Isnr 2007

Introduction Interpreting quantitative EEG results and correlating symptoms can be difficult when there is more than a single contributor or aberrant finding. The clinician may be forced to make decisions with their best estimate of where to begin with neurofeedback interventions. In these cases there are many sites which appear to be equally contributing to the cause leaving the clinician with less information on how to guide electrode placement and frequency band limits. Independent Component Analysis (ICA) allows precise source estimation pointing the clinician to the actual region responsible of the abnormal activity. Method This talk will illustrate the method with the aid of clinical cases. Typical quantitative EEG (spectral) analysis were performed and neurofeedback protocols were defined for 4 individuals who presented for neurofeedback intervention in a clinical setting. ICA analysis were performed and this information integrated into the protocol design. Results ICA analysis added valuable contribution to the typical quantitative analysis. The ICA analysis accurately identified the target activity with greater precision than spectral analysis alone. Conclusion It is suggested that ICA-based neurofeedback may provide faster and more effective neurofeedback training. Learning Objective Describe the concept of Independent Component Analysis and how it can be clinically implemented into a neurofeedback practice. Agenda 1. Definition and conceptualization of Independent Component Analysis (ICA) (5 minutes) 2. Case studies comparing QEEG analysis and ICA analysis to determine intervention (10 minutes) 3. Conclusion describing how the ICA neurofeedback might be imlemented (3 minutes) 4. Questions (2 minutes) Financial Interest: Leslie Sherlin is the president of Nova Tech EEG, Inc. which develops software, distributes hardware and offers analysis services. This project has been supported by Nova Tech EEG, Inc. Dense-Array QEEG/ERP Study of Frontal Deficits in Patients with Substance Use Disorder and PTSD (R & CA) Estato Sokhadze, Ph.D., University of Louisville, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract Introduction The goal of this exploratory study, based on dense-array EEG, event-related potential (ERP) and dipole source localization techniques (BESA), was to determine deficits in response conflict detection and motor response error monitoring functions during a speeded forced-choice task (Eriksen's flanker test) in patients diagnosed with posttraumatic stress syndrome (PTSD), in patients with cocaine abuse/dependence, and in patients with dual diagnosis (SUD comorbid with PTSD). We investigated QEEG and ERP in patients diagnosed with PTSD, SUD, and SUD co-occurring with PTSD to determine whether executive abnormalities in a speeded reaction time (RT) task are mediated by a dysfunctional interaction of prefrontal cortical networks with medial frontal (e.g., anterior cingulate cortex [ACC]) structures. Methods This study was aimed at investigating the functional chronometry of ERPs associated with response conflict detection and response error monitoring in patients with PTSD (N=12), patients with substance use disorder (SUD, N=10), patients with dual diagnosis (N=10), and matched control subjects (N=12). Specific aim of the study was to determine the differences in the induced EEG responses (e.g., gamma oscillations) and ERP indices of visual signal processing and action monitoring in this reaction task in patients with PTSD, SUD and matched healthy controls. In this speeded reaction time (RT) task with interferences we used the fronto-central N200 and N450 components of stimulus-locked ERPs, and the response-locked errorrelated negativity (ERN) and correct response-related negativity (CRN) measures of motor response conflict and action monitoring. The dipole sources of these ERP measures (N200, N450, ERN) and single trial-based evoked EEG responses using BESA-based technology are known to be localized in the different portions of the ACC. All subjects had EEG measured by an Electrical Geodesics system from 128 scalp loci during performance on the RT task with flanker distracters. This speeded RT test requires motor responses to congruent and incongruent stimuli is known to evoke response conflict, and can be used to assess response error monitoring function in psychopathologies under study. Decrement in performance in flanker task is thought to result from activation of the conflicting response by the incongruent flankers. The experiment was designed to test the hypotheses that (1) in patients with PTSD and comorbid SUD-PTSD, compared to controls, the medial frontal conflict monitoring system is over-responsive to response interferences, and that (2) in cocaine addicted subjects compared to