LORETA: Theoretical and Clinical Concepts Conference

Instructors: Dirk De Ridder, Joel Lubar and Nicholas Dogris

Note Date Change: DECEMBER 4-7 | CANCUN, MX

PROGRAM:

Overview:

Neurotherapy, the integration of neurofeedback with non-invasive brain stimulation, is witnessing a revolution. Modalities such as LORETA (Low Resolution Electromagnetic Topographic Analysis) neurofeedback allow us to intervene more deeply into the networks of the brain that more directly control dopaminergic reward learning as well as our “default” sense of self and well being. There is now a transcendence of 10-20 site targeting with approach that involve Brodmann areas, functional networks, and current source densities. While this much is fairly obvious to the field., less obvious is the deeper neuroscientific reasoning being applied by our faculty to effect faster and more robust brain change. The best way to stay inspired and successful in any creative field is to keep close tabs on the innovators, as well as the practitioners who are field testing and adopting the latest technology.

In this unique event, we will offer a model to think about, explore and explain to others the science of electrophysiological brain change and it's near term capabilities. Within this framework, many recent developments in neurotherapy will undergo critical analysis and creative application; normative database referenced z-score training, brain network analysis and training, functional (i.e, correlational) and effective (i.e., directional) coherence and connectivity metrics, new types of 3-D training displays, and perhaps most centrally, a integrative view of brain change from a EEG feedback and brain stimulation perspective. What we do not take for granted here is our working knowledge and subsequent interpretation of brain anatomy, physiology and brain change dynamics as it is commonly linked to client symptoms or functional deficits. We take the stand that the earnest scientist/practitioner incurs a potential “debt’ or a relinquishing of control and understanding every time part of the clinical targeting process is “automated.” The interpretation of brain physiology as it indexes a patient’s EEG, and its intimate relationship to brain change dynamics, must be transparent if we are to communicate more effectively to the medical, scientific, forensic and legislative communities that help shape our work. Furthermore, the use of research findings OR commonly accepted clinical heuristics to drive training decisions for the neurotherapist must also be as transparent as possible, because it is the clinician who must make the final decision of how well research findings or heuristics apply to the unique clinical presentation at hand. The overarching goal of the conference, then, is to utilize our extraordinary faculty to re-think and re-clarify our scientific understanding of the new LORETA-based technologies and the exciting clinical possibilities that entails.

SCHEDULE

Thursday, December 4th, 2014 | 9:00am-5:30pm

AN INTEGRATED FRAMEWORK FOR UNDERSTANDING NON-INVASIVE ELECTROPHYSICAL BRAIN CHANGE TECHNOLOGIES
Presenter: Dirk De Ridder, MD, PhD
Chairman, Departments of Neurosurgery and Neuroscience, University of Otago, New Zealand 
Formerly, Neurosurgeon and Director of the Neuromodulation Lab at University Hospital, Antwerp, Belgium

(7.25 APA CEs)
Leveraging what we currently know about the brain in pathology and in health, we offer a model of the brain as a complex adaptive system; a hierarchically organized, partially modular, with overlapping networks, connectivity driven “small worlds topology” with emergent functional properties. We portray the brain as having evolved into a “prediction machine” possessing the strengths and liabilities associated with active (constructive) perception. Having reached a limit to what can be safely and effectively achieved via medication and poly-pharmacy, we begin by examining clinical brain change via invasive electrophysiological methods such as deep brain stimulation. In the desire to increase clinical effectiveness with less invasive methods, we come to focus upon both EEG feedback in its various forms as well as the many types of low energy brain stimulation methods as different forms ofneuromodulation, defined here as any form of electrical, magnetic, acoustic or optical influence leading to the excitation or inhibition of neurons, brain structures, connectivities and networks.

We first examine EEG neurofeedback from a conditioning perspective, based upon dopaminergic reward prediction and the correction of prediction error, particularly in the dorsal anterior cingulate cortex, insula and nucleus accumbens. We contrast this with a higher-order model of the brain as a “prediction machine” that implicitly uses Bayesian statistics, rewarding more complex goal acquisition via progressively more accurate predictions of the behavior of the outside world.

We end by summarizing the unique contributions of LORETA technology and suggest how it may continue to evolve and contribute to the future of neurotherapy.

