Biofeedback
and Tourette Syndrome
Biofeedback
Biofeedback
is useful in helping the conditions of many disorders, ranging from
re-education of damaged nerves to certain types of epilepsy, but is
most typically used in treating disorders like TMJ, irritable bowel
syndrome, chronic headaches, high blood pressure, generalized stress,
anxiety and insomnia.
This specialized
type of training allows people to gain control over physiological
reactions that are ordinarily unconscious and automatic. Malfunctions
in these automatic responses contribute to a wide variety of medical
problems. In study after study, biofeedback has shown the ability
to help bring such counterproductive reactions back into line, providing
significant relief for many of the people who try it.
Biofeedback is
a valuable option, because it is a noninvasive therapy that can be
used to train you how to manage and change troublesome physical symptoms.
Biofeedback involves
using electronic instrumentation to monitor specific, often unconscious
physiological activities and habit patterns and then "feed back"
the information. Once the patient is aware of what the body is doing,
they can change those patterns to reduce or eliminate symptoms.
Although biofeedback
could help control certain ailments through disciplined mental effort,
it has nothing in common with some forms of mind-body therapy.
It does not rely on maintenance of some sort of theoretical balance
or harmony in order to achieve its effects. Instead, it seeks control
over specific, measurable physiological reactions that have somehow
gone awry. As such, it can prove especially useful for any disorder
caused or aggravated by involuntary muscular tension or tightening.
Like some forms of mind-body therapy, it's entirely useless for fighting
infections, curing cancer, relieving allergies, or healing injuries.
Like other mind-body
forms of therapy, biofeedback is notably free of side effects. Biofeedback
is often turned to by people seeking a respite from the side effects
of conventional medicines.
How the
Treatments Are Done
Biofeedback
is not a passive treatment. It requires intensive participation in
learning to control such normally involuntary ("autonomic")
functions as heart rate, blood pressure, brain waves, skin temperature,
muscle tension, breathing, and digestion.
The first session,
involves questions about health and that of family members. The biofeedback
therapist will then apply sensors to various points on the body. The
location depends on the problem that needs treatment. For migraines,
sleep problems, and mood disorders, for example, the electrodes are
often attached to the scalp; to treat heart problems and muscle tension,
they will be placed on the skin. Other possible sites include the
hands, feet, or fingers.
The sensors are
connected to a computer, a polygraph, or another piece of monitoring
equipment that provides instant feedback about the function trying
to be controled, such as the tension in a particular set of
involuntary muscles or circulation to a specific part of the body.
Some biofeedback machines signal changes graphically on a computer
display, others beep, buzz, or blink to indicate the strength or level
of the function they are targeting.
The therapist
will teach mental or physical exercises that can help affect the function
that's causing a problem. Success is gauge by noting any changes in
the intensity, volume, or speed of the signals from the machine. Gradually,
biofeedback associates successful thoughts and actions with the desired
change in involuntary responses.
Once an effective
pattern of actions are thoroughly learned control without the aid
of the feedback device is asserted.
Biofeedback
has been tried as a remedy for the uncontrollable tics and compulsions
of Tourette syndrome.
Although it's
not a sure cure, biofeedback could help some symptoms of patients
with Tourette Syndrome.
EEG Spectrum International
(EEGSI) has observed considerable clinical evidence for the effectiveness
of EEG biofeedback training as an adjunct modality for remediating
the symptoms of Tourette syndrome. Rather than focusing on the condition
as a whole, they focus on the individual classes of symptoms.
Tourette Syndrome
biofeedback could possibly impact many symptoms whether they are associated
with Tourette Syndrome or associated conditions and disorders.
i.e. attention deficits, anxiety and depression, oppositional-defiant
behavior, conduct disorder, obessive- compulsive behavior, episodic
dyscontrol, hypersexuality and addictive behavior. Little data exists
to date with respect to addictive behavior or sexual behavior as it
is affected by EEG training of Tourette patients.
Biofeedback
for Tourette Syndrome tics.
EEGSI experiences
a higher probability of achieving full remediation of tics if the
tics have recently developed. This is also similar for tics induced
by medication, such as that prescribed for hyperactivity and attention
deficits i.e. Ritalin , dexedrine, and Cylert. However in adults with
decades of history with tics, full remediation is much less likely.
It is often difficult
to establish one EEG training protocol which addresses all the possible
symptoms of Tourette Syndrome. For example, a protocol selected
to deal with attention deficits may not be appropriate for obsessive-compulsive
behavior. Under these circumstances, the most significant and troublesome
symptoms need to be addressed first in training, leaving minor ones
until later. The situation is similar to that which prevails in the
medical management of Tourettes, where a number of medications may
be required to address all of the symptoms.
Though EEGSI experiences
that the effect of the training is cumulative and permanent, it has
been observed that some Tourettes patients may backslide somewhat
between training sessions. In such cases, the training may have to
be more frequent, particularly in the early going (perhaps three times
per week), and the Tourette patient may benefit from occasional booster
sessions even after the bulk of the training is completed. In the
extreme case, children may even benefit from a continuation of EEG
training sessions on a regular schedule. Such continuing training
appears to be necessary in only a small fraction of cases.
Most of the clients
referred to EEGSI for Tourette syndrome are under pharmacological
management for the condition. As the training proceeds, downward adjustment
of the medication(s) is usually necessary, so the person should be
in the care of a supportive physician.
It is suggested
that if there are no improvement in 10 to 20 sessions, or if the Tourette
symptomes worsen, biofeedback is probably not right for the Tourette
patient. Discontinue the training and ask the doctor about other alternatives.
