Category: News

What are Seizure “Triggers”?

Before listing common seizure triggers and ways to avoid them, lets briefly review what is Epilepsy or commonly known as seizure disorder.

Epilepsy is a disorder in which nerve cell activity in the brain is disturbed resulting in seizures.  It is basically a result of abnormal electrical brain activity causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Epilepsy is defined as having two or more unprovoked seizures. One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy may occur as a result of a genetic disorder or an acquired brain injury, such as trauma or stroke. But in 50% of cases, there’s no known cause.

Depending on the area of the brain impacted by these abnormal activities, seizures can cause:

•  Shaking
• Twitches
• Confusion
• Blank Stares
• Pain
• Changes in sensation (hearing, vision, taste)
• Feelings of fear, anxiety, dread, or even pleasure
• Changes in heart rate or breathing
• Stiffness throughout the body
• Repeated or automatic movements

That said, no two cases of epilepsy are the same.  An individual’s trigger can be completely different than someone else’s triggers.

Some of the most common known seizure triggers include:

• Missed dosage of anti-epileptic drug (AED)
• Stress
• Lack of sleep
• Alcohol
• Caffeine
• Flashing lights or patterns
• Withdrawal from narcotics and/or barbiturates
• Low blood sugar
• Time of the day
• Hormonal changes
• Fever
• Infection or other illness

Increased awareness and understanding of what causes one’s seizures can help with diagnostics, treatment planning, and symptoms management.

Journal entry (information about seizures and factors associated with epilepsy) coupled with structured routine can help with identification of specific triggers as well as pathways to avoid the known trigger.

Once a patient understands and knows their specific trigger(s), the following can help avoid them or reduce its impact.

• Take medications as prescribed (right dosage at the right time)
• Limit stress
• Getting adequate amount of sleep
• Avoiding alcohol
• Avoiding caffeine, nicotine, and/or other substances
• Avoid flashing lights or patterns
• Modifying eating habits
• Planning around hormonal changes
• Treating at the first sign of illness
• Talking with others who understand (outreach group, medical professional, mental health provider)

Neurology should always be consulted first.  Once you have established  yourself with a neurologist, neuropsychology can help with the treatment of seizure disorder.

Please contact our staff or schedule an appointment with our providers for diagnostic clarification and treatment planning including identifications of triggers and help with managing them.  Our doctors can help you manage symptoms associated with epilepsy with evidenced based approaches including Medical Adjustment Counseling ®, Biofeedback, and Cognitive Rehabilitation Therapy

Mihir J. Shah, Psy.D.
Clinical Neuropsychologist

Cognitive Rehabilitation Therapy (CRT) focuses on improving thinking abilities related to everyday functioning and strengthening independent living skills.  Typically, CRT focuses on patients with various neurological conditions, including but not limited to strokes, TBI, epilepsy, multiple sclerosis, and mild neurodegenerative disorders such as mild cognitive impairment and early stages of dementia.

Thinking abilities related to everyday functioning include attention, the ability to process information coming into the brain via sight, hearing, touch, or other senses, as well as memory, language, and problem-solving.

Examples of daily activities affected by problems in thinking may involve basic skills: preparing meals, taking care of personal hygiene and appearance, maintaining a daily schedule, etc. Other, more complex, negatively impacted abilities may include taking care of finances, managing medications, driving, making decisions, and solving problems related to work and life at home.

The neuropsychological examination (NPE) helps determine which thinking processes are impaired, the significance of their impact on daily functioning and whether the person would be a good candidate for CRT.

CRT is based on research demonstrating that thinking abilities can improve with practice. The treatment usually starts with simple tasks that become increasingly more difficult. A doctor or therapist decides on the tasks’ order and complexity.  In addition to retraining the brain, another treatment component included in CRT is based on learning compensatory strategies to compensate for thinking deficits. For instance, one of the strategies to improve memory learned during CRT may include using alarms and calendars. Techniques to strengthen attention may focus on minimizing distractions and taking breaks.

If you have any questions regarding CRT, please contact our office for more information.

Eleonora Gallagher, Psy.D.
Neuropsychology Post-Doctoral Fellow
NJ Permit: TP# 213-079

It is no secret that depression can resemble dementia.  The question is, how can we differentiate the two?

Dementia and depression share common features.  Researchers have found that people who become depressed later in life have a 70% increased risk of developing dementia (www.health.harvard.edu).  Dementia in older adults is steadily increasing, along with emotional problems like stress and anxiety.  These emotional problems can lead to forgetfulness, confusion, and other symptoms that look like depression.  Many older adults develop memory problems from health issues, or side effects of medications, vitamin deficiencies, or even substance abuse. Cognitive issues related to these areas may be treatable.

What is dementia?  This is not a specific disease, but a group of conditions characterized by impairment of at least two cognitive brain functions like memory loss and judgment.  A few types of dementia include Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia.

