PANS: Neurofeedback and Family Therapy. Sarah Stodghill Haggis, M.A., LMFT NeuroCycles Wellness Center

Transcription

1 PANS: Neurofeedback and Family Therapy Sarah Stodghill Haggis, M.A., LMFT NeuroCycles Wellness Center

2 Tomas and family Tomas - 11 yo Nick - younger brother 8 yo Father Caucasian Silicon Valley Tech Mother Latina Silicon Valley Tech Upper Middle Class Private School Sports - Music

3 PANS vs PANDAS PANS: Pediatric Acute-onset Neuropsychiatric Syndrome PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections

4 PANS Symptoms Acute sudden onset of OCD and or Eating Restriction (plus at least 2 out of 7) Anxiety (particularly separation anxiety) Emotional Lability or Depression Irritability, aggression, and or severely ODD Deterioration in school performance ADHD related Memory deficits and cognitive changes Sensory or motor abnormalities Somatic sx, sleep disturbance, enuresis

5 Tomas Medical Treatment Medical Treatment - corticosteroid and immunoglobulin infusions 1x month 3 days 1 hour per day anti-inflammatory and immunomodulatory therapy Resperidone and Sertraline psychotropics to address OCD and Mood

6 Tomas Symptoms - before neurofeedback Compulsive behaviors; Obsessive worries 10 Anorexia 10 Sleep 10 (4 hrs) Poor Short term memory 9 Messy Handwriting 10 Sensory heightened sensitive to sound and light 10 Rages 10 ODD - 10 Mood Swings most of the emotional category 10 Nocturnal Enuresis 9

7 PANS impact on family conflictual and reactive relationships stress both financial and emotional fear and worry for the future

8 Neurofeedback and Family Therapy Reduce Tomas symptoms OCD, Anorexia, Mood, Rages, ODD Externalize the problem - PANS and OCD Invite respect and compassion back into family

9 Session 1-5 #1 no training #2 10 min T4 P4.01; 5 min T3-T4.01 #3 15 min T3 T4.01 #4 18 mins T3 T4.01 (increase time) #5 20 mins T3 T4.01 #1 no training #2 Better after session and for first 24 hours then much worse. -- Called for consult drop T4 P4 ramping him up #3 mom reports less rage and more calm entire week Laughing more interacting with others more - OCD still high #4 infusion after training was not as irritable or agitated after tx remarkable Tomas notes parents are less stressed and happier #5 Tomas reports - getting along better with brother playing guitar feels better this week

10 Session 1 5 Family Therapy Building rapport Listening to story impact of PANS on each family member and as a whole Increase empathy for each family member Hold upset grief and loss Externalize PANS/OCD unite family against PANS/OCD

11 Session 6-10 #6 20 min T3 T4.009 #7 11 min T3 T4.008; 11 min.007 #6 going lower to address OCD sx connecting with brother irritable and OCD remains high #7 Less stress in family OCD slightly better #8 11 min T3 T4.006; 11 min.005 #9 11 min T3 T4.004; 11 min.003 #10 4 min T3-T4.002; 24 min.001 #8 OCD not doing things that I use to do like writing things just because I need to getting along better sleep is good not waking up to study #9 good week more loving towards others able to do homework without it taking over #10 OCD and irritability high after infusions fight with brother mom slapped Tomas

12 Session #6 10 Family Therapy Listening to Nick scared he will get PANS Tomas offers comfort Dad acknowledges Tomas bravery in face of PANS proud of Nick for being good brother realizes OCD is not Tomas but hard to watch Tomas struggle Discuss how to help mom not let PANS/OCD get the better of her (yell/slap) - what she can do differently make commitments Tomas reassures family discuss what will help him taming PANS/OCD

13 Session #11 30 min T3 T4.001 #12 fell asleep after 3 mins #13 30 min T3 T4.001 #14 20 min T3 T4.001 #15 30 min T3 T4.001 #11 shut down and irritable. After training bright affect bubbly and relational - remarkable #12 talking - then conk over asleep MDs state this is recovery OCD is low #13 bright affect relational showing me apps discussing fractals- interest in world physical transformed strong presence - whole child #14 not feeling as sleepy OCD Taming better relationships #15 OCD decreasing - not perfect yet

14 Session Family Therapy Curious how family is helping slay OCD Tomas playing soccer with Nick Tomas playing guitar with Dad Tomas and mom reading together Tomas friend date went swimming Tomas asks family to meditate together each morning Family celebrations birthdays and anniversary attend Nick s soccer game Tomas still worried that if he lets go of OCD, he won t reach his full potential

15 Session #16 30 mins T3 T4.001 #17 10 mins T3 T4.001 #18 30 mins T3 T4.001 #19 12 mins T3 T4.001; 5 min T4 Fp2.001; 12 mins T3 T4.001 #16 Feeling better less sleepy better relationships with family OCD less time consuming #17 Fell asleep after 10 mins left session irritable #18 alert entire session joyful relating fully present #19 taking a break and going to OCD camp for 4-6 weeks

16 Session Family Therapy Addressing ups and downs in family relationships Explore -mixed bag in relationship with brother some arguing and disagreements more laughter playing soccer together sharing Tomas able to be snarky with therapist acknowledge Discuss taking a break from family therapy and neurofeedback pros and cons

17 Tomas Tracking - after neurofeedback Compulsive behaviors; Obsessive worries [10] to 5 Anorexia [10] 3 eating most meals Sleep [10 (4 hrs)] 2 sleeping hours most nights Poor Short term memory [9] - 4 Messy Handwriting [10] - 8 Sensory heightened sensitive to sound and light [10] - 4 Rages [10] 3 ODD [10] 2 Mood Swings [10] - 4 Nocturnal Enuresis [9] 8

18 Summary 5 months of consistent sessions Improved family relationships Improved sleep Reduced OCD, Anorexia, and Mood lability Some return to previously enjoyed activities guitar and soccer Brighter affect Reduced family stress

19 Impact of neurofeedback Family very grateful for neurofeedback believes it helped BUT Family not sure how much credit to give neurofeedback vs. medical infusion interventions believes it was a combination MDs believe improvement was due to infusions I note significant improvement a few sessions into training.001 it was magical remarkable shift in being Neurofeedback and infusion treatment provided enough symptom relief to work with the family on the emotional toll of PANS Family emotional repair

20