Sleep and the EEG

Electroencephalography (EEG) is a valuable diagnostic tool for physicians and researchers in the Boston area. One of the areas of science and medicine in which the EEG is extensively used is in the study of sleep and sleep disorders. Sleep is divided into phases, which are identifiable by the patterns observable on EEG recordings. Sleep stages are divided into REM (rapid eye movement) and NREM (non-rapid eye movement) sleep, with NREM further divided into three stages.

NREM Stage 1

Stage 1 NREM sleep, is a phase in between sleep and wakefulness. On an EEG, stage 1 sleep is associated with a transition in the brain from alpha waves (8-13 Hz) to theta waves (4-7 Hz). During this stage, a person’s muscle tone decreases and they lose most of their consciousness of the external environment.

NREM Stage 2

In Stage 2 NREM sleep, conscious awareness of the external environment disappears completely, although a person can be roused from stage 2 sleep fairly easily. In EEG recordings of people in stage 2 sleep, two distinctive patterns can be observed: sleep spindles and k-complexes. Sleep spindles consist of 12-14 Hz waves that last for about half a second. Scientists in Boston theorize that sleep spindles represent the brain inhibiting certain processes that might otherwise interrupt sleep. K-complexes consist of a brief, high-voltage peak followed by a slower complex. They occur every 1.0-1.7 minutes and are often followed by sleep spindles. They can occur spontaneously, but also occur in response to external stimuli such as sounds.

NREM Stage 3

Stage 3 NREM sleep in Boston is also called “slow-wave sleep” or “deep sleep.” The transition from Stage 2 to Stage 3 is marked by an increase in delta waves, which come to predominate during slow-wave sleep. EEG activity is synchronized, and consists of low-frequency, high-altitude wavelengths. Dreaming sometimes occurs in Stage 3 NREM sleep, although it is less common than in REM sleep. Slow-wave sleep is believed to be associated with consolidating memories within the brain.

REM Sleep

REM (rapid eye motion) sleep is characterized by rapid, random movement of the eyes. It generally comprises 20% to 25% of total sleep in adults, occurring in four or five periods during the night. Infants spend as much as 80% of their sleep time in REM. It is during REM sleep that dreams are most likely to occur. On an EEG, REM sleep can be seen to involve higher-frequency, lower-amplitude neural oscillations than NREM stages of sleep. REM EEG patterns are also more random and variable than EEG patterns during NREM sleep. Currently, evidence suggests that REM sleep may be important for consolidating procedural and spatial memory, whereas slow-wave sleep is more strongly associated with consolidating declarative memory. REM sleep is also thought to play a significant role in neural development, especially in infants.

EEG FOR INSOMNIA IN BOSTON 

Holistic Medicine that Works: Five Relaxing Herbal Remedies

If you’re stressed out or having trouble sleeping in Mansfield, there are some easy-to-come-by herbs that may help you get into a calmer state of mind. Many herbal remedies with long histories of medicinal use have been scientifically investigated, revealing natural occurring compounds that give the plants their effects. These five herbal remedies are often used as holistic medicine treatments to soothe anxiety and to remedy mild to moderate insomnia. If you’re feeling stressed, a calming herbal tea that incorporates some of these ingredients may help you to feel more relaxed and better able to deal with the problems causing the stress.

#1: Valerian Root

Valerian root (Valeriana officinalis) is an effective holistic medicine remedy for sleeplessness and anxiety. If you live in the Mansfield area and you’re struggling with mild insomnia, valerian root might just do the trick. Valerian root contains certain natural chemical compounds, including valerenic acids and sesquiterpenoids that have affinities for GABA receptors in the brain. GABA (gamma-amino butyric acid) is an important neurotransmitter. Benzodiazepines, a popular but troublesome class of prescription drugs used for anxiety and sometimes for insomnia, work via the same receptors. In addition to its sedative and anxiolytic effects, valerian also has some muscle relaxant qualities. Valerian root is often sold in capsules, and is also used as an herbal tea.

#2: Chamomile

Chamomile (Asteraceae family) is a tried-and-true holistic medicine remedy for relaxation. Chamomile contains numerous chemical compounds with medicinal effects, some of which act on GABA receptors. Chamomile also has anti-inflammatory effects and can soothe gastrointestinal discomfort. Chamomile tea is easy to find in Mansfield; you can usually find it at the grocery store.