Symptoms of dementia include memory loss that affects daily functioning, difficulty planning and problem-solving, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images, problems with words in speaking or writing, poor judgment, withdrawal from social activities, and changes in mood or personality.

If it is depression, a behavioral health issue is causing the person to feel continued sadness.  They lose interest in everyday things.  Depression is one of the most treatable mental health disorders.  Seeking help can significantly improve a person’s life.  Some depression signs and symptoms are:  Trouble concentrating, remembering detail, persistent fatigue, feelings of worthlessness, hopelessness, irritability, and suicidal thoughts.  If it is depression, getting treatment can improve memory, concentration, and energy.  Eating healthy, getting enough sleep, staying active, being socially engaged, exercise, and controlling stress levels are all important to one’s emotional health.

Depression vs. Dementia

A person with depression will likely recognize if they are having memory problems, whereas someone with dementia may be less likely to notice the decline. Depression, confusion, or forgetfulness can come on suddenly, whereas dementia typically causes a slow cognitive decline.  People who are depressed know who they are speaking with, what day and time it is, and where they are.  People with dementia are impaired in these matters.  Depressed people use language correctly, though they may speak slowly at times.  However, someone with dementia has many language issues such as difficulty remembering someone’s name or the name of certain objects.

Both depression and dementia are unique to the individual and vary case by case.  Whether memory loss or cognitive decline is caused by depression or dementia it’s important to seek a medical workup first and then see a neuropsychologist who will administer a neuropsychological examination, who will then be able to list the thinking problems and behavioral changes and make the case whether it’s dementia vs. depression.

For more helpful tips on how you can help your loved ones who are dealing with dementia or depression, give us a call for a consult and put the question to rest.

Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal, Director of Training

According to the International Dyslexia Association, “Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”

The role of Neuropsychology is to provide comprehensive evaluations via objective testing, to assess a person’s reading and writing abilities in the context of general neurocognitive functioning. In addition, the data via the Neuropsychological Examination provides information about brain-behavior functioning and cortical functioning involved in reading and writing conditions, such as dyslexia.

A pivotal article published in 2008, titled, “Learning disabilities: The need for neuropsychological evaluation” from Archives of Clinical Neuropsychology, reads the following, “A learning disability (LD) is a neurobiological disorder that presents as a serious difficulty with reading, arithmetic, and/or written expression that is unexpected, given the individual’s intellectual ability. A learning disability is not an emotional disorder nor is it caused by an emotional disorder. If inadequately or improperly evaluated, a learning disability has the potential to impact an individual’s functioning adversely and produce functional impairment in multiple life domains. When a learning disability is suspected, an evaluation of neuropsychological abilities is necessary to determine the source of the difficulty as well as the areas of neurocognitive strength that can serve as a foundation for compensatory strategies and treatment options.”

Here at NRS|LS, we are here to help you or your child assess for learning disability and provide comprehensive treatment and recommendations.

If you have any questions, please feel free to contact our office.

ADHD requires a multi-factorial treatment approach.

Besides the traditional neuropsychological approach consisting of consultation, neuropsychological examination, treatment (Medical Adjustment Counseling), and Cognitive Rehabilitation, the following are supplemental approaches:

Diet:

• Individuals with ADHD can be more sensitive to certain foods, meaning their symptoms worsen from consuming them.
• Foods with artificial additives, preservatives, and colors can increase ADHD symptoms.
• Sugar is a common additive in foods that increases the hyperactivity in those with ADHD.

Exercise:

• Physical exercise can be effective in reducing ADHD symptoms (inattention, impulsivity, &hyperactivity)

Supplements:

• Vitamins/Minerals (see your nutritionist for specifics)

Sleep:

• Not getting proper sleep can worsen ADHD symptoms
• Sleeping Disorder (Comorbidity)
• Difficulties falling asleep (sleep onset), awakening at night, low sleep duration

Neurofeedback/Biofeedback:

• Helps individuals control and understand their own behaviors
• Looks at brain waves to retrain the brain
• Individuals are taught to self regulate brain activity
• Neurofeedback therapy, alongside other services, has been found to improve ADHD symptoms

Aerobic Exercise:

• Walking, running, cycling, jumping, swimming, dancing (10-30 minutes daily)

Yoga

• Less intense form of exercise – physical postures, breathing exercises, deep relaxation, & mindfulness/meditation

Psychotherapy:

• Individual therapy
• Group therapy
• Family therapy
• Executive functioning building

Meditation/Mindfulness:

• Meditation and mindfulness can improve focus, concentration, behavioral issues, self-control, and sleep quality

Strength-Based Approach:

• Focuses on the individual’s strengths, success, and resources
• Pays less attention to the challenges faces by those who have ADHD
• This approach can be implements at home and in the school setting

Sleep Schedules:

• Having proper sleep schedule can help with troubles, falling asleep, and staying asleep

Please call our office for further information.

