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1. Introduction
Chronic Fatigue Syndrome (CFS) is characterized by
fatigue so severe that 43% of patients are unable to attend school or work [18] and as many of 85% of patients
report cognitive impairments [12,16]. Cognitive impairments usually include concentration/attention and
memory [5,7,8,17,21,23,25]. No consistent pathogenic
mechanism has been identified as a cause, and, thus,
its existence is often regarded as controversial and it
Address for correspondence:
D. Corydon Hammond, Ph.D., University Medical Center, PM&R, 50 No. Medical Dr., Salt Lake City,
UT 84132, USA. Fax: +1 801 585 5757; E-mail: D.C.Hammond@
m.cc.utah.edu.
NeuroRehabilitation 16 (2001) 295300
ISSN 1053-8135 / $8.00 2001, IOS Press. All rights reserved
296
2. Case background
The patient was a twenty-one year old, single female who experienced a relatively sudden onset of CFS
and who had no prior history of psychiatric comorbidity. Three years prior to seeing me, she had contracted
mononucleosis while in her senior year of high school.
She was an A student and graduated with honors, despite being unable to attend school for a while. The
following year she was diagnosed with CFS by an internist. She appeared to be a very intelligent young
woman, perhaps with a type-A personality.
The hardest symptoms for the patient were the cognitive impairments. She described problems with concentration and memory which had kept her from attending university. Her mother indicated that not being able to think is her biggest symptom. On a rating scale she indicated that since contracting CFS she
started projects but tended not to finish them, was easily
distracted, did not get much done, and had a short attention span. She also experienced sensitivity to noise,
and light sensitivity. For 24 hours each day she had
enough energy to do some things (e.g., go to the store),
but then she would get a little drifty mentally. Someone else would usually need to drive here anywhere that
she wanted to go because she felt so easily distracted.
As part of a thorough evaluation, the patient was
administered the Profile of Mood States, and a battery
of tests associated with the high risk model of threat
perception and evaluation of somatization [27]. She
scored in the average range (6) on the Harvard Group
Scale of Hypnotic Susceptibility, not displaying either
the high or low hypnotizability that appears to predispose someone to somatization. She also scored low
on other predisposing factors such as catastrophizing
(measured by the Dysfunctional Cognitions Inventory),
and negative affectivity (measured by the Eysenck Personality Inventory). She did appear prone to repres-
3. Treatment
Since the patient appeared relatively normal psychologically, a treatment strategy consisting of stress management and neurofeedback was proposed to the patient and her family. They responded very positively
and we engaged in an informed consent process.
A strategy was selected to decrease the left frontal
theta excess. She was treated with three sessions a week
using a Lexicor NRS-24 neurofeedback unit utilizing a
297
298
Pre-Tx
95.5%
33%
81.6%
Post-Tx
31%
84%
2.3%
Although the use of a cosine-tapered window is implemented, it can be optionally selected by the user, at the
output of the FFT, not on the raw EEG input. These
techniques bolster the power of Roshis unique audiovisual stimulation (AVS) system. These Fourier RMS
magnitudes are, then, subjected the standard 1 to 4 Hz
(Delta), 4 to 7 Hz (Theta), 8 to 13 (Alpha), 12 to 15 Hz
(SMR or low beta) and 15 to 20 Hz (Beta) frequencies. An added uniqueness of the Roshi system is in its
use of interhemispheric Fourier products in its training
modalities, with very low feedback latency. The A/D
conversion rate is 128 samples per second. Still another
beneficial advantage of the Roshi is that it also trains
simultaneously at two referential electrode sites.
We used a program called SMR Max. This program
provides photic stimulation, moment to moment, that is
focused on the patients peak frequency in the 1215 Hz
range, reinforcing this low beta band while simultaneously inhibiting the ranges from 4 to 12 Hz. We placed
electrodes at F3 and F4. Her immediate post-session
response was: The other sessions have been good,
but this was terrific! Due to a technical problem, it
was not possible for her to have another session on the
Roshi for 10 days. A few subsequent sessions with
traditional neurofeedback received continued positive
responses, but she still wanted to return to training on
the Roshi at the first opportunity. In her next session on
5 Months
34.5%
46%
3.6%
7 Months
65.5%
69.2%
4.5%
9 Months
58%
84%
6.7%
299
4. Conclusion
Given the preliminary QEEG data of Duffy [9] and
Billiot et al. [1] demonstrating excess slow brainwave
activity, the neuroimaging research documenting hy-
300
[14]
[15]
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