Len Ochs Voice: 510.906.0422
E-mail: [email protected]
The map is done at 1:1 (green, masked).
There is nothing automatic about the map program in the report assembly period. Merging different files has to be done manually, as well.
The order of visiting the sites was never clearly specified by me. Here it is:
Outer circle: FP, FP1, F7, T3, T5, O1, O2, T6, T4, F8, FP2,
Inner circle: F3, C3, P3, P4, C4, F4,
Midline: FZ, CZ, PZ, OZ
What do I need to do so that if I have to use the restore routine, these new setups will be included in the restore?
Use PKZIP to create a new PGM.EXE file in two steps, and copy that file to the EDSBU directory.
c:\pds\pgm> pkzip pgm.exe *.*
c:\pds\pgm> zip2exe pgm
c:\pds\pgm> copy pgm.exe c:\edsbu (and respond "y" to the overwrite? query.)
Do you have a version of the informed consent drafted for parents to sign
for their children?
On the last page of the informed consent there is a space for parent/guardian if the child is below legal age.
What other clinicians are doing good work with children?
Do you mean which other clinicians? Mary Lee is working with a four-year old; Ellen is working with an 11-year old. Susan has worked with a couple of pre-adolescent kids who were very difficult. It's spotty
Do you (and colleagues) have any experience with PMS? My own experience with conventions neurofeedback is that it is probably a revolutionary treatment for PMS.
No PMS experience that I know of.
Regarding the informed consent: when you mention rebound effect and the
other negative things, how often have those things applied to kids with ADHD?
As little or as much as with anybody else.
What are the most typical side effects seen in the average ADHD treated
And to the extent they apply, is it accurate to say that frequency and
magnitude of negative events is less than you've seen with, for example, head
injured patients you've treated?
I don't understand your question: are you asking "are the side-effects with ____?___ less than I've seen with head injury?"
I'm guessing here that the range and magnitude of the negative side you
mention may have been partly formulated on the first work you did with the
head injured population.
Side effects have varied with poor control of lights, first, sessions which turned out to be too long, second, and not hitting enough of the right sensor sites during the same session, third. Diagnosis has been irrelevant.
A corollary to the above: is it the case that with the map and with the "more gentle" approach to treatment that you are currently advocating, that the number and magnitude of side effects is decreased? Here's what I'm getting at: I want, of course to accurately represent the down side of this, but I want to put it in context. The PDR lists every conceivable negative possibility, but most of them are low probability occurrences. I will use the bulk of your consent language, but what can I say to people to help put it in perspective?
"Temporary side effects during treatment will occur if you have bodily change during treatment, or if we don't get the treatment just right immediately. The most frequent kinds of body change that leave side effects are on-coming colds, flues, viruses, allergies, hormonal changes, and medication changes. Treatment conditions that lead to side effects are if the lights are too bright, the sessions too long, or if a number of locations on your brain are over active in the same way and we can't locate them to work with them at the same time. It may take a while to successfully correct these problems for any individual, since everybody is a little different. But once these problems are identified, the side effects have almost completely been resolved rapidly. Nobody has ever encountered a symptom which they have never before had: that is, only old or current symptoms have been temporarily been awakened. Your information about what happens to you during and in-between treatments is essential to us to help care successfully for you.
There are some side effects that occur after treatment. The brain gets a little used to the simulation, and it takes time for it to make use of the treatment and spread its helpful effects to areas of the brain that were not included in the treatment. Your information about what happens to you after treatment is essential to us to help care successfully for you.
Last, some people feel as if the treatment is not successful because they are even more sensitive afterward than before. In fact, they are less hypersensitive but more aware of, and clearer about, things. Although they feel and see things more clearly, they are less reactive, find that they can control their lives more easily, and have more resources to make the changes in their lives that must be done."
How did you arrive at the rule of generally not more than 5 minutes at any site? What did you observe that led to this observation?
(1) It takes about five minutes to assess whether a site will react with decreasing amplitude and SD, and before I know whether I need to make a change to accelerate the drops or to move on. (2) If I spend too long at a site then I won't have enough time to move on to other sites to balance off success or attention to any particular site. (3) Either the amplitude/SD drops, or it doesn't. In either case, other sites need to be worked with to counterbalance the attention to the site. (4) Sometimes there will be a subjective discomfort at a site, which warrants moving on more rapidly.