Michelle Blose, PsyD
Neuropsychology Post-Doctoral Fellow

HRV biofeedback is a unique service offered at NRS|Lifespan. While some patients seek out this treatment intentionally, others are referred for biofeedback by their medical doctors and, therefore, have little knowledge about this treatment and how it may be useful to them. Here are some FAQs about HRV biofeedback to provide some brief background:

(1)   What is biofeedback?

Biofeedback is a tool that clinicians use to gain real-time metrics about an individual’s emotional and physiological status, similar to how a thermometer reads your body’s temperature at any given moment. In essence, it forges a connection between what you consciously think and feel in the moment and how your body is responding to it “under the surface”. Usually the major goals of biofeedback include building awareness into the mind-body relationship and then learning which coping mechanisms actually change your mental state and body for the better.

(2)   What is Heart Rate Variability (HRV)?

HRV is one type of metric that is an extremely useful global indicator of health, physical and emotional. It captures level of physical conditioning, balance between the sympathetic and parasympathetic nervous system, reactivity to stress and the body’s ability to recover from stress with respect to cardiovascular and immune system functioning. High HRV levels are correlated with lower levels of disease, depression, anxiety, and stress-influenced symptoms while low levels of HRV reflect the opposite – greater cardiovascular and autoimmune risks as well as higher levels of depression, anxiety, stress reactivity, and cognitive complaints (e.g., brain fog, short-term memory).

(3)   What types of issues does HRV biofeedback target?

Some of the positive effects of HRV training include: lowered heart rate, blood pressure and blood lipid panel; reduced inflammatory markers; increased pain tolerance; reduced cortisol levels; increased sense of well-being and sleep quality; reduced symptoms of depression and anxiety; better focus and ability to screen out distractions; improved executive functioning skills; and better clarity in thinking accompanied by creativity. Therefore, individuals with stress-driven physical, emotional, and cognitive complaints are good candidates for HRV biofeedback.

(4)   What does a typical course of HRV biofeedback look like?

In an outpatient setting, HRV biofeedback is intended to be a short-term treatment (6-10 sessions on average) that focuses on patient education, increasing awareness into the mind-body relationship, acquisition of skills, and application to everyday life. Clinicians customize the plan of care based on a patient’s medical and emotional complaints. This program is designed to be collaborative and highly dependent upon the motivation and participation of the individual. Therefore, its course and completion date are based on the patient’s goals, baseline status, and biofeedback metrics showing that HRV is trending in a positive direction.

(5)   How do I schedule a consultation appointment to learn more?

Call our main office number, 732-988-3441, to schedule a consultation appointment with our staff clinical health psychologist to find out if you could benefit from HRV biofeedback.

• Neurodivergent describes people whose brain differences affect how their brain works
• The word “Neurodivergent” is not a medical term. It exists as a way to describe people using words other than “normal” and “abnormal”
• Some Neurodivergent people struggle because of systems or processes that limits their abilities to demonstrate their strengths or that create new or more intense challenges for them
• For someone who is Neurodivergent, an accommodation is a way to accept that they are different or have challenges, and give them skills to succeed

• Common conditions of those who are described as Neurodivergent:
  • Autism Spectrum Disorder (ASD)
  • Attention-Deficit Hyperactivity Disorder (ADHD)
  • Down Syndrome
  • Dyslexia
  • Sensory Processing Disorders
  • Tourette Syndrome

Here at NRS|LS, our Pediatric Section is trained to address Neurodivergence in a subjective and objective manner, via Neuropsychological Examination and Treatment.

Please call our office for further information.

Steven P. Greco, PhD, ABN
Board Certified, Neuropsychology

Major depressive disorder (MDD) is a common mental condition experienced by millions of people. Based on National Institute of Mental Health research, more than 17 million adults in the U.S. experienced a major depressive episode the previous year.  While most people can manage depressive symptoms on their own, unfortunately some depression leads to severe impairments, affecting the ability to manage daily life. This warrants immediate attention due to increased risk for suicide. It is important, therefore, to recognize depressive symptoms/ suicide warning signs and seek professional help.

During major depressive episodes, symptoms occur most of the day, nearly every day for a period of two weeks.

