For periods of time in any given day, many people with fibromyalgia (FM) find themselves in a fog, unable to concentrate or to summon up energy. During the night instead of finding relief, they sleep fitfully with their rest interrupted by periods of wakefulness. Even more frustrating, it can be hard to show others that these episodes are recurring and valid symptoms of a disorder, not just ongoing complaints.
But you do not need to convince Myra Preston, a Ph.D. in psychophysiology. During more than 20 years of research and clinical practice in Charlotte, N.C., Preston has been reading thousands of brain waves using both traditional electroencephalography (EEG) and its quantitative counterpart, called QEEG. She has documented scientifically what people express anecdotally. There is a reversal of electrical activity in the brain for people with FM. It slows down during the day and speeds up at night.
This pattern, discernable through brain mapping techniques, is also found in other cases of brain injuries or diseases and it is pervasive in FM, according to Dr. Preston. “It’s abnormal.” Instead of registering brain waves, called “beta,” in various parts of the brain when they are needed to function normally, these patients often have “theta” waves, which are associated with falling asleep. Not only are theta waves slower, they also operate at a higher amplitude, indicating more sensitivity – including sensitivity to pain.
Until recent times, “fibromyalgia was not thought of as neurological,” says Dr. Preston. Researchers looked elsewhere for diagnostic markers. Based on her research, Dr. Preston developed a kind of physical therapy for the brain. In her program, which she has patented, she retrains patients’ brains by having them perform specialized computer exercises, done repetitively and with concentration, to stimulate the brain to increase electrical activity until it reaches a more normal range. While performing the exercises, a patient is constantly monitored by the QEEG, which tracks the level of brain activity. Success is marked by a “reward” in the form of a beep or other signal. Thus, a complete feedback loop of measurement, performance and reward is created.
Except for such EEG biofeedback, “we have no successful treatment for the cognitive deficits of fibromyalgia,” reports Charles Lapp M.D., a specialist in FM, in practice at Hunter-Hopkins Center in Charlotte, N.C. “When patients come to me and say ‘you know, the thing that bothers me the most is my mind,’ I tell them to speak to Myra Preston and consider EEG biofeedback.”
Though they may be computer exercises, it is not a game, says Dr. Lapp, who previously worked with Dr. Preston on research and in clinical practice. “Its work, and it takes a considerable amount of training.” But when people follow through on the program, he notes that “the patients have improvement in several areas – notably in sleep and cognition, and sometimes in energy.”
What enables the program to be covered under many insurance plans and to be accepted as evidence for disability is that the diagnosis is based on EEG technology, which has been long established and approved by the FDA. But, Dr. Preston contends, the typical methods of using EEG are too limited to adequately analyze FM patients. “We have a different way of acquiring data, reading it, analyzing it, and correlating it with all of the patient’s past medical history.”
Further, Dr. Preston says, unlike a typical EEG technician who may know nothing about the patient, she uses a lengthy checklist of symptoms as part of understanding the whole patient. After reading the conventional EEG, Dr. Preston also puts the data through a QEEG, which provides a computer analysis of a wider array of data, and “allows us to look at the individual’s brain function and compare any two parts of the brain. We’re able to see how far outside of normal that individual falls.”
The next step is to design an individualized program to awaken those areas of the brain that are too sleepy during the day – without overexciting them. In effect, the patient is guided to move from the slow theta waves to the beta waves necessary for normal functioning. Autogenics, a company that specializes in computer exercises for the brain, designs the exercises for Dr. Preston’s work. In brief, patients are instructed to perform a type of computer activity with their brain acting as the “joystick.” The objective is to perform the activity successfully for a specified number of minutes so that the patient suppresses abnormal brain waves and is able to “recruit” or produce more normal activity. All this is done in real time through a neurofeeback loop. That is, the moment a change takes place in a patient’s brain, they know it.
Unlike other activities that stimulate the brain, “when you’re in neurofeedback, there’s no guesswork. You know exactly what brain waves you’re producing, and what brain waves you’re suppressing,” Dr. Preston says. “It’s like hitting a target with a bow and arrow.
The exercises should be done twice a week, with a minimum of 40 sessions and a maximum of 120, Dr. Preston advises. In addition to her office in Charlotte, there are a few affiliate offices around the country and also the opportunity for patients to be trained and to acquire the equipment to do the biofeedback loop at home.
“Our long-term follow-up studies of patients we’ve been treating since 1989 have indicated to us that they maintain the majority of their improvement over a number of years,” reports Dr. Preston. As support, she cites a theory of neurofeedback that is used in the treatment of other illnesses: when you move the brain towards normal, the body’s homeostatic mechanism comes into play and the brain stays at the desired level once it has been achieved.
At the end of treatment she says you can expect to see improvement in your quality of life, including decreased intensity and frequency of symptoms, and improvement in cognitive function. Since the underlying disorders are so individualized, that improvement shows up differently for each person.