Neurotherapy & Brain Mapping
NON-INVASIVE BRAIN STIMULATION - NEUROMODULATION
Cranio-Electro Stimulation (CES) was developed in the Soviet Union in the late 1940s to help with sleep problems. Although electro-medicine has been in existence for well over a thousand years, developments in electronics and neuroscience research has seen this technology expand more rapidly, in recent years. Transcranial Magnetic Stimulation (TMS) using powerful, high voltage, electrical magnetics is increasingly used by psychiatrists. Moreover, research supporting the clinical effectiveness of weaker amplitude micro-currents – based, in part, on Arndt’s Law, which states that weak stimuli excite physiological activity, whereas medium-strength stimuli will encourage it and strong stimuli will suppress it – has cleared the U.S. Food and Drug Administration (FDA) for treatment of insomnia, depressed mood, and anxiety. Treatment consists of applying a very weak pulsed (A.C.) or continuous (D.C.) electrical current (typically 0.5 mA – 2 mA) to the scalp region. One mA is 1/1000 of an amp - a very tiny number, felt as a mild to modest sensation.
CLINICAL RESEARCH FINDINGS
“Sham-controlled studies and meta-analyses show that CES is a safe and effective treatment of generalized anxiety. . . A review encompassing 34 sham-controlled trials conducted between 1963 and 1996 concluded that regular CES treatments resulted in short-term symptomatic relief of generalized anxiety symptoms mediated by direct effects on autonomic brain centers (DeFelice 1997). In a 10-week open trial of daily self-administered CES therapy in 182 individuals diagnosed with DSM-III anxiety disorders, 73% of patients reported significant reductions in anxiety that were maintained at 6-month follow-up.” – James Lake, M.D., 2018
Non-invasive brain stimulation techniques are growing in popularity as they offer a safe, economical and increasingly accessible means of modulating neural activity. As of 2002, there have been approximately 200 clinical studies using CES, spanning 50 years and over 25 devices (Kirsch, 2002). Ray Smith (2006) completed an extensive analysis of the more credible studies of CES and cross-referenced them into effect-size, a unique type of statistical analysis, so they could be compared with other treatment modalities, as shown in Table 2.
Table 2. Studies of CES by 2005
Because of the direct neurotransmitter effects of CES and the scarcity of negative side effects, CES studies of over 1000 depressed patients, have shown relative success across the board. A meta-analysis study by Gilula & Kirsch (2005) of 290 depressed patients, showed a direct comparison of CES against various anti-depression medications. Figure 3 - shows the treatment-effect improvement in depression over placebo obtained from freedom-of-information data as provided to the FDA from pharmaceutical companies when seeking FDA approval. The CES data came from eight studies submitted to the FDA from Electromedical Products International, Inc., to reclassify CES from class III to class II for the treatment of depression, anxiety and insomnia. The CES studies reported no negative side-effects, whereas the drug studies indicated side-effects ranging from interruption of liver metabolism to reactions with other medications and an increase in thoughts and behaviors related to suicide ideation.
Figure 3. Medication vs CES for Treating Depression
- Gilula, M., and Kirsch, D. (2005). Cranial Electrotherapy Stimulation Review: A Safer Alternative to Psychopharmaceuticals in the Treatment of Depression. Journal of Neurotherapy, 9(2):7-26.
This meta-analysis data shows that CES reduces depression 63% better than the placebo response, which in the case of Prozac, is only 11% better than a fake pill! If the poor performance of most anti-depressant drugs surprises you, then consider the meta-analysis research of Irving Kirsch, Ph.D. He found that, “Analyses of the published data and the unpublished data that were hidden by drug companies [known only to the drug companies and the FDA] reveals that most (if not all) of the benefits are due to the placebo effect. . . Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future. , , When different treatments are equally effective, choice should be based on risk and harm, and of all of these treatments, antidepressant drugs are the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed.” - Kirsch I. (2014). Antidepressants and the Placebo Effect. Zeitschrift fur Psychologie, 222(3),128–134.
