Attention problems
Research Papers
Epileptic Electroencephalography Profile Associates with Attention Problems in Children with Fragile X Syndrome: Review and Case Series
Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and a variant of autism spectrum disorder (ASD). The FXS population is quite heterogeneous with respect to comorbidities, which implies the need for a personalized medicine approach, relying on biomarkers or endophenotypes to guide treatment. There is evidence that quantitative electroencephalography (EEG) endophenotype-guided treatments can support increased clinical benefit by considering the patient’s neurophysiological profile. We describe a case series of 11 children diagnosed with FXS, aged one to 14 years, mean 4.6 years. Case data are based on longitudinal clinically-observed reports by attending physicians for comorbid symptoms including awake and asleep EEG profiles. We tabulate the comorbid EEG symptoms in this case series, and relate them to the literature on EEG endophenotypes and associated treatment options. The two most common endophenotypes in the data were diffuse slow oscillations and epileptiform EEG, which have been associated with attention and epilepsy respectively. This observation agrees with reported prevalence of comorbid behavioral symptoms for FXS. In this sample of FXS children, attention problems were found in 37% (4 of 11), and epileptic seizures in 45% (5 of 11). Attention problems were found to associate with the epilepsy endophenotype. From the synthesis of this case series and literature review, we argue that the evidence-based personalized treatment approach, exemplified by neurofeedback, could benefit FXS children by focusing on observable, specific characteristics of comorbid disease symptoms.
View Full Paper →QEEG and 19-Channel Neurofeedback as a Clinical Evaluation Tool for Children with Attention, Learning and Emotional Problems
Attention, learning and emotional problems can have different causes that cannot be easily and clearly distinguished by clinical testing methods. But, QEEG and, even more so, live 19-channel Z-score training under different task conditions can both give very detailed insights about the specific functioning and dysregulations of an individual’s brain. The clinical intake evaluation of the child is optimized by including a quantitative, neurometric analysis of an eyes open (EO) and eyes closed (EC) EEG acquisition combined with a real-time analysis of the child’s (in vivo) brain functioning during a specific set of conditions, as described below. This method was developed and refined with more than 300 children who were tested between June 2012 and April 2014. The goal is to get as much information as possible in only one session lasting 45 to 60 minutes. The different parts of the evaluation consist of: eyes open (EO) and eyes closed (EC) collection of data, display of the actual brain waves, listing of the Z-score values (also presented as plots or instant brain maps with different task conditions), followed by games to play with a challenge condition. In addition, current source density (CSD) sLORETA of the different wave frequencies (usually delta, theta, alpha, beta, and gamma bands), distribution and velocity are shown as they change, as well as when the brain evaluates emotions. The session ends with a brief, individual 19-channel training with video feedback. Because of the usefulness of the information obtained from using this QEEG method, the author recommends that QEEG and an interactive neurofeedback session be included as a standard component in the diagnosis of and treatment planning for children with attention, learning and emotional problems.
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