With the map guided and more gentle approach, is it likely that the 5 minute limit is still important?
Yes, for the above reasons.
What are the indicators that someone should probably not go more than 1:1 at any site?
Subjective discomfort, rising amplitudes and variability over the entire course of the five minutes.
With someone like me with a few high sites, but sensitive to more than 1:1, what would you do with me over time?
(1) Have very short sessions consisting of very briefly visiting multiple sites per session, and repeating visits to the same multiple sites with succeeding sessions until the levels drop. (2) Having the courage to keep the session length minimal. (3) repeatedly reminding you of the reasons for doing so.
Have you written anything that would enable us to see representative treatment courses over time so we get an idea of the ebb and flow of this beyond the first session or two?
No, not yet. But it's a good thing for me to do.
Note: my experience with setting up the two computers to run your stuff leads me to think that the systems are not as "touchy" as we may have thought.
You haven't had the experience of a number of continuing nightmares: beginner's luck.
How easy would it be to modify the map software so that at the end of data acquisition at a given site it goes into pause and stays there until it is manually taken off, at which time, when the pause is manually lifted, the next site begins gathering data without any additional pause.
In other words, it would be desirable to eliminate the mandatory pause time
for people who want to control it manually. The benefit is that for people who
want to do it manually (please resist the obvious word play here) it would
appreciable reduce the time required to do a map.
Answer: It is a simple matter to extend that pause time to five minutes, permitting oodles of time. Please remember that there needs to be at least 18 seconds after the electrode is connected for conductivity to be re-established. Please remember, also, that the automatic hold can be defeated at any time simply by clicking on "skip" at the top of the screen.
If it, for whatever reason, is possible to do only part of a map in a given session, what is the easiest way to continue the map at a subsequent session?
When the person comes in to continue the mapping,
1. Session -> Load Patient Settings (Select patient name). This will show you your last sensor site. Change to the next site and proceed.
2. Save each session and either run the Word macro on them as they are completed, or do them all, one at a time, after the map is completed.
3. Open each of the Word map reports and have them all on the screen. Clean up the data to permit 4 rows per site. Copy the data from the earliest session to the
latest one on the map template and you're home.
DATABASE INQUIRY: I'd be interested in knowing whatever you can tell me about outcome information to date with chemical dependency.
Ans. We've had less than 5 patients who are chemically dependent, so there's nothing to say at this time. The data will bounce around too much until we have over 10 patients.
After I started EDS, all of a sudden I faced a DOS screen, black background with white lettering. What do I do about it?
One or more of the files in PDS or EDS has been corrupted, and the file fragments begin to act like a virus. PDS tries to load them and chokes, flipping the control of the computer back to DOS.
The solution is to run Restore, located in the C:\EDSBU directory. Restore should also be able to be run from the PCSHELL menu (if you are using PCSHELL). Restore actually erases all of the corrupted files and file fragments from the PDS directories before re-installing PDS and EDS. Simply re-installing PDS from the original installation disk will no erase all the corrupted files.
When proceeding up a delta map, working five minutes per site for four sites per session, generally at 1:1, if the patient reports that the feedback is making him tired OR that his heart rate is increased, Or, respiration has increased, would that be sufficient to consider doing less, to cut back in some manner.
I'm working with a head injured guy, working up the delta map, generally
spending five minutes per site, 1:1. Here I am not really rechecking the
levels, but simply proceeding up the map, five minutes at each site. Once I
get to the end of delta sites, what next? Would you simply go onto the alpha
I tend to re-map, based on the changeability of levels at various locations. See if there are any delta sites still high, re-treat them, and then approach the alpha sites in the specified order of the alpha graph.
What do you mean by "changeability of levels at various locations."
If the site Delta activity is very much lower (or higher) as I proceed through the Delta site treatment, then I'll remap, as I will do on completion of the Delta treatment and I find the Alpha site activity very different than it was in the original mapping. If I don't do this the order in which I approach Delta or Alpha treatment will not follow the activity ranking as it really is at the time.