At Pacific Psychological Care we strive to use the safest and the most effective methods of CES – with tiny amplitudes of specific microcurrents – with a personalized, tailored, approach of neurostimulation based on the latest qEEG and ERP brain mapping techniques.
The EEG is an electrical field measured by differential, direct coupled (DC) amplifiers. The main feature of an EEG is its oscillatory dynamics, the interplay between excitatory and inhibitory processes within the brain. The oscillations seen in raw EEGs are rows of up and down fluctuations, multiple sinusoidal waves, travel at certain speeds (Hz), or frequency bands. States of arousal, attention, motivation, emotions, and higher cognitive activities are linked to brain waves at different frequency bands.
An increasing body of evidence suggests there is significant value in using EEG information for guiding clinical interventions with medications, targeted nutrients, biofeedback or neurotherapies. Personalized approaches to neurostimulation based on QEEG and ERP maps may offer better clinical efficacy and treatment outcomes.
QUANTITATIVE ELECTROENCEPHALOGRAMS (qEEGs)
The qEEG is a noninvasive, safe, and painless, type of brain mapping. Compared to other forms of brain maps (e.g., CAT scans; MRIs; or SPECT scans), qEEGs are relatively inexpensive and more adept at assessing states of consciousness. An elastic cap with 19 electrode, plus two grounds, is placed over the skull, to only receive “read-only”signals from the brain. These electrodes do not alter brain activity in any way; they simply reveal the location and patterns of brain activity as underactive, balanced, or overactive. Brain wave patterns reveal important information about your state of arousal and overall brain function, including stress levels, cognitive strengths and deficits, and emotions. A qEEG can reveal brain wave patterns associated with impulsivity, cognitive inflexibility, anxiety, depression, autism, trauma, and other symptoms. It can be helpful in many ways, including:
Identifying brain-markers for cognitive and psychological challenges
Showing how your brain functions might be improved
Tracking your clinical progress using different therapies and treatments
Providing objective information to create your own personalized neurotherapy program, to increase brain metabolism, to help balance your emotions, to improve learning and performance, or to decrease inflammation.
WHO CAN BENEFIT FROM A qEEG?
A qEEG can be performed on people of all ages—adults, adolescents, children, and even babies. People struggling with mental health symptoms may benefit from an evaluation that includes qEEG testing. qEEGs can help to identify brain wave patterns associated with a variety of conditions, including:
Attention Deficit-Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Traumatic Brain Injuries or Concussions
PTSD or traumatic episodes
Schizophrenia or Bipolar Illness
EVENT RELATED POTENTIALS (ERPs)
ERPs are part of the EEG generated by sensory and cognitive processing of external stimuli; reflecting the summed synaptic activity produced when neurons fire in synchrony in response to a specific stimulus. The stimuli of the ERP test are grouped into sequences of repeating sounds or visual cues. The type, timing, and sequence of stimuli (often called an “ERP paradigm”) are organized to target specific cognitive processes such as selective attention, memory encoding, executive function, and motor speed. While the brain subconsciously analyzes the incoming stimuli, EEG time-locked to each stimulus is recorded. At the end of the test, the time-locked EEG recordings are averaged according to stimulus type, and all brain activity not related to the specific stimulus group is “filtered out”. What is left are the ERP waves that represent the physiological responses evoked by each stimulus type played during the test (Figure 1).
“Event-related potential (ERP) is one of the most informative and dynamic methods of monitoring cognitive processes, which is widely used in clinical research to deal with a variety of psychiatric and neurological disorders such as attention-deficit/hyperactivity disorder (ADHD).”
Event related potentials (ERPs) are an objective measure of cortical synaptic dysfunctions - that can result from traumatic events, psychiatric or behavioral conditions, or learning issues. ERPs are highly sensitive to cognitive deficits arising from even mild to moderate challenges. Thus, ERP mapping can improve patient treatments by providing clinicians with an accurate and objective assessment of a patients’ cognitive status after a trial of therapy.