Tourette’s

Tourette’s would actually usually be a combination of Filtering and Blocking:  ADHD with OCD features.  It is usually characterized by too MUCH dopamine, rather than too little.  Tourette’s often represents a very immature brain in terms of frequencies (tendency for many bands to be slower than you would expect for the chronological age), so you will want to look at the effective SMR frequency for your client.

If you find lots of fast activity at Fz, you may want to consider trying training that down (especially with something like an Fz/Pz or Fz/Cz montage).  Training SMR at Cz, which is more effective for motor control, or at C4, which is more effective for sensory control (distractibility) are often helpful.

One of the classic protocols for motor tics is also C4/P4 or C4/Pz (different clients respond better to one or the other), SMR up/theta down.

C4/P4 or C4/Pz SMR up and theta down are some classic “tic” protocols.  Especially look for fast activity at Fz in the assessment. Tourettes is a kind of OCD mixed with ADHD, so often protocols that  cool down the cingulate have a very positive effect. Tourettes is ADHD with OCD, so the beta at Cz is probably a pretty important part of the picture, as it suggests that the cingulate is pretty over-activated.

Several general comments on Tourette’s:

1.   One way of thinking of Tourette’s is that it is ADHD combined with OCD.   You really need to train both issues, as opposed to just working with the ADHD element.

2. Probably the best place to start, at least in my experience, is with the tics. An old Othmer protocol I always use with tics has seemed to have great power: C4/P4 or C4/Pz (these are bipolar, one-channel montages) training what you call the regular C4 design. As usual, you may find that by adjusting the SMR band frequencies you get better responses in individual clients.

3. Frontal midline training (here you could use FCz/A1-A2 or Fz/A1/g/Cz/A2 (L)) either to squash or to increase SMR levels can be very helpful.   Physical impulses (and positive experience) are related to dopamine levels, and dopamine is carried to the prefrontal cortex via the medial forebrain bundle, which runs right under the midline.   I’ve often used this kind of training with Parkinsons (another disorder with uncontrolled movements).

Lots of clients who have “low SMR” show excessive levels of theta and/or high-beta, especially those with “standard ADHD,” hence the protocol which trains down 3-7 and 23-38 and rewards 12-15 Hz. Lots of clients DON’T have this pattern.   Some have high levels of delta.   Some have high levels of alpha.   Some have high levels of beta in the 15-21 range.

The trainer’s goal presumably is to increase SMR amplitudes relative to the overall EEG.   As long as the client happens to fit into the theta/high-beta/smr pattern, the “regular” protocol works fine.   Even then, if you watch the levels during a successful training, you will probably find that as the two inhibits go down (theta and high-beta) the reward band (SMR) ALSO GOES DOWN!!   You are activating control loops in the brain, and those generally will move the brain toward greater efficiency (i.e. less activity in all frequencies). The EEG is not like a toothpaste tube, where if you squeeze down on both ends you’ll get a bubble in the middle. This is why I strongly recommend that, if you must use a multiple-threshold design like theta/high-beta/smr, you start all targets in auto mode and switch the inhibits to manual within about 30 seconds–LEAVING THE REWARDS AUTO!   That way, as the brain reduces the slow and fast activity (as desired) you don’t end up blocking the feedback by the fact that the SMR amplitudes also are going down.

Let’s say you have a client who has high levels of delta or alpha. Training up the percent of SMR, one of the most efficient things the brain can do to meet the training challenge is to reduce whatever frequency is too high!   You don’t need to know if that happens to be delta or theta or 2-5 or 3-7 or 4-9 or beta or high-beta. It doesn’t matter if it changes during a session from theta to alpha.   As long as SMR amplitude ends up as a greater share of the total EEG, you’re moving in the right direction.

And if the client reduces SMR amplitude as he reduces theta and high-beta (or whatever), it’s not a problem as long as the SMR reduction is less than the reduction in the overall EEG, since the percent of SMR will go up.

Finally, using SMR% has the huge benefit that it combines all the training into a single threshold.   You don’t have to fiddle with multiple thresholds to make sure the feedback is not being blocked by one mis-set target when the brain is doing exactly what we want it to do.   It’s easier for the trainer to keep track of and control the feedback and easier for the brain and client to get it.

The one thing you need to watch for in this design is the binaural beats.   Because the SMR% up design calculates the percent by dividing an SMR band by the overall EEG band (instead of using a band ratio filter), you can use the Tools: Filters commands to adjust the SMR band as you train. However, the binaural beats are set for 14 Hz.   If you are working with a a younger client, you may want to turn off the binaural beats until you have found the correct SMR frequency for that client.   Then you can reset the beats to provide guidance to that frequency.