#3: California Poppy

California poppy (Eschscholzia californica) is a flowering plant in the poppy family that is native to California. Historically, its leaves have been used by Native Americans for medicinal purposes. Although California poppy is related to opium poppy, it contains a different and much milder class of alkaloid chemicals. An aqueous extraction of the plant has sedative and anxiety-reducing qualities. In a study of the effects of California poppy extract on mice, it was shown to have affinities for the same receptors as benzodiazepines.

#4: Passionflower

Passionflower (Passiflora incarnata), also known as maypop, was first used medicinally by Native Americans and then later by European colonists. The fresh or dried leaves of this plant are often used to make a tea that soothes anxiety and insomnia. Many passionflower species, notably P. incarnata, contain a group of chemical compounds called beta-carboline harmala alkaloids. These chemicals function as MAO (monoamine oxidase) inhibitors, lending them antidepressant effects. Clinical investigations of the efficacy of passionflower for anxiety have produced promising results. In one study, P. incarnata extract worked as well as oxazepam, a benzodiazepine, but with fewer adverse side effects.

#5: Lemon Balm

Lemon balm (Melissa officinalis) contains compounds, notably rosmarinic acid that inhibits an enzyme called GABA transaminase. This results in reducing anxiety and sedative effects. Studies indicate that lemon balm extract reduces stress, as well as improves mood and even enhances mental performance. These effects are attributed to the plant’s effects on muscarinic and nicotinic acetylcholine receptors. 

NEUROFEEDBACK THERAPY IN BOSTON

Three Neurological Disorders That Affect Your Ability to Hear Music

When anyone in Foxboro sustains localized brain damage, strange things can happen to the person’s language, vision, cognition, and other capabilities. Some types of acquired neurological disorders can actually affect a person’s ability to hear and appreciate music. Usually these effects result from localized lesions in the brain that are created by a stroke or a traumatic brain injury. Music is a way to express emotions, and individuals generally differ in their musical abilities, proclivities, and tastes. Some people in Foxboro can sing perfectly, whereas others can’t quite carry a tune. Some people are more attuned than others to the beat and rhythm of music. Many music aficionados like rhythmic, pulsating electro, whereas others prefer smooth jazz. Despite these differences, nearly everyone enjoys music to some extent. Like language, music has its basis in the brain. The brainstem, primary auditory cortex, secondary auditory cortex, and other areas of the brain are largely responsible for the recognition of aspects of music like pitch, tone, rhythm, and melody. When one of these areas is damaged, it can result in neurological disorders that are characterized by the loss of the ability to recognize, produce, or appreciate music. 

#1: Amusia

Amusia, also called musical agnosia or musical deafness, can be congenital; however, it is usually acquired due to a brain injury. Amusia is strongly associated with deficits in pitch processing, which also creates difficulties in some aspects of language intonation recognition and spatial processing. Signs of amusia include:

·         Inability to recognize familiar melodies

·         Loss of ability to read musical notation

·         Inability to recognize out-of-tune or “wrong” notes in a piece of music

·         Loss of ability to sing or play an instrument

Like many neurological disorders, amusia can vary in presentation depending on the size and location of the lesion that caused it.

#2: Selective Musical Alexia or Musical Agraphia

Musical alexia and musical agraphia are neurological disorders involving, respectively, a loss of the ability to read musical notation and to write musical notation. Depending on where and to what extent the brain was damaged, a person in Foxboro can lose only one of these abilities while retaining the other. A loss of the ability to read or write music can also occur without an overall loss of musical ability and music recognition. 

#3: Auditory Arrhythmia

Auditory arrhythmia can result from damage to the right temporoparietal area of the brain. It is characterized by a disturbance of the person’s sense of rhythmic patterns in sounds, including music and language. A person with auditory arrhythmia will be unable to perform a basic “tapping task” in which a neurologist instructs them to tap their finger in time. This condition is thought by researchers to result from impairment of the brain’s central timing system. Although auditory arrhythmia is not restricted to music per se, it can severely impact a person’s ability to play or to write music because they can no longer keep time. 