Although biofeedback
is harmless--and can often be helpful--it is not a substitute for
regular visits to the doctor. If using biofeedback to help ease
Tourette symptoms, do not suddenly drop other forms of treatment for
depression, anxiety, tics or the likes.. Continue to see the neurologist
or Tourette Syndrome doctor. Eventually, he may be able to reduce
the dosage of a medication as training continues.
Remember, too,
that if biofeedback techniques suddenly fail to work, there may be
a new medical problem for which biofeedback is ineffective. At such
times, it's wise to see the doctor for a thorough diagnosis.
Tourette's
Syndrome and EEG Biofeedback Case, 9 year old boy
Summary
Before
biofeedback and medication.
"Jason
A bright child, totally bored by classroom activities. Extremely sensitive
to criticism or rejection. Makes funny faces and noises to get attention.
Will not comply with rules. Ignores the staff. Tests limits with every
adult. Inattentive, aggressive, disruptive, destructive, a loner,
doesn't interact with his peers. Orders other children around. Uses
foul language. Says things to intentionally hurt other children. Abusive
to the school's animals. Other children have learned to avoid him.
Parents do not want their children to play with Jason."
Jason
was diagnosed with Tourette Syndrome with attention deficit disorder
and started taking medication.
After
medication with out biofeedback
"Jason
has been a student in my class for six weeks. He has demonstrated
the ability to 'get along' or 'function' successfully in my classroom
atmosphere. Jason is working on level six in reading. He works on
his problems with very little difficulty and has no problem staying
on task. In my classroom, Jason has shown patience, creativity, the
ability to complete tasks from start to finish. He has shown me respect,
a willingness to assist me as well as other students. He knows my
class rules as well as the school rules and several times I have overheard
Jason reminding other students of the rules. Jason gets along well
with his peers as well as with those a grade older. He shares his
ideas and possessions. His social skills are good and he has learned
to accept responsibility."
In
the beginning, Jason was able to sustain this behavior on very
moderate doses of medication but as time went by the dosages had to
be increased, new medications were tried and abandoned.
During
second grade Jason started to attend a new school. He didn't exhibit
the wild out-of-control behavior but he was also not functioning well
in class. He had trouble starting his work and more trouble finishing
it. He was often seated outside the room. He was taking extremely
high dosages of all medications, at the top of the "safe"
limit.
Introduction
of EEG Biofeedback
We hoped that the EEG biofeedback could enhance the medication and
possible, in the long run, replace it.
Jason
began treatment one visit per week. After the first two or three visits,
I noticed that he was using his time more productively, was less fidgety,
and was calmer and more relaxed. His handwriting which had always
been very messy and hart to read was drastically improved. The letters
were well-shaped and within the lines, the spacing between words was
even.
With
this evidence I was convinced that this treatment would be effective
but I also knew that once a week would not be sufficient. Jason began
to attend sessions three times a week. We found that different frequencies
of brainwaves controlled specific behaviors. By working on SMR we
were able to improve his concentration and ability to stay calm. Focussing
on Theta helped with Jason's attitude. We wanted to get rid of his
defiance, oppositional behavior and negative attitudes. Beta improved
his concentration and energy. In addition, he became hungry for knowledge.
He would throw himself into his academic work and asked a million
questions. The fourth frequency we worked with was "High-Beta".
This had previously been used as an indicator of muscle tension. We
did not think it had value in treatment of symptoms but what we found
was that if Jason's High-Beta was not kept tightly under control he
would start to behave "weird", making strange faces, walking
strange, laughing hysterically at inappropriate times.
With
each treatment session his brainwaves were more stable as he began,
he had more control over them during the session, and was able to
sustain the control for longer periods. As the training was made more
and more difficult he could easily adapt and adjust his waves to the
more difficult level. It was like he was an athlete in training, the
more training he had the stronger his control and the longer he was
able to maintain this control. It was as if he had been born with
a "lazy brain" and the biofeedback was exercise which was
strengthening his brain. We began to have hope for a permanent "cure."
Jason's
daily medication was reduced drastically. He had been taking 8 mg
of Haldol, the highest safe level for someone of his age and weight.
He was able to reduce to 1 mg. He had also been taking 90 mg of Ritalin.
This was reduced to 15 mg.
Daily
treatment has continued for over two years now. During this time Jason
qualified for District's GATE program (Gifted and Talented). He made
honor roll for the first time, was awarded a teacher's award as most
outstanding student, and received recognition for outstanding citizenship
and sports. The level of his medication is lower than it has been
since he started taking it. It has been over a year since he had a
discipline or behavior problem of any kind at school. Jason has made
many new friends, has run for student council, and is in the honors
classes at his intermediate school. He can go for weeks without biofeedback
training while maintaining control. And he recognizes when he has
gone too long without biofeedback and says, "Mom, I need to go
on the machine." - Read
the entire essay on this EEG Biofeedback Case click here
A
simple and a complex tic (Gilles de la Tourette's syndrome): their
response to EEG sensorimotor rhythm biofeedback training.
Tansey MA.
This study presents
a clinical treatment regime for the treatment of tic manifestation,
both simple and complex. The response of a case of simple tic and
a case of complex tic (Gilles de la Tourette's syndrome) to EEG sensorimotor
rhythm biofeedback training are presented. Specifically, the simple
and the complex tic, both of long duration, were eliminated via this
EEG biofeedback training procedure. It is hypothesized that this exercising
of the sensorimotor cortex resulted in increased activation of this
cerebrocortical subsystem and was reflected in increased voluntary
muscle control and a heightened threshold for random motor discharge,
resulting in the elimination of both tics as in the response of cases
of epilepsy with motor involvement to EEG sensorimotor rhythm biofeedback
training. The additional psychophysiologic sequelae of the complex
tic--attention deficit disorder--remediated in the manner of the response
of learning-disabled to EEG sensorimotor rhythm biofeedback training.
- NCBI
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