controls action monitoring is under-responsive to errors, but response conflict function is spared. Results and Conclusions Patients with PTSD and SUD-PTSD comorbidity as compared to controls showed slower RT, higher error rate, and prolonged anterior N200 and N450 ERP components in an incongruent flanker condition indicating an overreactivity to potential response conflict. Both PTSD and PTSD-SUD groups compared to control subjects showed smaller ERN on error trials and smaller CRN on correct trials thus indicating lowered capacity of response monitoring function. Another important aim of our study was an investigation of feasibility using above EEG and ERP measures for functional assessment of frontal action monitoring neural networks in PTSD and SUD patientsIntroduction The goal of this exploratory study, based on dense-array EEG, event-related potential (ERP) and dipole source localization techniques (BESA), was to determine deficits in response conflict detection and motor response error monitoring functions during a speeded forced-choice task (Eriksen's flanker test) in patients diagnosed with posttraumatic stress syndrome (PTSD), in patients with cocaine abuse/dependence, and in patients with dual diagnosis (SUD comorbid with PTSD). We investigated QEEG and ERP in patients diagnosed with PTSD, SUD, and SUD co-occurring with PTSD to determine whether executive abnormalities in a speeded reaction time (RT) task are mediated by a dysfunctional interaction of prefrontal cortical networks with medial frontal (e.g., anterior cingulate cortex [ACC]) structures. Methods This study was aimed at investigating the functional chronometry of ERPs associated with response conflict detection and response error monitoring in patients with PTSD (N=12), patients with substance use disorder (SUD, N=10), patients with dual diagnosis (N=10), and matched control subjects (N=12). Specific aim of the study was to determine the differences in the induced EEG responses (e.g., gamma oscillations) and ERP indices of visual signal processing and action monitoring in this reaction task in patients with PTSD, SUD and matched healthy controls. In this speeded reaction time (RT) task with interferences we used the fronto-central N200 and N450 components of stimulus-locked ERPs, and the response-locked errorrelated negativity (ERN) and correct response-related negativity (CRN) measures of motor response conflict and action monitoring. The dipole sources of these ERP measures (N200, N450, ERN) and single trial-based evoked EEG responses using BESA-based technology are known to be localized in the different portions of the ACC. All subjects had EEG measured by an Electrical Geodesics system from 128 scalp loci during performance on the RT task with flanker distracters. This speeded RT test requires motor responses to congruent and incongruent stimuli is known to evoke response conflict, and can be used to assess response error monitoring function in psychopathologies under study. Decrement in performance in flanker task is thought to result from activation of the conflicting response by the incongruent flankers. The experiment was designed to test the hypotheses that (1) in patients with PTSD and comorbid SUD-PTSD, compared to controls, the medial frontal conflict monitoring system is over-responsive to response interferences, and that (2) in cocaine addicted subjects compared to controls action monitoring is under-responsive to errors, but response conflict function is spared. Results and Conclusions Patients with PTSD and SUD-PTSD comorbidity as compared to controls showed slower RT, higher error rate, and prolonged anterior N200 and N450 ERP components in an incongruent flanker condition indicating an overreactivity to potential response conflict. Both PTSD and PTSD-SUD groups compared to control subjects showed smaller ERN on error trials and smaller CRN on correct trials thus indicating lowered capacity of response monitoring function. Another important aim of our study was an investigation of feasibility using above EEG and ERP measures for functional assessment of frontal action monitoring neural networks in PTSD and SUD patients enrolled in biobehavioral interventions based on Cognitive-Behavioral Therapy, Motivational Enhancement Therapy, and neurofeedback. (Supported by the NIDA R03021821 and ISNR grants). Learning Objective Explain how dense-array qEEG and ERP measures can be used for functional assessment of executive deficits in drug abuse and PTSD. Agenda I will introduce to the methodology and will explain how we use this techniques to assess prefrontal fucntions in drug abuse and PTSD, and then present our own results. Financial Interest: No financial interests or relationships to manufacturers. Research was partially supported by the NIDA