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By JIM ROBBINS
Published: November 11, 1997
IN May 1987 Mary Obringer and her husband adopted
a 5-month-old South Korean infant. But there were problems with
the baby they named Max. ''He had speech disabilities, motor skill
problems, was hyperactive and had trouble concentrating,'' Ms. Obringer
said. He could not be in a large group of people without hitting,
kicking and screaming.
When he was 5, they started him in school in their
hometown, Jackson, Wyo., ''and it was clear right away he wasn't
going to be able to stay,'' Ms. Obringer said. Doctors diagnosed
his condition as attention deficit disorder, and put him on the
drug Ritalin, which helped. But he still had numerous problems and
stayed in a classroom for special students.
Ms. Obringer met a psychologist, Michael Enright,
who urged her to let Max try a new kind of biofeedback technique
in combination with the Ritalin.
''We started seeing immediate results,'' Ms. Obringer
said. ''Within a couple of weeks he could sit in a chair and not
fidget. Two years later, he was like every other kid. No kicking,
no hitting, no fighting.''
Max, now 11, has been in regular classes for several
years and does well in school, though he still takes Ritalin, at
a much lower dose.
The Obringers are among a growing number of people
who, concerned about the amount of drugs their children are taking,
are turning to a new kind of treatment called EEG biofeedback or
neurofeedback, a technique that reads a patient's brain waves with
standard electroencephalogram (EEG) equipment, and displays them
on a computer. Being able to see their brain waves, combined with
video games that they perform based on brainwave states, allows
patients and their doctors to exert a new level of control over
brain waves. And that, some researchers say, improves and sometimes
cures problems that have a physical component in the brain.
Prononents of the technique say some controlled studies
and a large number of positive clinical results show that neurofeedback
is very effective for patients with attention deficit disorder,
attention deficit hyperactivity disorder or hyperactivity, epilepsy
and closed head injuries.
Other scientists have a different view of the technique.
''It's highly experimental'' as a treatment for attention deficit
disorder, said Russell Barkley, director of psychiatry and a professor
of psychiatry and neurology at the University of Massachusetts Medical
School, and an expert on attention deficit disorder, which is known
as A.D.D.
''There's a tremendous placebo effect in a situation
like this,'' Dr. Barkley said. ''Case studies prove nothing because
they're totally uncontrolled.''
On the other hand, Dr. Barkley said, ''we don't have
any studies that say it's bad for you,'' adding: ''I don't think
it will do harm. But I don't think it should replace treatments
that are cheaper. Basically, it's buyer beware.''
The first part of treatment with neurofeedback is
a diagnosis by a doctor or mental health professional. In a typical
neurofeedback session, the user wears two sensing electrodes. The
brain waves are amplified and displayed on one computer screen,
while on the other a video game is displayed. The computer is programmed
to help the patient do well on a video game similar to Pac-Man,
when he or she is creating the right brain waves. Sessions take
30 to 60 minutes and vary in cost from about $60 to $100. Some health
insurance companies pay for sessions, and some do not. In Ms. Obringer's
case, the school system paid.
Biofeedback is based on a certain sort of electrical
activity in the brain, which produces what are called alpha waves.
The technique has been widely used since the 1970's to treat stress
and migraines, and to help manage pain, but some doctors are skeptical
about the wide range of claims attributed to biofeedback. In the
1970's researchers like Elmer and Alyce Green at the Menninger Clinic
in Topeka, Kan., found that biofeedback users could get into a deeply
relaxed alpha state in just a session or two.
But alpha waves are only part of the brain's frequencies.
There are several basic brain waves. Delta is the sleep state. Between
sleep and wakefulness is theta. Next is alpha, a relaxed and mentally
unfocused state. Beta brain waves indicate normal waking consciousness.
There is also something called sensory motor rhythm, or S.M.R.,
which is a similar frequency to beta waves. Sensory motor rhythm
governs body sensations and voluntary movement.
The new type of biofeedback trains the user in the
beta and S.M.R. ranges. ''It's a lot of old ideas put together and
made better by new technology,'' said Dr. M. Barry Sterman, the
research director for EEG Spectrum, a company in Encino, Calif.,
that makes EEG systems and treats patients. ''We can measure and
analyze things we never could before.''
For the past 30 years, working as a researcher at
the Veterans Affairs Hospital in Sepulveda, Dr. Sterman found that
by decreasing theta waves and increasing sensory motor rhythm he
was able to help some epileptics reduce grand mal seizures. Working
with people who did not respond to traditional therapies, Dr. Sterman
reported an 80 percent seizure reduction in more than 60 percent
of his patients.
Dr. Sterman, now a professor of neurobiology and biobehavioral
psychiatry at the School of Medicine of the University of California
at Los Angeles, says that biofeedback ''can activate neurons that
aren't being used, if they are intact.'' With more neurons, or brain
cells, working in the part of the brain that governs a problem like
epilepsy, for example, susceptibility to seizures drops. ''We're
not saying that people should go off medication,'' Dr. Sterman said.
''But it helps people reduce the amount they take.''
Other scientists are not convinced. Dr. Michael Goldstein
is a neurologist in Salt Lake City and chairman of the Practices
Committee of the American Academy of Neurology. He said that although
he was not familiar with the studies of neurobiofeedback and its
effect on epilepsy, there was no way such a system could work. He
attributed success stories to people who might be able to control
seizures naturally. There are some people who can do that, Dr. Goldstein
said. ''My guess is that would be one out of a thousand,'' he said.
A major proponent of neurofeedback is Dr. Joel Lubar,
a professor at the University of Tennessee at Knoxville. He created
the protocol for treatment of A.D.D. with neurofeedback in the 1970's
and has published a number of papers on the subject. He says 80
percent to 90 percent of people with attention deficit disorder
and its subcategory A.D.H.D., attention deficit hyperactivity disorder,
can benefit substantially from the treatment.
Another area where progress has been reported with
neurofeedback is in the treatment of closed head injuries, a banging
of the brain against the inside of the skull, which causes damage
to neurons. Symptoms range from psychological, like mood swings
and irritability, to short-term memory loss, to headaches, nausea
and blurred vision.
Dr. Jonathan Walker, a neurologist at the Neuroscience
Center in Dallas, has been treating mild closed head injury patients
with neurofeedback for three years. Of nearly 200 patients treated,
he said, ''the vast majority went back to work, got their memory
back, and their headaches and blurred vision went away.''
Many other uses of neurofeedback are being tried,
for everything from menopause to Tourette's syndrome, without any
sound evidence that it is useful in these cases.
Nor is the effectiveness of neurofeedback for A.D.D.
accepted. ''If someone says, 'is there proof this makes a difference
in the lives of children?' I would say no,'' said Sam Goldstein,
a psychologist at the University of Utah Medical School and an author
of a textbook on A.D.D. in children. ''I'm not saying it doesn't
work. But if you don't have the data, and I don't think they do,
you can't argue that it does work. They're overstating it.'
Dr. Goldstein also questioned possible long-term effects
of the treatment. ''When you ask them how messing around with the
brain waves of a 7-year-old is going to affect that person 10 years
later, they don't know,'' said.
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