NEUROFEEDBACK THERAPY FOR NEUROLOGICAL DISORDERS

Treating Obsessive Compulsive Disorder in Children

Treating Obsessive Compulsive Disorder in Children with Family-Based Exposure Therapy 

Obsessive-Compulsive Disorder is a relatively common anxiety disorder. OCD is characterized primarily by intrusive thoughts (“obsessions”) that cause significant and overwhelming anxiety, which often causes the person to engage in certain repetitious behaviors (“compulsions”) to try to temporarily relieve that anxiety. Although obsessive-compulsive disorder in Mansfield and the Boston area is more commonly diagnosed in adolescents and adults, this condition can also occur in children. OCD in children is arguably more difficult to deal with than obsessive-compulsive disorder in adults, and children often do not respond as well to psychiatric medications. However, a recent study has found compelling evidence that one form of behavioral therapy, called “Family-Based Exposure Therapy”, may be a particularly effective approach to pediatric obsessive compulsive disorder treatment. 

How is Obsessive Compulsive Disorder Diagnosed in Mansfield? 

Obsessive-Compulsive Disorder in Mansfield is diagnosed, usually by a psychologist or psychiatrist, based on an accepted set of diagnostic criteria. The ICD-10 lists the following criteria for a diagnosis of obsessive-compulsive disorder:

A. Obsessions and Compulsions.

·         OBSESSIONS are defined as:
 1.) Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, are intrusive or inappropriate, and cause marked anxiety or distress.
2.) The obsessions are not exaggerated real-life worries
3.) The person attempts to ignore or suppress the obsessive thoughts, or to neutralize them with a different thought or action.
 4.) The person recognizes that obsessional thoughts arise within their own mind, rather than delusionally believing they have been “inserted” by an outside party

·         COMPULSIONS are defined as:
 1.) Repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession, often according to rules that must be rigidly adhered to
2.) These behaviors or mental acts are aimed at preventing or reducing distress preventing a dreaded turn of events, BUT these behaviors are excessive or irrational and not connected to the thoughts and anxieties in a realistic way.

B. The person has recognized that the obsessions and compulsions are not reasonable or rational. (This does NOT apply to children.)

C. The obsessions and compulsions are distressing, time-consuming, and interfere with a person’s normal activities.

D. The obsessions and compulsions are not restricted to another comorbid disorder (such as generalized anxiety or major depression).

               

To diagnose a child in Mansfield with obsessive compulsive disorder, a psychiatrist or psychologist must rule out other possible diagnoses, including autism-spectrum disorders, attention deficit disorders, and other anxiety disorders. 

Family-Based Exposure Therapy: A Promising New OCD Treatment for Pediatric Patients 

Obsessive-compulsive disorder in children can be difficult to approach and treat. In Mansfield adults, SSRI medications are sometimes incorporated into treatment for obsessive-compulsive disorder. Although these medications can be effective for anxiety and depression in adults, however, they are not recommended for children. A better approach for treating obsessive compulsive disorder in children is to use behavioral therapies, such as cognitive-behavioral therapy or talk therapy.

Recently, a study conducted by the Bradley Hasbro Children’s Research Center has found that a technique called “family-based exposure therapy” was an especially effective approach for treating obsessive compulsive disorder in children between the ages of 5 and 8. Although CBT therapies have been well substantiated in adults and adolescents, there had previously been little research into their efficacy for young children.

Exposure therapy is often used to treat anxiety disorders in Mansfield, including obsessive-compulsive disorder. Exposure therapy is based on behavioral principles of “respondent conditioning”, famously discovered by Pavlov. This therapy approach aims to identify the thoughts and feelings leading to the anxiety response when a “trigger” is presented, and at reducing those responses though exposure to the stimulus. The “family-based” aspect refers to keeping the child’s family informed and involved in the treatment.

NEUROFEEDBACK FOR OCD

Warning: These Five Herbal Supplements May Be Harmful to Your Health

Many people in Mansfield use herbal supplements to either to treat a health condition or to increase their overall wellness. Although most herbal supplements are not FDA approved for the treatment or prevention of any diseases, and have not undergone rigorous, controlled peer-reviewed testing, most are benign; however, there are some supplements that could actually hurt you. There are five herbal supplements that may actually be harmful to your health and you may want to avoid if you’re interested in exploring alternative treatments like herbs and other supplements. 

