ISNR 21st Annual Conference 2013 Dallas, Texas L.A.Parkinson, A.J.Parkinson. BrainHealth, London

1. An Evaluation of the Psycho-physiological Concommitants of Increasing Alpha Wave Amplitude in Anxiety and Stress Disorders ISNR 21st Annual Conference 2013 Dallas, Texas • L.A.Parkinson, A.J.Parkinson. • BrainHealth, London

2. OUTLINE • The Importance of Alpha Brain Waves • The Brainstem involvement • Sensory –Cognitive Integration • Arousal • What is Cranial Electrotherapy Stimulation? • The Alpha-Stim • The Pilot Study • Summary • Mediating Mechanisms • Re -evaluation

3. The Importance of Alpha BrainWaves • Hans Berger first described the Alpha Waveband in 1929 (8-11Hz, rhythmic) • For many years thought to be associated with calm relaxation – even “zoned out” or idling state of the brain • Parkinson (1973) used alpha-wave training to induce relaxation in patients with agoraphobia.

4. Objectives WHAT is ALPHA ACTIVITY? Basanova 2009 • Brain dominant oscillations frequency in posterior area • Amplitude suppression in response to eyes open • Alpha bursting spindles eyes closed - EC eyes open - EO

5. Objectives Psychometric characteristics associated with alpha activity indices

6. Also Sensory Motor Strip Rhythm Mountcastle(1992) found that the alpha-wave band facilitates the integration of brain activity triggered by sensory stimuli with the activation of the neural images of current or past experience

7. Mountcastle(1998) “Using brain oscillations has become one of the most important conceptual and analytic tools for the understanding of cognitive processes.” Gebber et al(1995)found that the alpha-wave has the best test – retest reliability of all brain waves and is an intra individual stable trait.

8. Basar(2011) “Alpha is one of the fundamental functional operators of the brain for signal processing and communication in the sensory-cognitive field”. • Barman and Gebber(1993&2007) Alpha operating oscillations are found also in the spinal cord

9. The Brainstem • Hernandez-Peon(1961) The brainstem reticular system is a region where all sensory modalities converge • Basar(2012) The core of the brainstem may be viewed as a form of “high command” which constantly receives and controls all information from the external and internal environments.

10. The Alpha Rhythm • Steriade et al (2001) • : is generally considered an index of vigilance or arousal. • Vecchiato et al (2011) • :is widely used as an index of evaluation for relaxation or pleasure in neuromarketing.

11. Alpha Rhythm and ANS • Pineda(2005) Rhythmic oscillations in alpha become coherently engaged in transforming perception into action …a 10Hz rhythm reflects the organisation of a brainstem network that governs Sympathetic Nervous System overflow. • Fight Flight or Freeze . Anxiety/Fear Response

12. What is Cranial Electrotherapy Stimulation(CES)? • It is the use of variable current (0.5Hz pulses per second) applied to the brain with the aim of inducing the cortex to produce an increase in alpha-wave activity. • It also activates neurons in the brainstem.

13. The Alpha-Stim AID

14. The Alpha-Stim M For Pain

15. Research With Alpha-Stim • Approx. over 100 research reports • The Science of CES • www.Alpha-Stim.com

16. Key Findings on the Use of the Alpha-Stim 100/M Pain • That nerve pathways that project into the brain and spinal cord were activated. • Including the Serotonergic (5-HT) Raphe nucleii which inhibit the cholinergic and nor-adrenergic systems • Thalamo-cortical activity was suppressed reducing arousal and agitation

17. The Use of The Alpha-Stim 100 • Alters sensory processing and induces alpha-wave activity • Modulates pain perception • Alters pain perception, cognitions and emotionality through the limbic fore-brain

19. The Study Procedure • Patient population complaining of Stress or Anxiety but not on any medication or UDS • DASS – Depression, Anxiety & Stress Scale (Lovibond & Lovibond 1995) Excluded if scored 14+ on Dep Subscale 16 participants (8 males, 8 females) Age Range 24 – 63 years