R03021821 and ISNR grants. KEYNOTE PRESENTATION Integrating Neuromarkers for the Era of Brain-Related Personalized Medicine (R & CA) Evian Gordon, Ph.D., The Brain Resource Company, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: 1 Abstract The talk outlines the key drivers (including the FDA and DSM-V) for a 'Personalized Medicine'. Personalised Medicine has been driven by the FDA as finding the best markers of treatment prediction (of which individuals will respond to what drugs). The proof of concept successes in Personalized Medicine and exemplars of Neuromarkers will be presented in ADHD, Depression, MCI/Alzheimer's dementia, Schizophrenia and PTSD. This context will serve as a frame of reference, as to how a Personalized Medicine approach may be effectively implemented in Neurofeedback Training. The success of this endeavor is contingent on a deeper understanding of the mechanisms underpinning EEGs and how this insight translates into more valid and personalized protocol selection in Neurofeedback Training.The talk outlines the key drivers (including the FDA and DSM-V) for a 'Personalized Medicine'. Personalised Medicine has been driven by the FDA as finding the best markers of treatment prediction (of which individuals will respond to what drugs). The proof of concept successes in Personalized Medicine and exemplars of Neuromarkers will be presented in ADHD, Depression, MCI/Alzheimer's dementia, Schizophrenia and PTSD. This context will serve as a frame of reference, as to how a Personalized Medicine approach may be effectively implemented in Neurofeedback Training. The success of this endeavor is contingent on a deeper understanding of the mechanisms underpinning EEGs and how this insight translates into more valid and personalized protocol selection in Neurofeedback Training. Learning Objective Discuss Personalized Medicine and its application to Neurofeedback. Describe the mechanisms underpinning EEGs and how that translates into better protocol selection. Agenda Personalized Medicine, 20 minutes Neurofeedback, 20 minutes New EEG insights that lead to better protocol selection, 20 minutes Financial Interest: Evian Gordon is CEO of The Brain Resource Company which supplies clinical reports to neurofeedback practitioners. STUDENT SCHOLARSHIP PRESENTATION Concussions in Sport: Investigation of Assessment Measures and Functional Deficits (R) James Thompson, Ph.D., American Applied Neuroscience Institute, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .66 Abstract Introduction Mild traumatic brain injury (MTBI), otherwise known as concussion, continues to be one of the least understood, but most common injuries in both sports and the general population. It is estimated that in the U.S. the incidence of brain injury is over two million annually. According to a recent NIH Consensus Statement, mild traumatic brain injury is an evolving dynamic process that involves multiple interrelated components exerting primary and secondary effects at the level of individual nerve cells (neuron), the level of connected networks of such neurons (neural networks), and the level of human thoughts or cognition. Due to the multiple systems negatively affected by concussion it is necessary to use multiple testing modalities to assess concussions.Introduction Mild traumatic brain injury (MTBI), otherwise known as concussion, continues to be one of the least understood, but most common injuries in both sports and the general population. It is estimated that in the U.S. the incidence of brain injury is over two million annually. According to a recent NIH Consensus Statement, mild traumatic brain injury is an evolving dynamic process that involves multiple interrelated components exerting primary and secondary effects at the level of individual nerve cells (neuron), the level of connected networks of such neurons (neural networks), and the level of human thoughts or cognition. Due to the multiple systems negatively affected by concussion it is necessary to use multiple testing modalities to assess concussions. Method New research was conducted to test the sensitivity and specificity of the three currently most commonly used concussion assessment methods, namely neuropsychological testing, posture assessment and electroencephalographic recording. Reduction of variables was performed to determine the most sensitive tests within each category of test and a discriminant function was developed to classify individuals as injured or normal for each of the three testing methods. A fourth discriminant function was also formed, which combined the most sensitive tests from each category to form a multi-modal testing discriminant. The sensitivity, specificity and odds ratio of each discriminant was compared to determine the most accurate method for