I'm working with a patient that gets somewhat anxious at 1:1. Would that in
itself suggest staying at 1:1.
You bet. Shorten the length of treatment time, re-check the map and go to sites with less reaction.
About discomfort and deciding whether to increase or not. What do you do in
terms of decisions about increasing brightness or not, when you observe
increases in delta or alpha levels in response to brightness increase, but the
patient does not report any subjective change?
I go by the most sensitive indicator, objective or subjective. So if it's just the EEG that acts up, then that's what I go on.
The above implies the following question: in the normal course of working
up the map, how much rechecking do you do? How do you make judgments about how much overlap as you work up the map.
I'm much less strict about looking for decreases the first times through -- as long as there are no increases. I keep on going back reiteratively to previous, lower, sites, getting more perfectionistic about dropping delta amplitudes each time.
If values are low in a delta site for example, would he still spend 5 minutes at it before moving on.
No. My suggestion is that stay _no longer_ than 5 minutes at a site. However, if the delta is low, stay no longer than an additional 30 seconds before moving on.
Re: No. My suggestion is that stay _no longer_ than 5 minutes at a site. However, if the delta is low, stay no longer than an additional 30 seconds before moving on.
In the instance where delta is low at several sites successively, might you do 30 seconds at a site several times, perhaps doing 8 or 10 different sites in a given 20 minutes of overall feedback?
It would be nice to have numerical readings of movement to moment averages for each band. (in addition to derivative information that lets us know if things are moving in the right direction.
Given the change in your thinking regarding the desensitization process, is it still likely that there will be times when we want to use red goggles? If not, I may swap them to Senetics for a back up pair of green goggles.
Yes. If someone comes in with energy and verve, feel free to think about desensitizing him or her - all the way including with red glasses.
When working from delta map, and you observe increase in alpha (or other
bands) I assume you would go after those elevations.
No, I wouldn't, at this point (try me again tomorrow, though). Here's my rationale: I consider the rise in alpha a normal compensatory movement for the delta drop. I'm more interested in inter-site delta dynamics at this point, and want to go on to work with delta at other sites, knowing that alpha can rise. If I go after alpha prematurely I won't adequately finish the delta work.
If you start to raise the duty cycle or brightness and initially and there is an amplitude raise in the band you are trying to drive down, does this suggest that you should stop, or back down?
Related to the last question: would you back down even in the absence of report of discomfort by the patient.
Yes, for the reason stated 7 questions up (About discomfort....
Regarding the rate of increase, do you always go from 1 to 50 duty cycle,
then 2:1, etc. Are there times when it is prudent to increase more quickly?
I try to be most cautious. My cue about increasing duty cycle/brightness in larger increments is the speed of adaptation of the person. If they say "OK" when I've increased the brightness 3 times within the same minute, then I double the increment. (good question: I don't think I said this to you before)
At one point raised the duty cycle to 15, delta and theta came down, alpha when up. What does this suggest?
The alpha compensations pointed to above. How long did you wait for alpha to come back down. I give them five minutes for it to come back down. if not, I'd drop back a little until I saw it come back down.
Patient reported "I notice my sinuses clearing up." Any experience withsinus head-aches or related problems? This is interesting because sinus headaches are one of the most frequent reasons people see an MD.
No experience with it. Develop a quickie questionnaire, have everybody fill it out, and assess results. Publish.
I've got a client with a thyroid condition. How do we tell if she needs to take less meds? What to look for on the EEG? What to look for in her functioning, etc.
How old is she? And, does can she detect changes in herself if she is still having her period? Her ability to detect these kinds of changes will give you an idea of how well she can detect thyroid-related changes in herself.
Review with her the effects and side effects she first had when she started thyroid, and how she ordinarily knows whether to take more or less. If she's been on it for awhile, she'll have some pretty good ideas. If she doesn't, then you'll have to have her keep a good eye on herself, from depression, irritability, to elation, and report these instances to you, and use these instances as a possibility that she needs to adjust meds.
I'm wondering how to download files from hard drive onto floppies on the PC?