#1: Colloidal Silver

Colloidal silver consists of particles of silver suspended in a liquid solution. In the early 20^th century colloidal silver was sometimes used for antibiotic purposes, but by the 1940s it had been supplanted by newer, safer antibiotics. However, in the 1990s colloidal silver experienced a resurgence as an alternative remedy. No one has yet produced any evidence that silver has any health benefits, although much evidence of its adverse effects has been produced. A 2012 study indicated that when applied topically to a wound, silver may actually worsen healing time. Silver is essentially toxic. Silver does not play any role in the human body, and can accumulate to toxic levels over time. The chronic use of silver-containing products can cause a condition called argyria, in which silver or silver sulfide particles accumulate in the skin and can cause cosmetic disfigurement. Because no one has found colloidal silver or other silver-containing supplement products to be effective, and because they can actually harm your health or even cause an allergic reaction, you’re much better off using a clinically proven antibiotic instead. 

#2: Aconite

Aconite is derived from a poisonous plant called monkshood (Aconitum napellus). It has been used traditionally in both Chinese and Indian Ayurvedic medicine to treat pain-related conditions such as arthritis; however, no supporting evidence of any anesthetic or analgesic effects has ever been produced via scientific study. In fact, it has been shown to be toxic to animals, including humans. Aconite can cause nausea, diarrhea, and heart arrhythmias, as well as muscle weakness and dizziness. Since this poisonous substance has no proven health benefits, it’s best avoided. 

#3: Greater Celandine

Greater Celandine (Chelidonium majus) is used as a mild sedative, as well as a treatment for liver ailments and gallstones. However, little evidence has been produced for these benefits, while evidence does suggest that this plant may be hepatotoxic and cause liver disease. This plant is best avoided. 

#4: Germanium

Germanium—not to be confused with geranium, the flower—is a trace element; #32 on the periodic table. It has been promoted as a treatment for a variety of disparate ailments, including leukemia, asthma, diabetes, hypertension, fatigue, hepatitis, and Parkinson’s disease. None of these claims has been verified with scientific evidence, but germanium has been linked to liver and kidney damage. Germanium really doesn’t belong in your body and has no proven health benefits, so health-conscious Mansfield residents may want to avoid this one. 

#5: Comfrey

Comfrey is the common English name for plants in the genus Symphytum. Although this family of plants has a history of use in herbal medicine, it may not be good for your health. Although some evidence of the benefits of topical use has been produced, comfrey should not be ingested. This plant contains large amounts of a substance known as pyrrolizidine alkaloids, which are hepatotoxic. Ingestion of comfrey can lead to veno-occlusive disease (VOD), a condition in which small veins in the liver become obstructed. Although topical solutions containing comfrey might be beneficial, you should never ingest it. 

Most herbal supplements you’ll find are helpful at best and benign at worst; however, there are a few traditional medicinal herbs and supplements that have actually been shown to have negative health effects. These include silver, aconite, greater celandine, germanium, and comfrey. To preserve your liver and heart health, you should steer clear of supplements containing these ingredients, and find scientifically verified alternatives instead.

ALTERNATIVE MEDICINE IN BOSTON

EEG Neurofeedback in Norfolk County, Boston

A Brief Guide to EEG Brainwave Frequencies

Neurofeedback therapy, available in Mansfield and Norfolk County, is a cutting-edge new approach to managing the symptoms of a wide variety of disorders, including attention deficit hyperactivity disorder (ADHD), anxiety disorder, migraine headaches, and other psychological and pain disorders. Neurofeedback therapy uses electroencephalography (EEG), in which electrodes are attached to the scalp to measure the frequencies of electrical oscillations generated by collections of cells in different regions of the brain. Research has indicated that many conditions, including ADHD and anxiety, are associated with abnormal brainwave frequencies in certain areas of the brain that differ from those of “normal” individuals. Neurofeedback uses sound and images, often in a video game like setup, to teach individuals to consciously alter these frequencies to improve psychological or pain symptoms. There are several types of brainwave frequencies, which are associated with different states of consciousness and types of mental activity. These neural oscillations are referred to as “brainwaves” because, when displayed as an EEG reading or expressed using mathematical equations, they take the form of a wave. There are alpha, beta, theta, gamma, and delta frequencies. This article is a brief beginner’s guide to what these frequencies mean.