injury classification. Conclusions were drawn based on comparisons made between injured (concussed) and normal groups. Additionally, to improve our understanding of the brain regions most affected by concussion, we studied differences in subject’s neural resource allocation during different postural tasks following a concussion. Specifically we measured EEG differences in the frequency domain and localized modulation of the EEG as a function of MTBI. We studied changes in the amplitudes of these frequencies during both sitting and standing postures and determined the differing sources of EEG frequency power distributions using Low Resolution Electromagnetic Tomography (LORETA). Results Four main conclusions are drawn from our results. First, neuropsychological symptoms resolve themselves more quickly than do postural or EEG changes. Second, there is a clear mismatch between subjects’ injury classifications when neuropsychological, postural and EEG testing paradigms are compared. Third, the use of a testing paradigm that combines the most sensitive tests from each modality appears to provide a more effective system for diagnostic and return to play measurements than does any one method alone. Lastly, low resolution electromagnetic tomographic assessment (LORETA) emerges as an effective tool for localizing cortical areas that have been negatively affected by the concussive injury. Conclusion Due to the high incidence of MTBI, the vast array of affected systems and the possible detrimental affects of second impact syndrome, MTBI assessment methods should be expanded to assess all areas that are potentially negatively affected by concussion. The research presented here demonstrates the need for multi-modal testing paradigms. Learning Objective Discuss the strengths and weaknesses of currently employed head injury assessment measures (neuropsychological, postural, QEEG). Agenda Concussion history in the literature, definitions, incidence, Symptoms. 5 minutes Research findings for neuropsychological, postural and EEG assessment methods. 10 minutes Neural plasticity and cortical adaptations associated with MTBI. 5 minutes Financial Interest: None to report. KEYNOTE PRESENTATION Application of the Human Brain Institute Normative Database for Assessment Brain Functions and for Constructing Protocols of Neurotherapy ( R & CA) Juri Kropotov, PhD., Institute of the Human Brain, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: 1 Abstract Introduction The lecture is going to present the QEEG/ERP methodology of assessment brain functions that was developed in the Institute of the Human Brain of Russian Academy of Sciences in St. Petersburg, Russia during the last 30 years.Introduction The lecture is going to present the QEEG/ERP methodology of assessment brain functions that was developed in the Institute of the Human Brain of Russian Academy of Sciences in St. Petersburg, Russia during the last 30 years. Method The keynote lecture consists of two main parts. The first part deals with the HBI normative data base. The normative data includes 19-channel EEG recordings in 1000 people of age from 7 to 89 years old. It also includes recordings of 400 ADHD children and adolescents, as well as numerous recordings in other kind of patients (patients with epilepsy, OCD, addiction, depression, whiplash, etc.) 19-channel EEG was recorded in two resting conditions with eyes open (more than 3 minutes), eyes closed (more than 3 minutes), and four different task conditions, including two stimulus GO/NOGO task, arithmetic, reading and two auditory tasks. In order to obtain reliable event related potentials (ERPs) and event related desynchronization each task include 100 trials of each category of trials (such as GO, NOGO, ignore etc.) To reduce amount of time for preprocessing the data some procedures such as artifact correction, artifact elimination and spike detection are automated. To assess both global and local features of EEG two montages (global average and local average according to Lemos) are used. Absolute amplitude and power spectra, averaged and two-channel coherences, wavelet-transformations and ERPs are computed off-line and mapped into 2D representations or into 3D images using LORETA technology (including s-LORETA). Dipole approximation methods are provided in addition. The computed characteristics are normalized (using log transformations). Mean values and standard deviations for separate age groups are obtained. Comparison with the data base consists of computing z-scores standardized measures of deviation of individual EEG parameters from the normative data. ERPs are subjected to independent component analysis. Using this methodology, separate components associated with distinctive psychological operations are extracted. Each