Head trauma or post-concussion syndrome may have symptoms including headache, anxiety, depression, personality changes with temper outbursts, decreased libido, loss of concentration, posi-tional vertigo, effort fatigue, alcohol intolerance, oversensi-tivity to sound and light, reversal of letters or words, memory losses, and seizures.

Theories have suggested that head trauma has been associated with diencephalon and mesencephalon fiber disruption (1), altera-tion of cerebral blood flow (2), altered neurotransmitter metabo-lism (3), and psychosomatic or neurotic factors (4).

Within this paper, 250 adult individuals, ages 18 to 45, were assessed by the Neuroanalyzer and recorded on a Beckman EEG with Grass gold electrodes. EEG's were recorded on T4C4, T3C3, senso-rimotor cortex at evaluation. Following evaluation, individuals were trained to inhibit one frequency, 4 to 7 hertz, and following inhibition, produce 15 to 18 hertz. Each individual received twenty-four EEG neurofeedback sessions with an EEG taken after each six sessions for a total of four EEG's. Symptomology was recorded for each patient, and individuals were asked to report in each ses-sion any change in symptomology. The purpose was to determine if there was any consistent pattern of symptomology change with the EEG. All individuals had closed head injuries.

In utilizing the EEG, abnormalities correspond both in severity and localization with the site of head trauma. Initially a progres-sive slowing of the EEG rhythm may continue for twenty days, and then progressively increase in frequency and amplitude.

The choice to inhibit 4 to 7 hertz in head injury patients came from studies indicating a generalized slowing, as did the study by Dawson, et. al. (5), where foci of irregular slow activity at fre-quencies of 5 to 7 hertz were commonly seen. The slow activity was sometimes continuous, random, or intermittent. Facilitation of the 15 to 18 hertz was based on previous brain research work with the same instrumentation in alerting and motor control in epilepsy (6), insomnia (7), attention deficits (8), stroke (9), and head injury (10).

Utilization of the Neuroanalyzer and electroencephalographic neurofeedback instrument allows for differential diagnosis in head trauma. Its' sophisticated instrumentation allows one to detect head trauma that an ordinary EEG would miss. The Neuroanalyzer has the capacity to analyze not only the raw EEG but, to selectively filter out and display any narrow specific frequency band, and tell how much of that frequency is being produced at what voltage.

There are diagnostic landmarks in post-concussion syndrome in the EEG. These changes may be seen up to sixty years post injury. Usually, one may see a petit mal variant activity in the 3 to 5 hertz range in the cortical area where damage occurred. There will be a generalized slowing of the EEG, most predominately at the site of injury. The amplitude of frequencies in the 4 to 7 hertz range will be considerably higher at the site of injury. In addition, phasic spikes may be seen at the site of the injury.

There has been a dramatic lack of effective therapeutic re-solution of the post-concussion syndrome. Therapies such as elec-trical stimulation, ice packs, heat packs, ultrasound, acupuncture, electroacupuncture, muscle relaxants, and tranquilizers have often brought some relief but, these therapies have not dealt directly with the actual direct results of the concussion, such as the phasic spikes, petit mal variant activity, headaches, vertigo, memory loss, reduction in concentration, and depression. EEG Neurofeedback allows one to directly intervene with the central nervous system damage, and to inhibit the abnormal activity associated with the symptoms of headache, memory loss, depression, sensitivity to sound and light, loss of concentration, personality changes, learning dif-ficulties, and sometimes seizures.

Medical pharmacology is extremely important in EEG neurofeed-back. All patients in this study were not taking sedatives. Patients taking sedatives have slow wave activity equivalent to the normal sleep pattern, which enhances the petit mal variant activity and central nervous system depression in post-concussion syndrome, making it difficult, if not impossible, to do EEG Neurofeedback. In addition, when large dosages of sedatives are combined with mus-cle relaxants or analgesics, patients will experience intensified feelings of depression or irritability, increased dizziness, and one may see increased slow frequency high- voltage activity in the EEG since both sedatives and muscle relaxants tend to be central nervous system relaxants (as long as the dosage is minimal and the EEG demonstrates little central nervous system depression).

Following EEG Neurofeedback evaluation and training of 250 closed head trauma persons, individuals reported an increase in energy and a decrease in depression and temper outbursts in the first six sessions. Within the next six sessions, individuals reported a decrease in sensitivity to sound and light and an in-creased attention span. In the following six sessions, all indi-viduals had a reduction of dizziness, the headaches if vascular seemed to disappear, and, in the last six sessions, people reported increased libido and less reversal of letters or words. Only 150 people reported they got their short-term memory back.

Corresponding in the EEG after six sessions, most phasic spikes decreased. In the next six sessions, all spikes were gone but, slow 4 to 7 hertz activity remained. In the next six sessions, 4 to 7 hertz activity decreased. In the last six sessions, most 4 to 7 hertz activity was eliminated.

The implication for discussion of this study is that first, a method has been developed to directly deal with the post-concussion abnormal EEG firing pattern. Secondly, due to the large amount of subjects involved, it is implied that the brain has a developmental hierarchy of motor control. The simplest deficits disappeared first as all reported an increase in energy but, last to improve was the most sophisticated brain task of short-term memory as opposed to long-term memory.

A hierarchy of development in the EEG and behavior went as follows:

     First there was an increase in energy, followed by a decrease in
     depression or temper, then to a decrease in sensitivity to sound and
     light, to increased attention span, to reduction of dizziness, to
     vascular headaches disappearing, to increased libido, to less reversal
     of letters or words, and lastly, to an increase in short-term memory.
          

NATIONAL HEAD INJURY FOUNDATION ANNUAL CONFERENCE DECEMBER 11, 1987 MEETING MARGARET E. AYERS
PUBLISHED IN NATIONAL HEAD INJURY SYLLABUS, HEAD INJURY FRONTIERS, PAGE 380, 1987.

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