Neurophysiology of ASD

Transcription

1 Connectivity guided EEG biofeedback as a treatment for Autistic disorders Robert Coben, PhD Co-Founder/Neuropsychologist, Integrated Neuroscience Services Presented at the 2013 Autism One Annual Meeting Chicago, Illinois Neurophysiology of ASD Connec&vity theory of Au&sm Delta Theta Alpha Beta Gene'c findings on chromosomes 16, N = ASD 91 normals. Power subypes vs. heterogeneity of findings? Neural connec'vity anomalies Factor, cluster analysis. Increased frontal coherence. Abnormal power and coherence findings in ASD. Decreased temporal coherences. Epigene'c e'ology leading to neural inflamma'on. 11, and 7q31 MET receptor tyrosine kinase. underlie the brain dysfunc'ons in au's'c children. These neural connec'vity disturbances lead to regional brain dysfunc'ons. Discriminates by 95%. Au's'c children have overlapping neurophysiological dysfunc'ons. VARETA Analyses 1

2 Inferior Frontal Gyrus connec&vity. Pa&ent (Case 1) with Au&sm (Mu suppression deficit) (leb) and Normal control (right) 2

3 Facial/Emotional Processing deficits in Autism Superior temporal gyrus (Brodmann area 22/Wernicke s) connec&vity. Pa&ent 2 (Au&sm with leb seizure foci and impaired speech) (leb) and normal control (right) Superior temporal gyrus (Brodmann area 22/Wernicke s) connec&vity. Pa&ent 2 (Au&sm with leb seizure foci and impaired speech) (right) and his brother with more severe symptomatology who is non- verbal (leb) What is Neurofeedback? Human EEG biofeedback was first aqempted in the 1960s by Joe Kamiya at the University of Chicago. Early inves&ga&ons focused on operant condi&oning of alpha brain waves primarily to facilitate deep relaxa&on and medita&on. SMR/beta biofeedback developed from operant condi&oning of cats' EEG. Barry Sterman of UCLA serendipi&ously discovered that when cats were exposed to toxic chemicals that usually induce epilep&c seizures, those who had been trained in the middle to high frequency range (12-20 Hz) from a previous unrelated experiment had greater latency to seizure onset, and a higher threshold for seizure onset, than untrained cats. These results were replicated in monkeys and humans. The results with humans were subsequently replicated in some twelve research centers, comprising some twenty studies. ABer several years of trea&ng pa&ents with intractable seizures with SMR biofeedback, it was noted that the hyperac&ve children not only had decreased seizure ac&vity, but their behavior improved as well. In the mid 70's, Joel Lubar at the University of Tennessee examined the effect of neurofeedback on hyperac&vity absent any seizure history. 3

4 How Neurofeedback works EEG biofeedback Case 1 7 year old by diagnosed with FSIQ = 80; Verbal IQ 75; Born 36 weeks gesta&on due Impairments in recep&ve Walked at 2 years and spoke Unable to read or iden&fy PDD at the age of 5 to gesta&onal diabetes with high liver enzymes in uqernaces by 3 years Performance IQ = 90 language, motor sequencing, visual- perceptual analysis. leqers Difficul&es with focusing, sifng s&ll, temper outbursts, socializa&on, head banging, repe&&ve behaviors 4

5 EEG biofeedback Case 1 EEG biofeedback Case pre post epilep+form discharges 20 pre post 10 0 ATEC score (1 year) Neuropsychological measures all within normal limits, except recep&ve language rated as mildly impaired. Went from being alexic to now reading within one year of his age. 5

6 Empirical evidence supporting the use of NF for ASD 1. NF can lead to significant reductions in symptoms in just 20 sessions (40% reduction with an 89% success rate and no adverse effects). 2. Various forms of NF can be helpful. QEEG connectivity guided NF appears to have superior relative efficacy. 3. Specific symptom clusters and brain regions can be targeted with evidence of source localized changes. 4. Both higher and lower functioning patients can benefit from NF with increases in IQ and language functions in cases of Autism. 5. A complete course of NF training (at least 40 sessions) leads to indisputable improvements with an average 60% symptom reduction (30-90%) and success rate of 98%. EEG Biofeedback or Neurofeedback" 98% of children with ASD improve with a full course of treatment." 91% lessen their symptoms by 30% or more. " 0% worsen their condition or have long-lasting side effects." Average reduction in symptoms of 60 70%." Significant improvements in neuropsychological, language, social, and "behavioral functions." Helps children at varied levels of functioning and intelligence levels "(> IQ = 50) equally. " Helps reduce seizures/paroxysmal events in ASD with or without "medication." Effects of treatment appear to be long-lasting and promote future "developmental gains. " 6

7 NF/HBOT Project: Methods and Approach Setting: Autism Treatment Center near Phila, PA Multimodal treatment environment including Biomedical, HBOT, NF, and now ABA. Quantitative analysis method: symptom assessment and QEEG surrounding interventions. Attempts to not combine treatments at this time. NF approach: QEEG connectivity guided model administered by technicians with active consultation/ supervision. A-B Case: HBOT followed by NF The patient is a 9 year old male who lives at home with his parents and two sisters who are all very supportive. He attends the 4 th grade with some support. He suffered febrile seizures at 15 months that lasted for an hour and were followed by Todd s paralysis on his left side for hours. This was followed by a regression in function. Diagnoses as above include ASD and a Partial Seizure Disorder. Brain MRI in 2007 showed stable (compared to previous one 3 years prior) signal abnormality involving the right amygdale, hippocampus and inferior temporal gyrus. There was also evidence of right medial temporal sclerosis. EEG reportedly showed sluggish right temporal lobe. Reported symptoms include difficulties with attention, anxiety, social skills, reading comprehension, and blunted affect. Medications used include Lamictal, Focalin, Celexa. Following this course of HBOT and another QEEG, they underwent 20 sessions of QEEG connectivity guided NF. A-A-B: HBOT HBOT NF.! The patient is a 12 year old, mixed-handed, male who has been diagnosed with hypoxic encephalopathy and autism. He is nonverbal. Current medications include Keppra 15mg/ 12 hours, Valium 2mg/ 6 hours, Clonidine (1 patch), Prevacid, and ophthalmic eye drops/ointment.! Multivariate Coherences And following 20 sessions of QEEG connectivity guided NF. Begins talking and is more alert and engaged 7

8 Typical results of HBOT Typical results from NF Summary of Findings NF (N = 6)/HBOT (N = 6) alone 8