component is characterized by time dynamics, 2D topography and LORETA image. Spatial filters are built up on the basis of these topographies and provide the means to extract the amplitude of each component from the individual ERPs. Comparing these amplitudes with the normative data gives the insights concerning different stages of information processing in the individual under assessment. The second part of the lecture deals with application of the HBI normative database for constructing protocols of neurofeedback and transcranial Direct Current Stimulation (tDCS). Results The results of application of the HBI database and the corresponding methodology for diagnosis of various brain dysfunctions will be presented. As an example, a research of application of tDCS for rehabilitation of stroke patients with spatial neglect will be presented. Conclusion The Human Brain Institute Normative Database is a new step forward clinical application of ERPs. It opens new dimensions in assessment brain functions and dysfunctions and in constructing protocols of neurotherapy. Learning Objective Identify what information can be extracted from spontaneous (QEEG) and evoked EEG (event related potentials ERPand event related desynchronization. Explain how this information can be used for diagnostic purposes and for constructing protocols for neurotherapy. Agenda A brief history of QEEG, ERPs and neurotherapy. The development of the Human Brain Institute (HBI) normative database. The main differences of the HBI methodology from other approaches application of independent component analysis for extracting components with functional meaning. Application of the HBI normative database for constructing protocols of neurotherapy: EEG spectra-based neurofeedback, s-LORETA neurofeedback, ERP-based neurofeedback, transcranial Direct Current Stimulation. Financial Interest: Juri Kropotov is a scientific consultant for Mitsar, Ltd., a Russian manufacturing company. KEYNOTE PRESENTATION The Role of Direct Currents in the Brain (R & T) Karl Pribram, M.D., Ph.D. (Hon), Georgetown University, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: 1 Abstract Wolfgang Köhler, Gestalt Psychologist and good friend, proposed that the brain process of perception is based on the composition of direct currents in the brain cortex. Köhler and I then showed that the elicitation of a DC current was accompanied by desynchronization of the underlying EEG. I then performed experiments in which I implanted an epileptogenic substance in the visual cortex to produce epileptic seizures in the electrical activity of the cortex and tested the perceptual abilities of monkeys. The monkeys showed no perceptual deficit. Köhler stated: "Now that you have disproved not only my theory but every other brain theory of perception, what are you going to do?" What I did was wait until the holographic process came along. But meanwhile I had learned something from the experiments: the monkeys' learning was slowed some sevenfold. Interestingly it was the onset of learning that was delayed while the slope of their learning curve, once the monkeys had begun to learn was normal. My collaborators and I then showed that imposing a direct current across the cortex (from outside in) changed learning rates of tasks that were processed by the involved cortex.Wolfgang Köhler, Gestalt Psychologist and good friend, proposed that the brain process of perception is based on the composition of direct currents in the brain cortex. Köhler and I then showed that the elicitation of a DC current was accompanied by desynchronization of the underlying EEG. I then performed experiments in which I implanted an epileptogenic substance in the visual cortex to produce epileptic seizures in the electrical activity of the cortex and tested the perceptual abilities of monkeys. The monkeys showed no perceptual deficit. Köhler stated: "Now that you have disproved not only my theory but every other brain theory of perception, what are you going to do?" What I did was wait until the holographic process came along. But meanwhile I had learned something from the experiments: the monkeys' learning was slowed some sevenfold. Interestingly it was the onset of learning that was delayed while the slope of their learning curve, once the monkeys had begun to learn was normal. My collaborators and I then showed that imposing a direct current across the cortex (from outside in) changed learning rates of tasks that were processed by the involved cortex. Learning Objective Evaluate the role of DC currents in the brain. Agenda Experiements demonstrating the role of DC brain currents. Financial Interest: None to report. Friday, September 7, 2007 STUDENT SCHOLARSHIP PRESENTATION QEEG Based Protocol Selection: A Study of Level of Agreement on