Head trauma, or post-concussive syndrome may have symptoms including headache, anxiety, depression, personality changes, de-creased libido, loss of concentration, positional vertigo, alcohol intolerance, and effort fatigue. The syndrome may persist for months to years. Often there are no abnormal physical signs, thus contributing to the attitude that the symptoms are psychosomatic or a neurosis.

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, differential diagnosis, expected course of recovery when utilizing EEG feedback, and medical pharmacology in electroencephalographic feedback and head trauma will be covered.

It is necessary to differentiate head injury from other causes of unconsciousness such as diabetes, alcohol, hepatitis, cerebrovas-cular injury, and epilepsy. In addition, it is necessary to iden-tify the malingerer. In utilizing the EEG, abnormalities correspond both in severity and localization with those of the site of the head trauma. Initially, a progressive slowing of the EEG rhythms may continue for 20 days, and then progressively increase in frequency and amplitude. Stability of the EEG pattern may remain abnormal for months or years.

I utilize the Neuroanalyzer 4000, an electroencephalographic feedback instrument for differential diagnosis in head trauma. Its' sophisticated instrumentation allows me to detect both real head trauma and the malingerer. The Neuroanalyzer 4000 has the capacity to analyze not only the raw EEG but, to selectively filter out and display any narrow specific frequency band, such as 12 to 15 hertz, and tell how much of that frequency is being processed at what volt- age. Originally this instrumentation was designed for brain re-search with grand mal epilepsy in the reduction of grand mal seizure activity.

There are diagnostic landmarks in post-concussion syndrome in the EEG. These changes may be seen one to ten years post injury. Usually one may see petit mal- like activity in the 4 to 7 hertz range in the cortical area where damage occurred. There will be generalized slowing of the EEG, most predominate at the site of the injury. In addition, single polyphasic spikes may be seen at the site of the injury.

After electroencephalographic evaluation, I have the patient attempt to train to inhibit one specific frequency, associated with the loss of concentration and petit mal-like activity. A bipolar hookup is utilized on the site of the damage, and the patient will train for 30 minutes. Then, another EEG recording will be make to determine if the patient is trainable, and if some normalization in the EEG occurred. Usually patients will feel substantial improve-ment within the first three sessions, and training will be necessary in direct proportion to the severity of head trauma. For example, one patient, five years post-concussion, complained of chronic head-aches, positional vertigo, and moodiness. Unfortunately no existing therapies had helped. After four training sessions the patient had no headaches, the dizziness was gone, and she reported feeling better. One might contrast this with a severe head trauma patient, resulting in hemiparesis, seizure activity, and memory loss. Such an individual required a years time to inhibit the seizure activity, and restore his concentration.

There has been a dramatic lack of effective therapeutic resolu-tion of the post-concussion syndrome. Therapies such as electrical stimulation, ice packs, heat packs, ultrasound, acupuncture, elec-troacupuncture, muscle relaxants, and tranquilizers, have often brought some relief but, have not dealt with the actual, direct re-sults of the concussion, such as the petit mal-like activity, head-aches, vertigo, memory loss, reduction in concentration, and depres-sion. EEG feedback allows one to directly intervene with the cen-tral nervous system damage, and to inhibit the abnormal activity associated with the symptoms of headache, memory loss, depression, and vertigo. If EEG feedback was utilized in addition to therapeu-tic modalities for the whiplash, resolution of the problem would be more likely to occur, unless no whiplash was involved.

Medical pharmacology is extremely important in EEG feedback. Patients taking sedatives have slow wave activity equivalent to the normal sleep pattern, which enhances the petit male-like activity and depression in post-concussion syndrome, making it difficult, if not impossible, to do EEG feedback. In addition, when large doses of sedatives are combined with muscle relaxants or analgesics, patients will experience intensified feelings of depression, irri-tability, and increased dizziness. Additionally, one may see in-creased slow frequency high voltage activity in the EEG since both sedatives and muscle relaxants tend to be central nervous system depressants. One may do EEG feedback and be taking a sedative or muscle relaxant, as long as the dosage is minimal and the EEG demon-strates little central nervous system depression.

I have utilized electroencephalographic feedback for approxi-mately 50 post- concussion patients. Concussions two to ten years post injury without cerebrovascular lesion will respond immediately, with patients experiencing relief in the first six sessions, and follow-up EEG's taken every three months for a year, demonstrate EEG normalization concomitant with symptom relief a year after EEG training.

Department of Continuing Education in Health Sciences, U.C.L.A. Extension, and the School of Medicine, U.C.L.A., Editors MAY 1983

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