The Neural Plasticity Model of Fibromyalgia Theory, Assessment, and Treatment: Part 4
Research evidence to date strongly suggests that EEG neurotherapy can be an important tool for affecting neuroplasticity. From a “regulatory challenge” model point of view, EEG neurotherapy is a method of gently challenging the brain out of equilibrium or homeostasis, to which it will attempt to return. Successive, repetitive exercise of the brain’s self-organizing system will lead to an improved ability to maintain homeostasis and improved stability of the regulatory system.81
As mentioned previously there appears to be a significant alteration in the brain wave activity of people with fibromyalgia that is primarily reflected in an excess of slow wave activity. With respect to the treatment of fibromyalgia, EEG neurotherapy is primarily focused on the alteration of the slow wave activity through the reduction of slow wave amplitude. It is believed that the abnormal qEEG evident in people with fibromyalgia reflects a disregulation in the brain’s self-organizing system that results in a concentration of power in the slow wave frequencies (primarily theta, although some lower frequency alpha is also seen) and prevents the brain from shifting freely and appropriately in response to task demands. It is thought that this concentration of power prevents or reduces an individual’s ability to shift into slower delta frequencies in order to get deep sleep and prevents or reduces a shift into faster beta frequencies so sustained focused concentration can occur.
The basis for EEG neurotherapy comes from the current widespread acceptance of the concept that the brain’s neuronal connections are continuously being modified by ongoing experiences.184-187 Some of these changes include increases in dendritic length, increases (or decreases) in spine density, synapse formation, increased glial activity, and altered metabolic activity.188 Cerebral blood flow has been altered in response to photic and auditory stimulation as well.149
EEG neurotherapy may be presently subdivided into two subtypes based upon the conditioning properties — operant and classical. Operant conditioning techniques utilize certain features of the EEG, such as digitized amplitudes of selected frequency ranges, presented in a visual display on a computer screen to the patient in relative real time as a form of biofeedback. The patient’s task is to actively learn to modify these displayed features to achieve a pre-determined, specified goal of EEG change through maintenance of some “correct psychophysiological state.”
Lubar and his associates189 use an operant conditioning procedure in their neurotherapy protocol for treating attention-deficit disorder. In this procedure an active electrode is placed on the scalp over the brain at CZ or FZ and referenced to both ears (i.e., monopolar referencing setup). The goal is to decrease the level of theta and slow alpha activity while simultaneously increasing the level of low beta activity apparent in the EEG as recorded from these locations. A computer displays real-time information to the learner on the amplitude of the slow wave frequencies to be decreased as well as the amplitude of the low beta activity to be increased. When a pre-determined differential is obtained, the learner is rewarded with an auditory or a visual stimulus reinforcing the achieved pattern of EEG activity and the “mental state” that produced it.
Studies of the use of similar operant conditioning biofeedback techniques in treating fibromyalgia are extremely limited, with only anecdotal reports and uncontrolled studies of improvements reported. Controlled studies using such EEG biofeedback techniques in altering ADD dysfunctions (decreasing theta and slow alpha and increasing SMR or lower beta) demonstrate significant and long-term changes with improvements in functioning and measured intelligence noted (see Lubar55,189,190). Until more comprehensive research is completed, the use of this technique in treating fibromyalgia must be considered exploratory in nature.
Classical conditioning techniques utilize light, sound, kinesthetic, or electromagnetic stimulation to drive the brain and alter brain wave parameters. In the classical conditioning model, multimodal sensory stimuli in the environment are seen to contribute to the background EEG. A device is used to provide multimodal rate-modulated stimulation to drive the background EEG to a modified rate over repeated training sessions in which the random sensory stimuli in the environment are coincident with the rate modulated stimuli.135
There are two basic forms of classical conditioning EEG treatment — photic stimulation (or photic combined with auditory stimulation) and electromagnetic (infrared) stimulation. As with the operant conditioning programs, controlled studies are few, with most of the classical conditioning data coming from the treatment of ADD/ADHD191 and, in the fibromyalgia areas, from Siever192 and Ochs (research in progress).
Chaudhuri193 reported on the treatment of 23 people with fibromyalgia using EEG-Driven Stimulation® (EDS) (see Ochs194) to normalize brain wave activity. Patients averaged 25 hours of EDS therapy over a period of approximately 12 weeks. Nine patients showed significant improvement in their symptoms, 11 showed some improvement, and three showed no change by the end of treatment. No data as to what specific changes occurred is available.
Russell191 demonstrated that intermittent photic stimulation coupled with binaural sound, activated groups of neurons in the visual and auditory cortex. The rate of stimulation was controlled by the dominant frequency of each individual’s brain. Forty treatments produced significant improvements in cognitive functioning, which lasted over time (16 months). Micheletti has recently replicated these results.195
Siever192,196 has used similar techniques in treating fibromyalgia and chronic fatigue syndrome. Using photic stimulation (white light produced by incandescent bulbs covered by a translucent plastic sheet tinted light blue) and auditory stimulation (pulsing isochronal tones at a frequency of 170 Hz) techniques, Siever and his colleagues in a number of uncontrolled studies, have demonstrated significant change in a number of commonly reported fibromyalgia symptoms.192,196-198 Reported positive changes include a reduction in pain, anxiety, and fatigue.