Sites, Sequences, & Rationales Among a Group of Experienced QEEG-Based Neurofeedback Professionals (R) Mark Johnson, M.S., University of North Texas, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract Introduction With the increasing advocacy and use of QEEG to determine neurofeedback protocols, several clinicalIntroduction With the increasing advocacy and use of QEEG to determine neurofeedback protocols, several clinical questions regarding their use have arisen. One question relates to how much uniformity exists in neurofeedback protocols derived from pre-treatment QEEG data. A small investigation was initiated to address this question of how much commonality actually exists among neurofeedback professionals experienced in using QEEG to guide their protocol selections. Method Eight individuals experienced using QEEG and neurofeedback were given the QEEG data, background information and presenting problems of an anonymous client who had previously received neurofeedback treatment. The client data was edited in both Neurorep and Neuroguide, and both edits were provided to the study participants. Each respondent was asked to outline a treatment protocol based on the QEEG and client data provided and to indicate the sites, sequences, and rationale that supported his/her protocol recommendation. Results Differences in the QEEG-based protocols recommended by survey participants were greater than the commonalities among them. All respondents agreed on the specific 10-20 sites to be treated; however, participants diverged rather significantly when it came to sequences, rationales, inhibits versus enhances, etc. . (All protocols recommended will be presented in table form, without identifying any of the respondents). Conclusions The recommendations provided by this limited sample of QEEG-based neurofeedback practitioners were more dissimilar than similar in how they would determine and proceed with neurofeedback treatment, even though most provided clear theoretical or research rationale as bases for their recommendations. Clinical implications of these results are not clear, other than that there is quite a bit of diversity in how individual neurofeedback practitioners approach treatment based on QEEG results. The main conclusion derived from this study is that there is more than one way to do neurofeedback, even when using QEEG as a basis for protocol selection. Learning Objective Describe how experienced QEEG practitioners use QEEG to develop neurofeedback treatment protocols. Financial Interest: No financial interest. Observed Effects of Neurofeedback Training On a One Hundred Year-old Brain (CA) Sebern Fisher, M.A., Private Practice, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract Introduction I am presenting observations of neurofeedback training with a 97 year-old woman with initial complaints of severe neuropathic pain in her legs. During the course of neurofeedback training for neuropathy she reported a resolution of a life long sleep disorder, and improvement in her eyesight. She has been blinded due to macular degeneration (wet type), glaucoma, and a cataract on her left eye. The reported findings are serendipitous so there are no pre or post measures. All results are those reported by the subject. She has been a scientist all of her life and was initially biased against neurofeedback. She is no longer. Method Weekly neurofeedback sessions with portable Neurocybernetics EEGer at her nursing home facility. Due to blindness she trained to the auditory reward alone.Introduction I am presenting observations of neurofeedback training with a 97 year-old woman with initial complaints of severe neuropathic pain in her legs. During the course of neurofeedback training for neuropathy she reported a resolution of a life long sleep disorder, and improvement in her eyesight. She has been blinded due to macular degeneration (wet type), glaucoma, and a cataract on her left eye. The reported findings are serendipitous so there are no pre or post measures. All results are those reported by the subject. She has been a scientist all of her life and was initially biased against neurofeedback. She is no longer. Method Weekly neurofeedback sessions with portable Neurocybernetics EEGer at her nursing home facility. Due to blindness she trained to the auditory reward alone. Results She reports a significant reduction in neuropathic pain, improvement in sleep and improvement in eyesight. Conclusion This case study suggests that neurofeedback can be used to improve the health and quality of life in the geriatric population. Learning Objective Explain why age itself seems to present no observable barrier to effective neurofeedback training Agenda I will present a case study of the effects of neurofeedback training on vision, hearing, sleep