoms. However, more recently, tests of brain function have found a basis for the symptoms. These tests include quantitative (QEEG) brain mapping, radioactive PET and SPECT scans, and evoked potential response measurements. These functional tests reveal changes in brain activation and abnormal EEG activity traceable to brain injury, stroke, seizures, and decline with aging.
Below is part of a QEEG brain map on an individual with a serious stroke that affected the central and right frontal areas of the brain. There is a deficiency of efficient beta brainwave activity, and an excess of slow, theta brainwave activity.
Symptoms which accompany head and brain injuries can include impairment in short-term memory; difficulty concentrating; loss of energy; irritability, temper outbursts; impulsiveness; mood swings; depression; headaches and chronic pain; dizziness; anxiety; aphasia; sleep disturbance; visual perception problems and reversal of letters or words; oversensitivity to light and sound; tremor, spasticity; problems with coordination and balance; decreased libido; and seizures or seizure-like activity, and loss of smell. Persons with difficulties such as attention deficit disorder, migraines, fatigue, or sleep problems may find these symptoms exacerbated by the brain injury. The apparent severity of the injury, including the length of them being unconscious (if they were), is not always correlated with symptom severity.
TREATMENTS
Changes in the EEG are usually seen in post-concussion patients and may persist for years unless treated. Usually, there is a slowing of brainwave activity, especially in the area where damage occurred. This is shown in the illustration below of a coup-contracoup injury where a woman’s head was hit on the back left side, causing a slowing of brainwave activity into the 6-8 Hz range both there and in the right frontal area where her brain rebounded from the impact. Over the last two decades, various clinicians have published articles and obtained considerable clinical evidence for the effectiveness of EEG neurofeedback (brainwave training) as a modality to assist in the rehabilitation of brain injuries and seizures. The training appears to usually be helpful in relieving many of the symptoms listed above, even 10+ years post-injury, when spontaneous improvements are no longer expected. Frank H. Duffy, M.D., a Professor and Neurologist at Harvard Medical School, stated in an editorial in the January 2000 issue of the journal Clinical Electroencephalography that scholarly literature now suggests that neurofeedback “should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.” He said, “It is a field to be taken seriously by all.”
Many traditional rehabilitation modalities (medication, PT, speech therapy, OT) provide some relief, but do not deal directly with the results of the brain injury. Sedatives may even slow brainwave activity further, intensifying problems with concentration and depression. Neurofeedback allows us to intervene directly with brain function, inhibiting the abnormal activity associated with symptoms like difficulty concentrating, learning/memory problems, headache, depression, sensitivity to light/sound, spasticity, seizures, and problems with physical balance and incontinence.
One large study with head injuries found that some of the earliest improvements were an increase in energy and decrease in depression, mood swings, anxiety, and anger. A decrease in sensitivity to sound/light and an increase in attention span often improved next, followed by a reduction of dizziness and headaches, and finally, an improvement in libido and less reversal of letters or words. Many patients report significant improvement in short-term memory. Improvements in quality of life and skills following neurofeedback that has been reported in publications and in our work is very encouraging, but because of the absence of extremely large, controlled studies, it may still be regarded as investigational by some people. However, with somewhat similar cortical problems of abnormally slow brainwave activity with uncontrolled seizures and ADD/ADHD (including placebo controlled, blinded studies), research conducted over the past 30 years has documented that neurofeedback can effectively bring about significant improvements about 80% of the time.
Following neurofeedback, most people become much more productive in their lives after having been disabled or limited for years due to their brain injuries or seizures. Sometimes seizures come under control or medications can at least often be reduced, which is especially important in pregnancy and because of long term negative effects of medication. The training will not always be able to assist in overcoming all of the damage from strokes or head injury, but it usually brings improvement in the quality of life and improvement in symptoms. Research indicates that a large proportion of patients who undertake neurofeedback training for seizures or brain injury derive significant improvements.
A quantitative EEG (QEEG or brain map) is needed for individualized assessment prior to starting neurofeedback. A QEEG is an assessment tool to evaluate a person’s brainwaves. Research has found that the QEEG has high reliability, equal or superior to routinely used clinical tests such as mammograms, cervical screenings, and CAT scans. The procedure takes about 1 hour. It consists of placing a snug cap on the head which contains 20 electrodes to measure the electrical patterns coming from the brain–much like a physician listening to your heart from the surface of your skin. No electrical current is put into your brain. Your brainwave patterns are relayed to the computer and recorded. We then compare your pattern of brain function to those of extremely healthy and very normal people of your age that is contained in a sophisticated, FDA registered, normative database. The results allow us to then determine in a highly scientific, objective manner (free of any cultural or ethnic influences) whether and how your brainwave patterns are significantly different from what they should be. This allows us to individualize our work much more precisely. QEEG has been an accepted procedure for evaluating head trauma in the military and V.A. hospital system. After the QEEG evaluation, neurofeedback training can begin.
Neurofeedback training is brainwave biofeedback. During training, an electrode is placed on the scalp that samples your brainwave activity over 1,000 times a second. This high tech electronic equipment then provides you with real-time, instantaneous feedback about your brainwave activity. This process works through operant conditioning, reconditioning and retraining your brain into a healthier pattern. Ordinarily, we cannot reliably influence our brainwave patterns because we lack awareness of them. However, these technological advancements provide us with the opportunity to retrain and rehabilitate the brain in ways not previously possible–like physical therapy for the brain. With repeated sessions healthier brainwave patterns are conditioned. Most patients are aware of initial improvements beginning within 4-6 sessions. Thus whether the problem stems from unfortunate genetics, a stroke, head injury, deficits following neurosurgery, uncontrolled seizures, cognitive dysfunction associated with aging, ADD/ADHD, learning disability, tremor, tics, or Tourette’s.