PMS, EEG, Biofeedback, and Photic Stimulation

Paper presented at the 1995 SSNR Annual Conference
David Noton, Ph. D.* 

Abstract

Recent EEG research on women with pre-menstrual syndrome 
(PMS), shows that, when they are pre-menstrual, their EEG's 
show more slow (delta) activity and slower P300 evoked 
response than when they are mid-cycle.  Thus PMS joins a 
growing group of brain disorders, such as ADD, CFS, Minor 
Head Trauma, and Depression, all of which are now seen to be 
characterized by a general slowing of the brainwaves, ie, 
excessive theta or delta activity and slower P300 evoked 
response.  All the disorders in this group are being 
successfully treated with EEG biofeedback, using positive 
reinforcement of beta frequencies and negative reinforcement 
of low frequencies.  Alternatively, daily photic stimulation 
at beta frequencies has been shown to be effective, in 
several ADD studies and now informally in work with PMS 
patients.  Apparently the brainwave slowing can be corrected 
either by learning to produce higher frequencies oneself 
(EEG biofeedback) or by external stimulation driving the 
brain to higher frequencies (photic stimulation).  A trial 
is now underway at the Royal Postgraduate Medical School in 
London with 20 women, to assess the effects of beta-
frequency photic stimulation on PMS.  Anecdotal results are 
very positive.  Preliminary work is also underway in the US 
with CFS and minor head trauma patients.


Slowing of EEG during PMS

Recent EEG research at the Royal Postgraduate Medical School 
in London, on women with pre-menstrual syndrome (PMS), shows 
that, when they are pre-menstrual, their EEG's show more 
slow (delta) activity and slower P300 evoked response, than 
when they are mid-cycle (Toner et al. 1995).  Since these 
results are new and not yet published in the US, they are 
described in brief below.

Six women with self-reported PMS, all staff at The 
Hammersmith Hospital in London, had 21 channel QEEG 
recordings and P300 evoked potentials measured during mid-
cycle and premenstrually.  Ages ranged from 30 to 43 and all 
were taking no treatment for PMS.  

QEEG was measured using a 21-channel topographic brain 
mapper.  Electrode placement was according to the 
International 10-20 system and recordings were performed 
under standard conditions.  Relative power over all 21 
channels was determined from 40 seconds of artifact-free EEG 
for the frequency bands:  delta (1 - 3.5 Hz), theta (4 - 7.5 
Hz), alpha (8 - 11.5 Hz), and beta (12 - 23 Hz).  Means (SD) 
and p values following Wilcoxon test were as follows (5 
subjects, 1 omitted):

				Delta %	Theta %	Alpha %	Beta %
		PMS		40.2 (27)	9.9 (7.1)	38.5 (32)	4.4(1.8)
	Mid-cycle		24.5 (17)	10.8 (5.7)	49 (28)	6.3 (3)
		p		0.043	0.786	0.224	0.138

A significant increase in delta activity during PMS is 
shown, along with a suggestive, but not necessarily 
significant, decrease in beta activity.  This is consistent 
with previous reports of increased slow activity and 
decreased fast activity during PMS (Harding et al. 1976, 
Lamb et al. 1953).

P300 evoked potential was elicited using an odd-tone 
procedure with a frequent tone (1000 Hz) and an odd tone 
(2000 Hz) presented in the ratio 4:1, for 40 msec each at a 
rate of 1 per second, at a level 50 dB above the patient's 
hearing threshold.  Using global field power averaging, the 
P300 latency and amplitude for the 6 women were as follows:

	                     Premenstrual	                Mid-cycle
    Subject	Latency (msec)  Amplitude (V)   Latency (msec)  Amplitude 
(V)
	1		408		7.7			360			11.3
	2		384		2.5			376			13.7
	3		398		18.0			318			10.1
	4		382		6.6			340			3.7
	5		356		12.6			314			8.6
	6		328		7.5			292			5.0

The increased latencies during PMS are statistically 
significant (p=0.027).  The amplitude differences vary, some 
being higher and some lower, and are not statistically 
significant.


The Bigger Picture:  PMS is One of a Group of  Similar 
Disorders

In view of the EEG research results presented above, PMS may 
be seen to join a growing group of brain disorders, such as 
Attention Deficit Disorder (ADD), Chronic Fatigue Syndrome 
(CFS), Minor Head Trauma, and Depression, all of which seem 
to be characterized by a general slowing of the brainwaves, 
ie, excessive theta or delta activity and slower P300 evoked 
response.

Excessive slow activity in ADD has been widely reported, 
especially during ineffective task execution (for example, 
Lubar 1989).  Clinicians and researchers using EPS (EEG-
Driven Photic Stimulation, also known as EDF or EEG-Driven 
Feedback) on patients with minor head trauma and CFS report 
that these patients' EEGs before treatment typically show 
excessive slow activity (Robertson, Ochs 1995).  Depressed 
patients show low levels of beta activity, but typically may 
also have low levels of all EEG activity and a general 
condition of underarousal (Shealy et al. 1989, Smith, 1981).


Speeding up the Brain with EEG Biofeedback

If this group of disorders is characterized by a general 
slowing of the brainwaves, then speeding up the brainwaves, 
by whatever means, might be expected to benefit patients.  
One way to do this is to train patients to speed up their 
own brainwaves.  In fact, biofeedback practitioners are 
reporting great success with all of the disorders in this 
group, using EEG biofeedback with positive reinforcement of 
beta frequencies and negative reinforcement of low 
frequencies.