and neuropathy in a nursing home resident. I will discuss protocols that I used. I plan to present a brief video interview Financial Interest: I am a stockholder in EEG Spectrum, Inc. I do expect a financial gain as a result of this presentation. Can LENS Neurofeedback Treat Anosmia Resulting from a Head Injury? (CA) D. Corydon Hammond, Ph.D., University of Utah School of Medicine, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract: Loss or reduction of olfactory acuity (anosmia) is a symptom associated with moderate to severe accelerationdeceleration traumatic brain injuries (TBI). The process by which this occurs will be elaborated. Posttraumatic anosmia has been regarded as an irreversible symptom, particularly after 12-18 months post-injury, and it usually results in deficits in taste. This paper presents two case reports where there were spontaneous reports of the reversal of anosmia following neurofeedback treatment with the Low Energy Neurofeedback System (LENS). These reports provide encouragement that neurofeedback may have potential to treat posttraumatic anosmia, as well as improving other TBI symptoms. Clinicians using neurofeedback to treat TBI are encouraged to evaluate patients for the presence of anosmia and to track possible improvements. Loss or reduction of olfactory acuity (anosmia) is a symptom associated with moderate to severe accelerationdeceleration traumatic brain injuries (TBI). The process by which this occurs will be elaborated. Posttraumatic anosmia has been regarded as an irreversible symptom, particularly after 12-18 months post-injury, and it usually results in deficits in taste. This paper presents two case reports where there were spontaneous reports of the reversal of anosmia following neurofeedback treatment with the Low Energy Neurofeedback System (LENS). These reports provide encouragement that neurofeedback may have potential to treat posttraumatic anosmia, as well as improving other TBI symptoms. Clinicians using neurofeedback to treat TBI are encouraged to evaluate patients for the presence of anosmia and to track possible improvements. Learning Objective Explain the role of acceleration-deceleration head injuries in causing posttraumatic anosmia. Identify the potential role of neurofeedback in remediating posttraumatic anosmia. Financial Interest: None to report. Simultaneous Training of Slow Cortical Potentials (SCP) and Coherence in Children with AD/HD Using Realtime z-Score Neurofeedback: A Preliminary Study (R & CA) Donald DuRousseau, Ph.D., Human Bionics, LLC, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract Introduction Many new techniques have been introduced recently for providing neurofeedback training; with varying degrees ofIntroduction Many new techniques have been introduced recently for providing neurofeedback training; with varying degrees of success. Here, we report on a brief exploration of a new technique, known as Z-Score Training, and discuss its application in simultaneously changing deviant slow cortical potentials (SCP) and coherence patterns as determined by quantitative electroencephalography (QEEG) in two righthanded male children diagnosed with ADHD (ages 13 and 15 at the beginning of training). Methods A stretchable elastic electrode positioning cap (QuikCap, Neuroscan Inc.) containing thirty-two linked-ear referential EEG sensors, two bipolar eye movement sensors (VEOG and HEOG), one bipolar neck muscle sensor (EMG) and one bipolar heart activity sensor (ECG) was positioned according to the modified 10-20 system (Sharbrough et al., 1990) and attached to a medical amplifier (N7000, Embla Medical Systems, Inc) to record twenty minutes of eyes closed and ten minutes of eyes open data from each child. The EEG data was reviewed for anatomical abnormalities and seizure activity and edited for horizontal and vertical eye movement, neck muscle, and ballistocardiogram artifacts using the simultaneously recorded bipolar signals to ensure that only uncontaminated data were included for visual and digital evaluation of the EEG. A nineteen-channel subset of the EEG was then exported to NeuroGuide (Applied Neuroscience, Inc) to generate the QEEG analysis (a statistical comparison of each boy's EEG to an age-matched normal population). With an understanding of the symptoms and neuroanatomy of each child, two QEEG locations with the excessive SCP amplitudes that also showed a significant hypocoherence were selected for the neurofeedback protocol. Neurofeedback was provided using the BrainMaster Version 3.0 software and Atlantis 4x4 amplifier system running with the realtime Z-Score computation software developed by Applied Neuroscience. Audiovisual movie stimuli were presented using the Multimedia Player addon to the BrainMaster system. Results Results indicate