​Arthur Lewis, MD, IFMCP, BCN
233 Sopher Road
Titusville, PA 16354
What is Neuromodulation?
Could you benefit from neuromodulation?
Neurologic, psychiatric, and learning disorders affect both the biochemistry and the electrical function of the brain. Functional medicine does an excellent job addressing the brain’s functioning on a biochemical level. However, there are now newer therapies which directly impact the electrical, biochemical, and structural function of the brain. We use the results of a 3D quantitative EEG brain map to determine which therapies would most benefit you.
Neuromodulation for Neurologic, Psychiatric, & Learning Disorders: A Brief Introduction (8 minutes)
In this brief video Dr. Lewis describes some of the latest technologies now available in order to evaluate and treat brain-related disorders, all of which can be performed in his office and/or in your home. To view this video with captions click here.
Neuromodulation for Neurologic, Psychiatric, & Learning Disorders: A Deeper Dive (19 minutes)
This video provides the same information as above but with the addition of a more in-depth description of the 3D quantitative EEG brain map as well as information from the medical literature explaining which conditions can benefit the most from these therapies and how they work. To view this video with captions click here.
This is an example of improvement in the abnormal brain wave activity noted in the quantitative EEG following 7 months of neurofeedback. The red areas on the left lower brain map demonstrate excessive slow (theta) brain wave activity. The grey areas in the images on the subsequent right lower brain map demonstrate resolution of the abnormal slow brain wave activity. The change in color of the interconnecting lines of the executive network shows improvement in the connection between those parts of the brain. The images in the top of this diagram demonstrate by color the amount of change in brain wave function which has taken place between the two lower scans.
Brain Mapping and Brain Therapies
3D brain-function mapping using quantitative EEGs
A quantitative EEG is a diagnostic tool that can be very valuable when assessing individuals who have a variety of neurologic, psychiatric, and/or learning disorders. It is performed by placing a cap on your head which has 21 sensors that send information about your brainwaves into a computer. The computer software is able to produce 3-dimensional images of the function of your brain. It divides the brain into 12,270 voxels (similar to pixels but in 3D) to give state-of-the-art high-resolution images of your brainwaves’ frequency, amplitude, and connectivity (i.e., how efficiently each part of the brain connects with the other parts).
This information is then compared with a normative database of quantitative EEGs taken from a healthy population. Those specific areas or networks of your brain which show sub-optimal brainwave activity and relate to your specific symptoms or needs are then selected for neuromodulation with neurofeedback training and/or neurostimulation treatments, such as transcranial direct current or alternating current electrical stimulation, pulsed electromagnetic frequency stimulation, and/or photobiomodulation using near-infrared LEDs. In addition, other functional medicine interventions are usually of great value in helping to address the root causes of abnormalities identified on the quantitative EEG.
An example of a 3D quantitative EEG brain map, which we can perform in our office.
Neurofeedback (brainwave biofeedback)
Neurofeedback is a therapy used to assist in the treatment of a variety of neurologic, psychiatric, and learning disorders. Many of these conditions are associated with imbalances in brainwave activity in specific areas and networks of the brain, which are assessed using a 3D EEG brain map as described above. Neurofeedback provides real-time feedback of your brainwave activity with the goal of correcting imbalances which are present. We utilize the highest resolution software available, swLORETA, which is the only neurofeedback software able to target deep structures in the brain such as the cerebellum and thalamus in addition to more superficial areas of the brain.
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This therapy is performed by placing sensors on the scalp which monitor your EEG brainwaves. That information is sent to a computer where software continuously analyzes your brainwaves and you are given immediate audio and/or video feedback on a TV screen that encourages your brain to adjust its functioning to a more optimal pattern.