Alpha Brainwaves

Alpha waves are defined as neural oscillations that fall within the frequency range of 7.5-12.5 Hz. Alpha waves are notably generated in the occipital lobes, the region of the cortex at the back of the brain associated with visual processing, when a person is awake with their eyes closed. Alpha frequencies are associated with relaxation. Early work with EEG neurofeedback was focused on training people to enter the “alpha state” more easily. Alpha biofeedback has potential applications for treating depression, as well as seizures. Some types of zen meditation are associated with increased alpha waves. They are associated with a mentally restful state, as opposed to active mental attention.

Beta Brainwaves

Beta brainwaves have frequencies ranging from 12.5 to 30 Hz. Beta states, unlike alpha states, are associated with normal waking consciousness and active mental attention. Neurofeedback therapy for ADHD involves using EEG feedback to change from alpha to beta frequencies in certain areas of the brain, including the prefrontal cortex, to increase attention and reduce impulsiveness.

Delta Brainwaves

Delta brainwaves are high-amplitude, low-frequency brainwaves that fall in the range of 0-4 Hz. Delta waves are most strongly associated with deep non-REM stages of sleep, which is known as “slow-wave sleep.” EEG studies of infants and young children have shown that infants spend a lot of time in slow-wave sleep, and that even during wakefulness, children from infancy to as old as five years produce delta waves. Disruptions of delta states are implicated in a number of disorders. For example, in fibromyalgia, research using EEG neuroimaging has revealed the presence of alpha wave intrusion during sleep, when alpha waves appear when actually delta waves should be predominant. This involvement of brainwave frequency in sleep in people with fibromyalgia has led researchers to explore the potential of neurofeedback therapy for treating this difficult and pervasive disorder. Another disorder involving delta-wave dysregulation is schizophrenia. Reduced delta wave activity during sleep, along with increased delta activity during wakefulness, have been shown to correlate with negative symptoms of the disorder such as amotivation, poverty of speech, and the inability to experience pleasure. Disrupted delta wave activity is found in a wide range of other disorders, including depression, anxiety, obsessive-compulsive disorder, and narcolepsy.

Theta Rhythms

Theta brainwave rhythms have frequencies of 4-7 Hz, and are detectable with EEG sensors when emitted in the cortex. Cortical theta is most common in young children. In adults, it often appears in drowsy or deeply meditative states, though not in the deepest stages of sleep. It is associated with REM sleep (rapid eye movement), which is when most dreams occur.

Gamma Brainwaves

Gamma frequencies range in frequency from 25-100 Hz. Research into gamma waves has provided evidence that these frequencies may be heavily involved in what we experience as subjective consciousness. These frequencies have been observed in association with the coordination and synchronization of different brain areas involved in conscious awareness, notably visual awareness. Interestingly, EEG neuroimaging research involving monks in meditative states have demonstrated a correlation between gamma activity and transcendental states of consciousness. In a 2004 study, when Tibetan monks were instructed to generate a sense of compassion, they correspondingly generated rhythmic, coherent activity in the 25-40 Hz range. Gamma synchrony may be involved in the bliss, compassion, and tranquility associated with transcendental meditative states. Neurofeedback training may one day be used to help train novice meditators to achieve these states of consciousness, although scientists are still exploring the role of gamma waves in consciousness.

Neurofeedback therapy in Mansfield works by using EEG measurements of brainwave frequencies to help train people to learn to alter their brainwave frequencies at will. Many psychological and pain disorders, including ADHD, anxiety, and fibromyalgia, have been shown to involve underlying brainwave dysregulation. Using neurofeedback therapy, you can actually learn to change these frequencies at will. For example, a child in Mansfield with ADHD may have excessive alpha activity in some brain areas, and can be trained to change to beta frequencies associated with mental focus and concentration. Neurofeedback therapy in Mansfield is an excellent therapy option, and lacks many of the side effects associated with various medications.

EEG NEUROFEEDBACK - HOW IT WORKS

Concussion Treatment in Boston

How Doctors Handle A Blow to the Head 

A concussion is defined as a brief and transient loss of consciousness, often with a brief period of amnesia, resulting from a blunt impact to the head. The most common causes of concussions are falls, car or bicycle accidents, and sports injuries. Concussions can vary in severity. Although there is not one classification system for concussion severity that is universally agreed upon, the American Academy of Neurology guidelines divide concussions into grades:

·         Grade I: There is no loss of consciousness, and symptoms of confusion and disorientation last for less than 15 minutes.