a rapid reduction of excess EEG amplitudes with concomitant increase in abnormal hypocoherence over the first 10 sessions. The initial period was followed by 15 sessions, which showed continued improvement in both the amplitude and coherence measures indicated as deviant in each child's QEEG, however, at a reduced but steady rate of improvement. Subjective assessments performed by parent’s bi-weekly confirmed that symptoms reported at intake were improving throughout the study. Conclusion Although very preliminary, these early results indicate that simultaneous training of sub-optimal SCP and coherence measures is possible and may provide a faster approach then training each deviant EEG feature individually. Learning Objective Discuss the concepts and issues involved in providing neurofeedback using real-time Z-Score measures. Agenda When recording QEEGs, it's important to include additional signals, like eye, heart, and muscle for the purpose of improved artifact editing...will also mention current methods of realtime denoising. Discussion of methods used for selection of sites, amplitudes, and coherence parameters for training SCPs and coherence will include QEEG, LORETA, and issues of neuroanatomy, connectivity, and symptomology. Financial Interest: No financial interests Efficacy of QEEG and Neurofeedback in the Assessment and Treatment of Post Concussive Syndrome: 24 Cases (R & CA) Tanju Surmeli, M.D., Living Health Center for Education and Research, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .33 Abstract IntroductionIntroduction Mild traumatic brain injury is associated with damage to frontal, temporal and parietal lobes. Post concussion syndrome has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on MRI and CT scans. The cluster of symptoms reported by these patients is referred to as post-concussion syndrome. The reported symptoms are : (a) attention deficits and difficulty sustaining mental effort,(b) fatigue and tiredness,(c) impulsivity, irritability, temper outbursts and changes in affect,(d) learning and memory problems,(e) impaired planning and problem solving (f) inflexibility, concrete thinking and lack of initiative,(g) dissociation between thought and action,(h) communication difficulties, (i) socially inappropriate behaviors, (j) selfcenteredness, lack of insight and poor awareness,(k) impaired balance and (l) headaches and personality changes. QEEG has been shown to be highly sensitive (96%) in identifying post-concussion syndrome. The approach is to determine to assess who has post-concussive syndrome and to see if subjects with postconcussive syndrome will benefit from neurofeedback. Methods Evaluation measures include CGI, pre and post QEEG analysis with Nx-Link Data bank, MMPI, T.O.V.A, SA-45 Questionnaires and Dr. Amen's ADD Questionnaires and subjects and their family interview with videotaping.Nx-Link data bank used to determine post-concussive syndrome with clinical history of subjects. In Neurometric QEEG Analysis all QEEG variables are calculated as z-scores which means -/ +2 standard deviation for age is normal. The magnitude of the standard deviation represents the severity of neuropathology and abnormality. Our hypothesis was that neurofeedback treatment will most benefit those patients who normalize the z-score on their QEEG. Lexicor QEEG signals were sampled at 128 Hz. 30 minutes neurofeedback sessions were completed in between 40 to 120 sessions. Electrodes were sited according QEEG analysis. Results 24 subjects (10 male, 14 female), age range between 18 to 54. 22 out of 24 subjects showed improvement according to CGI, MMPI, T.O.V.A , AMEN's ADD Questionnaires, QEEG Neurometric analysis, SA-45 Questionnaires and subjects' family interview with videotaping. Z-score normalization help improvement of their symptoms of those 22 cases. Neurofeedback treatment may be promising intervention in post-concussive syndrome. Further control studies are warranted. Learning Objective Explain how psychiatric disorders are misdiagnosed. Describe how to make objective diagnosis by using Neurometric analysis in psychiatry and why neurofeedback could be one of the most important treatment strategies. Agenda Neurometric analysis may be usefull in diagnosis of post concussive syndrome, normalization of z scores with neurofeedback may improve patient's sxs. Financial Interest: I don't have a financial interest or relationship with commercial supporter(s) or manufacturer(s) of any commercial product or service that is discussed as part of my presentation. INVITED PRESENTATION Effects of Cognitive-Behavioral Therapy on Regional Neurometabolism in Obsessive-Compulsive Disorder Joseph O’Neill, Ph.D., UCLA NPI, [email protected] CME, APA, ASWB and CA/BBS CE credits and BCIA recertification credits: .66