From the DOS prompt:
c:\pds\data or c:\pds\report\
type the following:
copy whatever the name of the file is a:\
example: copy mbmap.xls a;\
or copy chewb003.doc a:\
Do this for each file to be copied unless they all have the same extension. In that case, type the following:
copy *.whatever the extension is a:\
example: copy *.xls a:\
Are residual effects of PTSD?
All you can tell is whether there is high amplitude at any location, and whether the problem is focal or generalized, but not its cause.
2. Any residual effects of Prozac? Can a map tell us that?
Not about Prozac residuals.
If so can I fax you the map so that you can tell her what you see?
I'll be willing to take a look at the map. Basically, all I can tell is if there's a problem, but not its cause.
If someone was using Crack Cocaine would you see unusually high Beta and
unusual hypersensitivity to the light?
Only sometimes...and a lot of other things could cause these problems.
If you see those two things in a session would you jump to the conclusion that young man was using?
If I'm doing 1:1 masked at a site and the patient begins reporting increased respiration or heart rate or anxiety, etc., you've indicated that one should cut back. When we are already doing 1:1 masked, the only way to cut back is to simply stop at the time of the reported sensations and go on to the next site. Is this what you are suggesting?
Yes. If you still find the cardiovascular reactions prominent at a few more sites, stop for the day.
Keep in mind about he above question patients are reporting only minor bouts of discomfort OR minor respiration OR heart rate increases. Do I understand that you would cut back in whatever way appropriate even in response to minor changes in the above?
The maintenance of subjective sense of comfort is the key issue. If there are cardiovascular changes without any subjective sense of discomfort, then you can proceed apace without cutting back. If there is discomfort, then cut back appropriate to the level of discomfort.
A woman patient reported "drowsiness" in response to a 1:1 masked placement, but described the drowsiness as pleasant. Given that you've said that feelings of tiredness are an indication to stop or cut back, what would pleasant drowsiness suggest suggest to you?
There's a difference between drowsiness and being pleasantly stoned, although the two can co-exist. Being stoned from the lights is fine; I'd still like to avoid drowsiness.
Regarding the situation where you are doing 1:1 at a given site and the patient describes increased heart rate OR increased respiration rate OR increased anxiety, etc.
1. You have indicated that if a patient is uncomfortable at a given site that you should stop, or back down. What if what is reported, i.e. increased heart rate, or in-creased respiration is identified as occurring, but not labeled as uncomfortable by the patient? Would you still discontinue at that point and go on to the next site?
Please see my previous response to this question.
2. What if the heart rate increase, for example, is described as really slight would you discontinue? And if so, would you discontinue as soon as the sensation is reported?
Yes, I'd move on even with slight discomfort.
3. How about the patient getting sleepy in response to a site. Would you discontinue?
I'd move on to the next site, and discontinue the session if the fatigue persists.
4. In general, if the patient describes something uncomfortable, do you discontinue at that point and go on to another site?
I've got an adult ADD woman who wants to do EDS, but can only come in two times per week. What do you think?
For conventional neuro I believe it is necessary to do at least two per week initially. I won't do less. In you experience is it worth perusing if we can only do two. A response by early next week would be appreciated because she is coming back in.
There is no absolute rule on treatment frequency. Treatment frequency is a function of the reactivity of the person. If the person can comfortably tolerate the demands of desensitization or daily treatment, daily is probably fine. However, some may well benefit from once or twice a week, others will maximally benefit from four minutes -- or a minute -- a week. And others will maximally benefit from 18 seconds/week. Feel free to experiment.
Addendum: this same woman just revealed that she has a significant history of bulimia, secondary perhaps to some early child abuse (not sexual). Any experience or knowledge of EDS impact upon bulimia?
Bulimia has responded with the usual range of success ranging from the startling to what has amounted to trench warfare, depending on how complex the issues are.
The last bulimic I treated "lost" her excessive appetite after one session, and did well through the next 10 sessions over three weeks. There was still more Delta EEG to be cleaned up. However because she was doing so well, and because I didn't know how perfectionistic I needed to be with her EEG, we discontinued treatment. Two months after treatment she became angry at the return home of her older sister and came in for a counseling session. She left happy, but again returned to her symptoms. I believe I needed to be a lot more strict about the criteria of average of 2 uV across the EEG spectrum.
As of 4/12/96