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This audio or video screen feedback can happen one of several ways. You can watch a TV program with a screen that changes its level of volume or brightness based on how the targeted areas or networks of your brain are responding. For example, the better your brain responds, the brighter the screen gets and vice versa. Another way to receive feedback is by playing a video game in which you are racing a car or flying a plane. With this form of feedback, the performance of the car or plane improves when your brainwaves are improving. By trial and error your brain is able to adjust its brainwave functioning in order to receive the reward of a brighter video program or a more successful video game outcome. The number of synaptic firings in your brain is estimated to be on the order of 10 quadrillion per second (10,000,000,000,000,000/second). Your brain is able to change how its nerves fire to get the reward you want in ways that are beyond your conscious control.
With practice, as your brain cells repeatedly fire in a healthier pattern, those circuits in your brain are reinforced. When your brain cells are exercised in this way on a regular basis, new connections will form between the appropriate brain cells and brain networks, and improved rates of brain cell firing become established. We usually schedule 1 to 3 training sessions per week, each lasting 30 to 60 minutes. Most people need between 20 to 40 sessions. Generally, the more complex or severe the neurological disorder is, the more sessions that are needed to help improve or correct the underlying problems. This training gradually changes the architecture of your brain leading to lasting changes that can continue long after the neurofeedback has been completed. There is an even greater likelihood of lasting change when the underlying factors which have led to your condition have been identified and corrected through additional functional medicine assessment and treatment. Dr. Lewis is currently the only board-certified provider of neurofeedback in western Pennsylvania.
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An example of watching a video as a type of feedback during neurofeedback.
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An example of a video game as a type of feedback during neurofeedback.
Neurostimulation
Neurostimulation is another category of therapeutic neuromodulation in which energy is delivered to targeted areas of the brain in order to optimize brain function. We can provide these therapies using transcranial photobiomodulation (tPBM) with near-infrared LEDs, transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and pulsed electromagnetic field (pEMF) stimulation. These therapies can often be administered simultaneously if indicated.
Transcranial Photobiomodulation (tPBM)
This method of neurostimulation uses individual LEDs or a helmet containing 256 LEDs to target specific regions of the brain with near-infrared light. The LEDs are programmed at the desired frequencies based on your symptoms and the results of the quantitative EEG. These near-infrared lights are able to penetrate a few centimeters into the brain and effect changes in the brain through stimulating enzymes that improves the production of ATP. This provides the brain with more energy. The light also improves blood flow and oxygenation to the brain, reduces inflammation, and increases nerve growth factors in the brain. Photobiomodulation can also be used to address a number of conditions which affect other parts of the body as documented in over 20,000 peer-reviewed articles on the subject. This therapy can be done in the office and/or at home.
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Transcranial Photobiomodulation
Transcranial direct current stimulation (tDCS)
When using tDCS a low-level current of electricity passes in one direction through a targeted region of the brain. This changes neuronal firing rates, the connectivity between different parts of the brain, and the levels of neurotransmitters (GABA and glutamate) leading to increased neuroplasticity with new neuronal connections. Animal studies have shown that tDCS also reduces inflammatory cells and chemical mediators of inflammation in the brain. This therapy has been the subject of research for many decades with over 10,000 publications per year for the last few years. As with other forms of neuromodulation, this treatment needs to be repeated on a number of occasions in order to promote lasting changes.
Transcranial alternating current stimulation (tACS)
tACS is a therapy in which a low-level current of electricity passes back and forth through targeted areas of the brain. One form of tACS is Alpha-Stim M which is FDA cleared for the treatment of anxiety, insomnia, depression, and centrally mediated pain syndromes. Alpha-Stim can be self-administered at home or used in our office. Another option is the use of customized tACS protocols based on the findings of the quantitative EEG brain map where specific dysregulated areas of the brain are targeted.
Pulsed electromagnetic field (pEMF) stimulation
With pEMF a low intensity pulsed electromagnetic field is directed over targeted portions of the brain. pEMF has been shown to reduce inflammation, improve blood flow, and improve cellular communication.
tDCS, tACS, pEMF, and targeted tPBM can be administered simultaneously.