For example, the Lubar's have for many years worked with 
children with ADD, training them with beta frequency 
biofeedback, with excellent results (Lubar 1989, Lubar and 
Lubar, 1984);  the Othmer's have a long history of success 
with beta frequency biofeedback with patients with all of 
the disorders in this group (Othmer 1994);  and there are 
many other practitioners using this approach to speed up 
brain activity (for example, Tansey 1990).


Speeding up the Brain with Photic Stimulation

Unfortunately the process of learning to control and speed 
up one's brainwaves is slow and demands many hours of 
training with fairly expensive equipment.  Not all patients 
with disorders of this type are willing or able to make the 
effort.  For some, it may be more practical to speed the 
brain up by external stimulation.  (The drug Ritalin, 
frequently prescribed for children with ADD, is also a form 
of stimulation but, compared with the therapies discussed 
here, it is considered to be undesirably invasive.)  Photic 
stimulation with flashing lights has been shown to be 
effective in entraining brainwaves and driving them to 
higher frequencies and it is beginning to be applied to the 
group of disorders described above.  

For example, H. L. Russell, J. L. Carter, and other 
researchers have used photic stimulation (sometimes combined 
with auditory stimulation) for a number of years with a 
large number of children with ADD and related learning 
disorders and have reported very impressive improvements in 
learning and IQ (Russell et al. 1993 and 1995).  And the 
practitioners of the more-recently developed EEG-Driven 
Photic Stimulation have reported success with all of the 
disorders in this group, especially with minor head trauma 
and chronic fatigue syndrome (Ochs 1994, Robertson 1995).  
D. J. Anderson, while working with photic stimulation with 
migraine patients (Anderson 1989), discovered 
serendipitously that many of the women patients were 
reporting significant improvements in their PMS.  This is 
now the subject of a separate study described below.

In sum, it seems that the brainwave slowing that is 
characteristic of these disorders can be corrected either by 
learning to produce higher frequencies oneself (EEG 
biofeedback) or by external stimulation driving the brain to 
higher frequencies (photic stimulation).

This group of "EEG-slowing disorders," which are being 
treated by speeding up the brainwaves,  is to be 
distinguished from a separate group of disorders, such as 
alcoholism, drug abuse, and certain stress syndromes, which 
are being successfully treated by slowing down the 
brainwaves (eg, Peniston and Kulkowski 1989) and perhaps 
also from hyperactivity disorders, which are being treated 
by SMR-frequency biofeedback training (Lubar and Lubar 1984, 
Othmer 1994).  In each case, the objective is to normalize 
brainwave frequency and activity.


Test of Photic Stimulation for PMS now underway

A trial is now underway at the Royal Postgraduate Medical 
School (Hammersmith Hospital) in London with 20 women, to 
assess the effects of beta-frequency photic stimulation 
(light only, no sound) on PMS.  Final results are not yet 
available, but anecdotal results are very positive.

The photic stimulation device used is that previously 
described by Anderson for treatment of migraine (Anderson 
1989).  It uses red LED lights, which flash alternately in 
left and right eyes, and a control box.  The frequency of 
flashing is controlled by the patient, but it is initially 
suggested that the patient start at the flicker-fusion 
point, around 30 cycles per second (one cycle consisting of 
light in the left eye for half the cycle and then light in 
the right eye for half the cycle).  The brightness of the 
light is controlled by the patient for best comfort, with a 
maximum of 500 millicandela.  The patient is asked to use 
the device for 15 minutes per day, every day.

Meanwhile, in the US, preliminary studies are starting with 
US doctors and practitioners on the effects of this style of 
photic stimulation on CFS and minor head trauma;  additional 
participants are invited.

That something as simple as flashing light in the eyes for a 
few minutes every day can have profound effects on mental 
and even physiological functioning is a source of constant 
amazement, but eventually one comes to accept that it is 
"strong medicine," to be used to advantage.

Some Additional Comments on the Photic Stimulation 
Technology

Why alternate left-right flashing rather than simultaneous?  
Clinical results in the migraine work that preceded the PMS 
study suggested that alternate was more effective.  In 
addition to the slowing down of the brain in PMS and these 
related disorders, some researchers have found that there is 
also an imbalance between the left and right halves of the 
brain (for example, Davidson 1992) or a lack of 
centralization of brain activity (Anderson 1994).  The 
alternate left-right flashing has perhaps some balancing 
effect betwen the left and right halves of the brain and/or 
stimulates left-right communication between the two halves 
of the brain (but this effect is not a simple one, since 
nerve impulses from each eye are received by both halves of 
the brain).

Why 30 Hz rather than the 15 - 18 Hz range usually used in 
beta frequency EEG biofeedback?  Again this was based on 
reports from patients, who were free to choose their own 
frequency setting, but there is some supporting research 
evidence:  the work of Bird et al. (reported in Lubar 1989) 
suggests that focused mental or intellectual activity uses 
beta frequencies as high as 40 Hz and that the lower beta 
frequencies are more associated with alertness, awakeness, 
and even anxiety.  Unfortunately, above about 30 Hz EEG is 
increasingly contaminated by muscle (EMG) artifacts from the 
scalp and this prevents EEG biofeedback from operating in 
this high beta area (at least without special equipment).  
Photic stimulation is not subject to this limitation.


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