Concussion Chronicles Making my brain work again
The CDC estimates that 288,000 hospitalizations and 2.87 million emergency department visits are associated with a Traumatic Brain Injury (TBI) diagnosis in 1 year (1) and that the numbers have been increasing.
When you’ve got a broken leg, or a swollen joint, everyone can see your injury, but when it’s a brain injury, sometimes no one it able to see it. Many traumatic brain injuries get better, but a lot do not.
Of course these people often see the neurologist, as well they should, but other than physical and cognitive rest, people are not often given anything else to help make the symptoms better.
The FDA states clearly states, “The FDA has not yet cleared or approved any standalone medical products that are intended to specifically diagnose or treat TBI, including concussion.” (2)
However, what if there was something that could help these people get better, quicker? Neurofeedback may be one of those things. Neurofeedback involves the same type of technology that neurologists use to test for seizures, the EEG, but it quantifies the brain waves in different parts of the brain (Quantitative EEG i.e. a brain map). What is unique is that peoples’ injuries are different and this brain map can identify the part of the brain the needs to be worked on specifically. Once that information it attained, it can be uploaded to a computer that can develop a program of light and sound to be given through later neurofeedback sessions to help the individual’s brain recover in a way specific to that person.
Research is ongoing about how to make the neurofeedback better and better. (3)
The journal of NeuroRehabilitation reported on a small case series of people with more than 7 post concussive symptoms (4). They gave them 20 sessions of neurofeedback testing before and after with symptom surveys, formal neuropsychological testing and MRI brain scans. There was significant improvement in cognitive scores as well as concussion symptoms. Further, both gray matter and white matter increased so much that there was less than a 1 in 10,000 chance it could have happened by chance. In fact, the researchers could tell increased connections between different parts of the brain.
As long ago as the 1980’s a case series of 250 head injury patients were found to improve with 24 sessions of neurofeedback (5). In a study of memory deficit specifically in brain injury improvements, ranged from 68% to 181% in the group of patients with brain injury, because of the EEG biofeedback interventions (6). In another case series of 26 people significant improvement (>50%) was noted in 88% of the patients (mean = 72.7%). All patients that were employed before the injury returned to work. On average, 19 sessions were required. (7)
So if all these studies support it, why not approve it?
That’s not how the FDA works,
First, the FDA really likes randomized controlled clinical trials, but for head injuries it’s hard to do that in humans. How can you go around ensuring that the treatment group and placebo group get the same head injury? For some reason people don’t volunteer for researchers to hit them in the head.
Secondly, the FDA prefers really big trials and multiple large studies are better. By comparison, there was a chelation trial funded by the NIH, which studied chelation for over 4 and half years on 1,708 people with a prior heart attack. Amongst people with diabetes, it showed a very significant 43% decreased risk of death and a 41% lower risk of the combination of heart attack, cardiovascular death, all cause death, stroke, need for a stent, or being admitted to the hospital for angina.
That was an enormous benefit.
Did the FDA approve chelation at least for diabetes with a prior heart attack after that $30 million trial with a benefit better that any drug has ever shown?
They said “Impressive. Do the trial again, this time only with diabetics.” The first trial took about 5.5 years to finish. I think if I was a diabetic with a prior heart attack, I might not want to wait for the second trial.
Nothing like that has been done for Biofeedback. So, of course the FDA doesn’t feel there is strong enough data to formally approve it. Because of the ethical considerations, there never will be a perfect trial and even for a non-perfect placebo controlled case matched trial, no drug company will cough up that kind of money. How would it help them? The Neurofeedback makers don’t have that kind of money. And government grants are hit or miss.
So we may be waiting a while for a definitive trial, but in the meantime, could it help?
Yes it can.
And yes, we do have that at Health and Wellness of Carmel.
Please call today to schedule your initial brain map and neurofeedback sessions TODAY!
Bruce Thomas, MD
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. TBI: Get the Facts. cdc.gov/traumaticbraininjury/get_the_facts.html Accessed Aug 19, 2020
- https://www.fda.gov/consumers/consumer-updates/traumatic-brain-injury-what-know-about-symptoms-diagnosis-and-treatment Accessed Aug 19, 2020.
- Małgorzata Łukowicz3ABDEF, Juri D. Kropotov4,5, Izabela Herman-Sucharska, Jan Talar Evaluation of differentiated neurotherapy programs for a patient after severe TBI and long term coma using event-related potentials, Med Sci Monit, 2011; 17(10): CS120-128
- Munivenkatappa A1, Rajeswaran. 2020 J2, Indira Devi B3, Bennet N2, Upadhyay N EEG Neurofeedback therapy: Can it attenuate brain changes in TBI? 2014;35(3):481-4. doi: 10.3233/NRE-141140
- Ayers, M. E. “Electroencephalic neurofeedback and closed head injury of 250 individuals.” Head injury frontiers (1987): 380-392.
Thornton K. Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback. Journal of Head Trauma Rehabilitation, 2000;15(6), 1285-96.
- Walker, J. E., Norman, C. A., & Weber, R. K. Impact of qEEG-guided coherence training for patients with a mild closed head injury. Journal of Neurotherapy, 2002; 6(2), 31-43.