DR. HOGAN PESANIELLO
Image 1. pirHeg Infographic (Tamara,2018)
PirHEG
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Passive Infra-red Hemoencephalography Neurofeedback
By Hogan Pesaniello, MD
Psychiatrist, Snow Hill, Maryland
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PirHEG is one of my favorite tools in my toolkit as a psychiatrist. While I find the process to be relatively elegant, and the assessment straightforward, its effects are sometimes surprisingly potent and long-lived. While it is in the category of a “wellness tool” that works by neurofeedback, and is appropriately used to target “relaxation”, the understanding of how it works – the theory – is that this form of neurofeedback trains the brain to be more effective at regulating functions associated with the prefrontal regions of the brain. PirHEG can sometimes be quickly effective ( in reducing intensity and frequency of migraine pain and aura). It can also be helpful for mood and attention symptoms, and/or help prepare the brain for eeg neurofeedback.
PirHEG may be used in the comprehensive treatment of any condition in which the individual experiences “over-reactivity in timing or quality”, such as impulse control, irritability, and anxiety symptoms. It is particularly useful on migraines, and for post-concussive symptoms involving frontal lobe (executive issues), as well as in attention issues involving the frontal lobe, and in some anxiety and depression. I’ve seen it be helpful as well for a few patients with “brain-fog” from chemotherapies (for hepatitis, cancer,), and have seen improved energy and sleep.)
The process involves placement of an infrared sensor on the forehead, facing toward the skull, held in place with the attached headband. While the patient watches a movie, the camera reads the infra-red energy output from the area in front of the frontal lobe of the brain, (The infrared camera can read through bones) and displays a reading on the computer screen which only the therapist can see. When the infrared output drops (This occurs naturally as the patient becomes drawn into the experiential aspects of the movie.), the movie freezes, and the patient has to increase the infrared output in order for the movie to continue. (The patient simply watches the bar indicator and allows him/herself to relax and gently intends to notice the bar, and allows the brain to figure out how to raise it. The patient is instructed to do his/her best to detach, relax and “gently observe” the signal rather than strategize.) Once the increased output of infrared energy is detected, the bar rises and the movie comes back on.
While the movie is playing, the patient simply allows him/herself to be drawn into the movie in an experiential way, forgetting about the process of neurofeedback. When the movie pauses again, the patient is instructed to come back into the moment and focus attention on the bar instead of the movie. This is done repeatedly. The objective of the neurofeedback is to increase one’s ability—by operant conditioning —to train the person to activate their executive functions (those controlled by an activated prefrontal cortex), and with more strength and flexibility/mental agility.
It is theorized that the increased regulatory ability gained from asking the individual to raise the output from the frontal regions –” on command” leads to the functional gains: reduced migraines, better impulse control, better focus, less reactivity, improved mood, more progress in therapy, etc. This is thought to reflect increased flexibility and regulation of these executive /cognitive functions, through the process of neuroplasticity and learning. The range of possible benefits is broad because the frontal lobe is involved in a regulatory way with so many brain functions. (For example, the frontal lobe is very involved in regulating the temporal lobes that process emotion, and in attention and executive/inhibitory functions in general)
These are unconscious brain abilities; neurofeedback trains the brain’s ability to make connections that achieve better functions. It is a learning process. Like learning to ride a bike.
The clinician coaches the patient, observes the length of the pauses, and determines how much ease or difficulty the patient is having, and determines when fatigue is appearing. The client is instructed to acknowledge promptly if fatigue, pulsation, or head discomfort or strain occurs, as it is preferable to avoid pushing too far and causing unnecessary fatigue.
There are patterns of performance during training that patients may show, similar to lifting weights – fatigue with repeated exertion, endurance growing over time, etc. Improvement, if it occurs, is sometimes seen after one session, and if not, is generally seen within six or so sessions if it is going to be helpful.
Sessions are usually once a week. Generally, the degree of benefit, and length of benefit-- if benefit occurs-- increases with repetition, until sessions can be spaced out to two weeks, a month, etc. As with neurofeedback in general, sometimes improvement is sustained, or “refresher sessions” at some interval may be necessary. Reduction of medications must be considered at times as appropriate. (A common observation of neurofeedback practitioners is that as these self-regulatory functions are better regulated, the side effects of medications may increase, signaling the need to consider reduction, which should be discussed with the prescribing physician.) Sometimes – but not always – medications might be discontinued.
Negative side effects on the day of training may occur if the patient gets too fatigued. In that case, some of the usual symptoms might be worse the rest of the day. (It is essential, as with any medical treatment, that the clinician be advised of all effects, positive and negative, so treatment parameters can be adjusted with relevance.) But the next day, after sleep, any negative effects are usually dissipated, and benefit might still be seen. AV malformations in the brain are a contraindication. Risks involved include risk of no response, risk of worsened symptoms (such as headache, fatigue, reactivity – which are generally short lived).
PirHEG is a wellness device, which can be used for general relaxation, and is in the category of “intrinsically safe devices” because there is no stimulation delivered and there is no actual electrical interface with the body. Therefore, it does not require FDA approvals. It is not a “medical device” which does require FDA approvals. Despite this, when used for general relaxation/in a wellness approach, in the treatment of stress-related conditions, it can also be the preferred neurofeedback. It should be used of course in collaboration with the medical clinician primarily treating the migraine or stress related conditions.) There has been research on the specific utility of pirHEG biofeedback, used in conjunction with eeg-guided neurofeedback, that has shown enhanced positive results in work with traumatic brain injury, attention disorders, and autism – all of which can involve impairment in frontal lobe regulation.
Equipment required is the software for the pirHEG program and the accompanying headset, and a dedicated computer meeting the requirements of the software. Information about the equipment and training would be available through the website http://www.stopmymigraine.com/. It requires a licensed clinician (or a supervised technician) to administer. Its use is appropriate for clinical indications as determined by licensed practitioners. This is similar to the use of many medications and treatments used “off label” or according to clinician education and preference, as most medicine is practiced. (Evidence based medical practice includes the first-hand experience and collegial experience of clinicians, as well as case studies and formal intensive research with its limitations.)
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Click below to view my presentation on neurofeedback given at TidalHealth Peninsula Regional Grand Rounds.
shared with permission from TidalHealth
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For more information on PirHeg Neurofeedback please click on the PowerPoint below:
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Click on the link below to listen to the Northeast Region Biofeedback Society's podcast interviewing Dr. Jeff Carmean
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