Thursday, August 4, 2016

Integrative treatment for tics and tourette syndrome in Malaysia - By Hiro Koo






INTRODUCTION
Human brain can be trained at any age and new neurons are produced throughout our life. The term of neuroplasticity is well accepted nowadays.  EEG biofeedback or neurofeedback is based on the concept of neuroplasticity that trains the brain like a muscle. It is safe, non-invasive, with no known side effects. It is basically based on the principle of operant conditioning which utilizes the reinforcement concept to change the brain.
When it comes to neurological or mental disorders, pharmaceutical intervention is usually recommended to deal with the brain by improving neurochemical or brain structure components. Interestingly, the electrical component which is brainwaves has been neglected most of the time. Even a person with perfect neurochemical and brain structure but without any noticeable brainwaves, this can be certified as brain death by a qualified neurologist or physician. Thus, brainwaves intervention such as EEG biofeedback training should be included as one of the treatment plans while dealing with issues related to our brain and mind. In fact, EEG biofeedback is not something new as it has more than 50 years of established scientific studies. It is proven to be helpful in cases such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, insomnia, depression, and tics and Tourette Syndrome. EEG biofeedback for tic disorder is worth investigating as it directly deals with the brain. Another major benefit is the hope that it can help patients avoid pharmaceutical intervention which might cause side effects. As mentioned earlier, a healthy state of brain includes the component of electrical, brain structure and neurochemical. EEG biofeedback alone might not be sufficient to get rid of the entire problem as it primarily improves the brain function to perform better. In this case, integrative treatment approach such as combining with psychotherapy, hypnotherapy, and nutritional therapy can be recommended to get the best therapeutic outcome.

Neuro-hypnotherapy on the other hand, is the first of its kind in Malaysia. It is a technique by combining EEG biofeedback technology and the science of hypnosis. Hypnosis is a skill which involves the use of words and suggestions to achieve therapeutic outcome, while the clinical hypnotherapy is a technique which utilizes the concept of hypnosis to achieve clinical outcomes (Kaya & Alladin, 2012). Clinical hypnotherapy has been acknowledged as an evidence based therapy tool by various medical councils in the world and it has been proven to be helpful for various medical conditions (Abbot NC, Stead LF, White AR, Barnes J, Ernst E., 2008). Clinical hypnotherapy is considered as the oldest form of psychotherapy as well as complementary medicine (Lam, 2013). By utilizing this technique, we can combine self-hypnosis method with other psychotherapy method such as habit reversal training. Habit reversal training (HRT) is evidence based non-pharmaceutical interventions for tics and Tourette syndrome, which has been found to alleviate motor and vocal tics (Piacentini & Chang, 2006). Once patients learn the self-hypnosis technique, they learn to deal with their stressors and healthier ways to remain calm. 

Tourette Syndrome (TS) or Gilles de la Tourette Syndrome is one type of Tic disorder. TS is characterized by involuntary tics, repetitive movements, and vocalizations. Normally it will start between the ages of 5-7 years old and becoming more severe between the ages of 8-12 years old. Motor tics (simple or complex motor tics) and vocal/phonic tics (simple and complex vocal tics) are two common characteristics of tic disorder. Simple motor tics include eye blinking, head jerking, jaw movements, shoulder shrugging, neck stretching, and arm jerking. Complex motor tics include hopping, twirling, and jumping. Simple vocal tics include sniffing, throat clearing, grunting, hooting, and shouting. Complex vocal tics include words which may or may not be recognizable or it could be socially unacceptable words. Tic disorder can be differentiated into three types which is Tourette Syndrome, Chronic Tic Disorder (Vocal or motor type), and Provisional Tic Disorder. Individual with at least two motor tics and at least one vocal/phonic tics over the course of more than 1 year can be classified as TS. One suffered with either motor tics or vocal/phonic tics for more than 1 year can be classified as Chronic Tic Disorder. If the tics were presented less than 1 year, it can be classified as provisional tics disorder. Patients with TS are at high risk of having comorbid major neurodevelopmental and neuropsychiatric conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Learning difficulties, behavior problems, anxiety, mood issues, social skills deficits, or sleep related problems.

Author: Hiro Koo






References
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Tourette syndrome therapy malaysia - H Case


“Stress has made my son’s tics worst. My son is diagnosed with Tourette syndrome and his condition turned distressing when he was 15 years old, the year when he would sit for his PMR examination. Hamzah’s tics are very obvious, believed to be caused by the stress he received from the important exam and it had caused an impact to his academic performance. He could not control his tics as it affected his writing and concentration. Even though he was given extra time in exam, it was still very difficult for him to complete it due to his uncontrollable movement and his low concentration level. Not only that, his daily-struggle includes dealing with the jokes and sarcastic statements made by his school mates.”
“It was suffering to see him going through all these difficulties. I started to seek for all kinds of treatments for Tourette syndrome. But it is disappointing that there are not much treatments for Tourette syndrome in Malaysia. H is taking medications prescribed by hospital though it helps him to relax a bit, I would still want to look for a better solution for him. Then, I found here. I’d read through the testimonials regarding the Brain Trainer therapy in the website and the outcomes of the therapy gave me confidence to bring H here.”
“I’d been introduced to Brain Trainer, the EEG-Biofeedback treatment which can help to relieve H’s condition. According to the professional neurotherapist here, they recommended H to first take up a 20-session therapy and I decided to give it a shot. I am totally impressed by the result of the treatment as on the 15th session of the therapy, H starts to show positive feedbacks on his tics control. And his condition is remarkably improved after completing the 20th sessions of Brain Trainer.”
“H is now becoming calmer, being able to control his movement and becoming more confident. He is more sociable now and he managed to proceed to his tertiary studies on culinary art. His teacher and friends are very surprised of his improvement. Most importantly, I can see him living happier and more healthily now.”

By H'S MOTHER
Remark: Our client's information will be kept strictly confidential all the time. All reviews and photos have been acknowledged and provided by past and current clients of Spectrum of Life proactive healthcare centre (Clinical Hypnotherapist Hiro Koo). Clients names have been changed to protect their identity.

Friday, July 29, 2016

2nd Asian Neurofeedback Conference 2016




During the 2nd Asia Neurofeedback Conference this year, I speak about Tic disorder and Tourette syndrome management by using Neuro-hypnotherapy and EEG biofeedback. I am really glad to be here today. 
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Abstract
This paper discussed EEG biofeedback as a standalone tool or used together with neuro-hypnotherapy approach for Tics and Tourette Syndrome. In this paper, the advantages of EEG biofeedback alone or integrating EEG biofeedback in neuro-hypnotherapy were explained. Four cases of patients with presenting problems related to tics and Tourette syndrome were presented. The protocol and improvement were mentioned and highlighted. 







Speakers of the day




*Special thanks to Miss Tan Wan Yen. Thank you for giving me a hand in doing research.