Friday, December 5th | 9:00am-12:30pm

LINKING THE MOST APPROPRIATE HYPOTHESES CONCERNING PHYSIOLOGY AND QEEG ACTIVITY TO PATIENT SYMPTOMS AND FUNCTIONAL DEFICITS PART 1

Presenter; Joel Lubar, PhD
Professor Emeritus, University of Tennessee, Knoxville

(3.25 APA CEs)

The Symptom Checklist (SCL) in the Neuroguide LORETA Neurofeedback software is an important and perhaps necessary component in rationally targeting what is to be trained or modified in clinical work. The SCL is an attempt to apply the conclusions and evolving consensus of recent neuroimaging research on various brain and performance pathologies. As such, it helps to guide more inexperienced clinicians who have yet to develop a sophisticated working knowledge of applied brain physiology as it directly applies to the clinical interpretation of QEEG activity as indexed by a normative database. With experienced clinicians, the SCL provides an invaluable point-of-departure for the interpretive and treatment targeting process. In this presentation, we highlight the investigative process we undertake as we carefully compare everything we know about a patient’s presentation with the SCL’s treatment recommendations. We start by examining the “goodness of fit” between the recommendations and the presence of patient findings that suggest certain symptom category sub-types that might usefully modify the SCL’s recommendations. From there we critically examine medical conditions that could obfuscate or distort the clinical picture, and how to correct for them. We then explore the intriguing notion that certain brain structures can have a disproportionate clinical importance or brain change “leverage” that is not always consistently reflected in the neuroimaging literature. Examples could include the normalization of the insula and/or the precuneus in addiction cravings, or the normalization of the anterior cingulate in many forms of PTSD and other disorders. Sometimes the organization of the brain lends itself to faster or more extensive treatments at specific structures given the nature of neurofeedback in general and LORETA neurofeedback in particular; for example, the relatively unhindered and unambiguous access to the anterior cingulate. Certainly, the highly experienced clinician will always be in a position to better disambiguate the many possible symptom “candidates” and effect the best possible “fit” between the overallclinical picture with the treatment plan. Fortunately, the SCL in Neuroguide lends itself to editing and over-ride as needed, allowing us the best of both worlds; guidance for the relatively inexperienced clinician, but flexibility and data-tracking afforded to more the clinically sophisticated.

Friday, December 5th | 2:00pm-6:00pm

LINKING THE MOST APPROPRIATE HYPOTHESES CONCERNING PHYSIOLOGY AND QEEG ACTIVITY TO PATIENT SYMPTOMS AND FUNCTIONAL DEFICITS PART 2

Presenter; Joel Lubar, PhD
Professor Emeritus, University of Tennessee, Knoxville

(3.75 APA CEs)

In this presentation, we offer case studies and data that suggest that the different types of data sets and data views captured in the Phil Jones LORETA report generator can enhance the performance of the SCL, especially in more complex or multi-faceted clinical presentations. One open question we will explore is the value of capturing the most extreme z-score associated with a given Brodmann area (BA), in addition to the most central value. We consider the practical “pros and cons” of relying on one value or the other as it relates to the question of neighboring BA “smearing” vs. overlapping involvement of multiple BAs, even multiple networks, in aberrant EEG behavior.

Friday, December 5th | 7pm-10pm

SPECIAL EVENING PRESENTATION: EXAMINING THE USE OF LORETA NEUROFEEDBACK TO TRANSFORM THE BRAIN’S DEFAULT NETWORK IN THE TREATMENT OF ADDICTIONS
Presenter; Ed Pigott, PhD
Clinical Director; New Directions LLC, Boynton Beach, Florida

(2.75 APA CEs)

Dr. Pigott will discuss the current thinking of Dr. Rex Cannon, who has been a leader in the use and research of LORETA NFB in general and in particular, the treatment of addictions. Recently, he has developed an elegant model of brain-based addiction recovery that focuses on the ways in which brain physiology reflects and shapes our interlocking sense of “self,” bodily experience, and cravings for certain substances in the face of dysphoria and stress. Dr. Cannon has discovered the critical, perhaps pivotal importance of influencing the precuneus, a deeper structure in the brain that has not been easily influenced by traditional neurofeedback but with LORETA neurofeedback it has become accessible and responsive. In this presentation, we will explore the model’s development and rationale, and more to the point, share published and pre-publication clinical data that speaks to the power and validity of this approach. The broader implications of our approach to LORETA NFB and the treatment of addictions, as well as its co-morbidities, will be discussed.