20. Baseline CNS monitoring at Cz Midline of SMS delta 1 – 4 Hz theta 4 - 7 Hz alpha 8 – 11 Hz lo-beta 12 – 15 Hz beta 16 - 20 Hz hi-beta 21- 30 Hz gamma 38 – 42 Hz

21. Put on one month waiting list • Then Re-Assessed : CNS and DASS • Provided with Alpha-Stim for 2 months Home Use – 20 minutes per day. • Re – Assessed CNS and DASS

22. Results • Mean Alpha Wave Amplitudes T1 T2 T3 3.71 4.23 6.52 T1 to T2 ns T2 to T3 p < 0.05

23. Results T1 to T2 ns T2 to T3 p < 0.05

24. Results: DASS Mean Scores Depression T1 T2 T3 10.2 9.8 8.4 (mild) (normal) (normal)

25. Results: DASS Mean Scores (Mild) (Normal) (Normal)

26. Anxiety Mean Scores T1 T2 T3 15.6 15.2 8.2 (severe) (severe) (mild) T1 to T2 ns T2 to T3 p< 0.01

27. Results (Severe) (Severe) (Mild) T1 to T2 ns T2 to T3 p < 0.01

28. Stress Mean Scores T1 T2 T3 26.7 28.2 16.2 (severe) (severe) (mild) T1 to T2 ns T2 to T3 p< 0.01

29. Results (Severe) (Severe) (Mild) T1 to T2 ns T2 to T3 p < 0.01

30. Summary So Far Using CES led to a significant increase in alpha - wave activity and to a significant decrease in self – report measures of stress and anxiety. The importance of the alpha – wave in therapeutic progress should not be under estimated in view of its role in the sensory – cognitive field, the processing of unwanted images and the amelioration in levels of stress and anxiety. This was a pilot study and further research is needed. There is likely to be greater clinical applicability than is currently realised.

31. Mediating Mechanisms? Why Does It Work? What Is Going On?

33. Omata et al(2013)Department of Functional Brain Research, Tokyo • Using EEGs and FMRIs with alpha rhythm • The slow fluctuation component is correlated with signal changes in the brainstem, the medial thalamus and ACC • The fast fluctuation component is correlated with signal changes in the lateral part of the thalamus and the ACC but NOT the brainstem

34. Some Other Clinical Applications • Depression • Insomnia • Addiction Withdrawal • Multiple Sclerosis • As a Potentiator • Pain

40. Methadone Self Withdrawal Study Gomez et al (1979) Brit. J. Psychiatry 28 Heroin Addicts 3 groups – CES, Sham CES, Placebo Over 10 day period CES group reduced Heroin significantly from 42mg to 12mg Sham from 42mg to 37mg Placebo Control (WL) from 42mg to 41mg

42. Mood, Addiction and CES • USA retrospective study. • 200 patients with alcohol, cocaine, heroin or prescription meds addictions in 28 day in-patient setting.

43. Profile of Mood States % Improvement Pre-Post StateWithout CESWith CES Anxiety 20 92 Depression 19 142 Anger 27 58 Lethargy 5 38 Fatigue -20 78 Confusion 2 76

45. Fibromyalgia • Lichtbroun et al (2002) Double blind study: Alpha Stim, Sham or Control • Significant improvement in pre to post tender point pain ratings in CES group

47. La Jolla CES Open Clinical StudyTyers (2000) • 28 Started study: daily 60 minute CES treatment for 3 weeks • 19 completed and found improvement in:- • Tender points, self rated pain, sleep, feeling of well being, quality of life. All changes significant

49. Tyers (2000) cont: • Significant improvements in the 19 :- • Anxiety, Depression, Anger, Lethargy, Fatigue, Confusion, Total Mood Disturbance