·         Grade II: There is no loss of consciousness, but symptoms of confusion and disorientation last for longer than 15 minutes.

·         Grade IIIa: There is a loss of consciousness lasting for less than a minute.

·         Grade IIIb: There is a loss of consciousness lasting for minutes.

In movies and television shows, it is not uncommon for a character to be struck on the head and lose consciousness, and then “come to” hours later. This is highly unrealistic; the longer someone is unconscious as a result of a concussion, the more severe the concussion and the higher the risk of permanent brain damage. In real life someone will not lose consciousness from a head impact for hours on end and then wake up perfectly fine!

Concussion treatment is usually the domain of a neurologist, a doctor who specializes in the diagnosis and treatment of nervous system injuries and disorders. When a concussion results in loss of consciousness, the person often experiences some degree of amnesia as well. This may take the form of anterograde amnesia, the inability to retain new information, or retrograde amnesia, the inability to remember what happened before the injury. In most cases, the amnesia improves in a matter of hours, and does not result in a loss of autobiographical information such as the person’s name and birthday. 

How do Doctors in Boston Respond to a Concussion? 

When a concussion occurs, even a Grade I concussion, medical attention should be sought right away. Proper concussion treatment is important to evaluate the severity of the injury, the extent of damage, and to plan for appropriate treatment. The first step after a concussion is often to check the patient for any sign of neck injury. If the patient has neck pain, this could indicate a neck injury, and cervical immobilization is usually required. The next matter of concern is whether the impact has caused a brain hematoma. A hematoma is a collection of blood outside the blood vessels. This is very serious, but fortunately, less than 10% of concussions result in hematoma, and less than 2% require neurosurgical intervention. A hematoma can be detected with a CT (cranial computed tomography) scan. A neurological evaluation is given, with signs like poor arousal or hemiparesis indicating the need for a CT scan. The patient will also be evaluated to ensure that the skull has not been fractured.

After the concussion, the patient will need to be monitored for a period of time. Usually, a person with a normal neurologic examination after a minor concussion will be observed for two hours. If the patient’s CT scan has revealed small surface contusions on the brain or limited hemorrhage, which may not produce symptoms beyond a headache, a longer period of observation or overnight hospital stay may be required.  

After the Concussion: Watching for Signs of Post-Concussion Syndrome 

Post-concussion syndrome (PCS) is a constellation of symptoms that may persist for days, weeks, or even longer after a concussion occurs. It is estimated that a post-concussion syndrome occurs in around 15% of patients who have had a concussion, and it generally subsides after a period of time. 

Symptoms that indicate a post-concussion syndrome include:

·         Headache

·         Dizziness

·         Blurred vision or double vision

·         Ringing in the ears

·         Increased sensitivity to light or noise

·         Insomnia, fatigue, or other sleep problems

·         Irritability

·         Anxiety

·         Depression

·         Mood swings

·         Changes in personality

·         Problems with attention and memory, especially short-term memory

·         Cognitive deficits

Concussion treatment for post-concussion syndrome in Boston generally involves treating individual symptoms. Pain relievers may be used for headaches, antidepressants for mood changes, and sleep aids for insomnia. About 50% of people with post-concussion syndrome are referred for psychotherapy as part of their concussion treatment. Evidence has shown psychotherapy to be effective in reducing cognitive and affective symptoms associated with PCS. Neurofeedback therapy has also shown promise as a treatment for PCS.

With proper concussion treatment and management of a post-concussion syndrome, if it occurs, most patients have an excellent prognosis. Symptoms usually resolve completely over time, and approximately 67% of concussion patients are symptom-free three months after the injury. Excellent concussion treatment is available in Boston, both to evaluate damage and severity after the injury, and also to manage a post-concussion syndrome, if it occurs. Recently, neurofeedback therapy has become available in the Boston area, providing an exciting and highly effective new approach to managing post-concussion syndromes. Thanks to advancements in modern medicine, most people who suffer a concussion have a favorable outcome.

BOSTON - NEUROFEEDBACK THERAPY FOR BRAIN INJURY