Saturday December 6th | 9:00am-5:30pm

LORETA IN A MULTI-MODAL TREATMENT SYSTEM: INVENTING THE FUTURE OF NEUROTHERAPY WITH NEUROFIELD
Presenter; Nicholas Dogris, Phd
Co-Founder and CEO NeuroField Inc.

(7.25 APA CEs)

In this presentation, we first describe the current “best practices” that have evolved with the NeuroField system. Over the last seven years, much has been learned about the clinical power of our implementation of certain pulsed electromagnetic “field” programs, both stand alone and in conjunction with 19-channel “live” z-score and LORETA targeting. We examine what LORETA assessment and treatment technology has given the working clinician. Just as LORETA allows us to “go deeper” into the brain as we assess and train, pulsed electromagnetic field (PEMF) technology allows us to access and transform the deeper structures of the brain LORETA uncovers. A key scientific and practical clinical question involves the degree (or lack) of influence we can expect with different types of neurotherapy interventions. We know the physics of neurofeedback are such that we are successful in influencing the brain to the extent that; 1) the region of interest (ROI) contains pyramidal cells, 2) we can consistently evoke dopaminergic reward circuits and 3) we can achieve sufficiently compelling feedback loops with the ROI that leads to the desired modification of neuronal firing patterns. PEMF has a number of ways in which it can directly strengthen the electrical activity of a ROI, thus allowing the brain to reset itself and function normally. It has been suggested by a number of scientists that PEMF can also positively effect brain activity and normalization by it’s contribution of needed electrons that possess a anti-oxidant effect of brain cells and indeed cellular activity in the rest of the body. It follows there is a natural synergy between LORETA NFB and PEMF. With the advent of 19 channel normative database guided z-score targeting and training, we can intervene more powerfully with a “weak” brain network or structure. Interestingly, we can retain the advantages of a more “thorough” z-score-based targeting but add the capability, with our RTZ system, of moving beyond “training to the norm” and simultaneously influencing amplitudes to specific map derived or clinician selected criteria.

The truth is we do not yet possess enough scientific knowledge as to how PEMF stimulation influences the brain and the organ systems that support it, or how it compares to various forms of neurofeedback, but the ongoing clinical experience of the NeuroField user community underscores the promise and power of this approach. One issue that seems clear, however, is the fact that the CNS is at root an electromagnetic system in it’s own right that is indexed, and influenced, in health and pathology, by electromagnetic frequencies. NeuroField provides the perfect “test bench” to explore and therapeutically exploit this fact

We conclude with a look into the future as to how NeuroField should and is evolving.

Sunday, December 7th | 9:00am-12:00pm

NON-SURGICAL & SURGICAL NEUROMODULATION (TDCS, TACS, NEUROFEEDBACK, TMS). HOW DOES IT WORK?Presenter: Dirk De Ridder, MD, Phd
Chairman, Departments of Neurosurgery and Neuroscience, University of Otago, New Zealand, Formerly, Neurosurgeon and Director of the Neuromodulation Lab at University Hospital, Antwerp, Belgium

(2.75 APA CEs)

We will look at LORETA neurofeedback and evaluate how it improves upon traditional neurofeedback. We look at the range of non-invasive brain stimulation technologies, comparing repetitive transcranial magnetic stimulation (rTMS), transcranial direct electrical current stimulation (tDCS), transcranial alternating electric current stimulation (tACS), and various types of random stimulation technologies. In the case of those “pulsed” systems that stimulate specific frequencies, we discuss how certain frequency ranges can inhibit or increase electrical activity in a targeted area of the brain. It is known that certain stimulation frequency ranges can act as “virtual lesions” that halt or block activity at a given brain site/network, forcing other networks and “transient” connectivity patterns to take over. This process interacts with the region of interest’s neurochemical secretion “responsibilities”, primarily inhibitory or excitatory. These variables may be useful to be considered in planning more efficient brain stimulation treatment.

Sunday, December 7th | 1:30pm-4:00pm

PANEL DISCUSSION: TYING IT ALL TOGETHER

Dirk De Rider, MD, PhD | Joel Lubar, PhD | Nicholas Dogris, PhD | ED PIGOTT, PHD

(2.25 APA CEs)

During this panel, the moderators will present questions and concerns of the working clinician in private practice to help stimulate and guide a dialog. Also, where there are communalities or divergence of opinion of the presenters, the moderators would like to seek clarification. Finally, it is important that the key “take home messages” of the presenters are summarized.

Reserve your room at the BSI reduced rate of $160.94 (+19% tax)/night HERE. 

TO PURCHASE CLICK HERE