Common Depressive Symptoms:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Irritability/anger, frustration
• Loss of interest/pleasure in activities once enjoyed
• Sleep problems (sleeping too much or not enough)
• Lack of energy
• Reduced appetite (weight loss) or increased food cravings (weight gain)
• Anxiety, agitation or restlessness
• Trouble thinking, concentrating, making decisions and remembering things
• Feelings of worthlessness or guilt
• Frequent/recurrent thoughts of death, suicidal thoughts or attempts

Common Suicide Warning Signs:

• Talking about suicide/making statements such as “I’m going to kill myself” or “I wish I were dead”
• Obtaining means to commit suicide (e.g., purchasing a gun, stockpiling pills)
• Withdrawing socially
• Being constantly preoccupation with death
• Feeling hopeless/trapped in a situation
• Engaging in risky behaviors (driving recklessly, using drugs)
• Giving away belongings/getting affairs in order without rational reason
• Saying goodbye to people as if seeing them for the last time
• Experiencing shifts in personality (being severely anxious, agitated)

If you have depression and you’re struggling to cope, help is available. Here at NRS|LS we provide effective treatments for depression like cognitive behavioral therapy (CBT) and Biofeedback. We can teach you skills to effectively cope with your depression and restore your ability to function in your daily life.

If you or someone you know is struggling with symptoms of depression, please call our office for a consultation.

If you or someone you know is in crisis:

• Call 911 in an emergency
• Contact Suicide and Crisis Lifeline: In U.S., call or text 988 to reach the 988  Suicide & Crisis Lifeline 24 hrs./day, 7 days/week
• The Suicide & Crisis Lifeline in the U.S.-Spanish speaking: 1(888) 628-9454

Basia Andrejko-Gworek, Ph.D.
Clinical Psychology, Post-Doctoral Fellow
Permit# TP #213-03

• Social Pragmatic Communication Disorder is a disorder in understanding pragmatic aspects of language.
• SPCD is characterized by reduced verbal and nonverbal communication abilities that cannot be explained by low cognitive ability, whereas ASD includes communication problems, but also has restricted, repetitive behaviors (RRB’s).
• Communication problems in SPCD can include inability to communicate appropriately in different social contexts, inability to change communication to match context, difficulty following conversational rules, and difficulty understanding what is not specifically stated (DSM-5).
• RRB’s in ASD can include repetitive motor movements or use of speech or objects, inflexible adherence to routines, and highly fixated interests (DSM-5).
• One reason that SPCD became a diagnosis was to encompass individuals affected by language and communication difficulties that did not fall within the range of typical Specific Language Impairments (Amoretti 2021).
• One study led to implications that children with SPCD may diverge more in comprehension than children with ASD (Svindt, Suranyi 2021).
• ASD must first be ruled out for SPCD to be diagnosed and therefore they cannot cooccur.
• A study conducted by Ward et al. (2020) found that 19 of their participants met the criteria for an SPCD diagnosis, but 18 of those also met the criteria for an ASD diagnosis, so therefore SPCD was ruled out for the 18 participants.
• Weismer et al. (2021) found that children that likely had SPCD reported lower levels of RRB’s than children with ASD.
• A study comparing prevalence’s of DSM-IV and DSM-5 disorders found that children diagnosed with DSM-IV Autistic Disorder, Asperger Disorder, and Pervasive Developmental Disorder had 99%, 92%, and 63% DSM-5 ASD prevalence’s respectively whereas only 1%, 8%, and 32%, respectively, met criteria for a DSM-5 SPCD diagnosis (Kim et al. 2014).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Amoretti, M. Christina; Lalumera, Elisabetta & Serpico, Davide. (2021). The DSM‑5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosphy of the Life Sciences 43(4).

Kim, Young Shin, et al. (2014).  A comparison of DSM-IV PDD and DSM-5 ASD prevalence in an epidemiologic sample.  J Am Acad Child Adolescent Psychiatry 53(5).

Svindt, Veronika & Suranyi, Balazs. (2021). The comprehension of grammaticalized implicit meanings in SPCD and ASD children: A comparative study. International Journal of Language & Communication Disorders 56(6).

Ward, Audrey; Boan, Andrea D., Carpenter, Laura A. & Bradley, Catherine C. (2020).  Evaluating the rate of Social (Pragmatic) Communication Disorder in children at risk for Autism Spectrum Disorder. Children’s Health Care 49(4).

Weismer, Susan Ellis; Rubenstein, Eric; Wiggins, Lisa & Durkin, Maureen S. (2020).  A Preliminary Epidemiologic Study of Social (Pragmatic) Communication Disorder Relative to Autism Spectrum Disorder and Developmental Disability Without Social Communication Deficits.  Journal of Autism and Developmental Disorders 51.

In the past, the major focus of neuropsychology has been largely diagnostic and primarily concerned with relationships between lesion localization and subsequent cognitive/behavioral alterations. Currently the primary issue, especially in forensic and clinical settings, is to determine an individual’s functional capacity.

An individual’s ability to be successful in activities of daily living (ADL), is vitally important during personal injury litigation.  Plaintiff and defense attorneys undoubtedly are interested in determining how an individual is functioning post-injury.  Plaintiff and defense attorneys have different roles and view assessment outcomes according to their client representation (e.g., maximize deficits; minimize deficits).  The neuropsychologist will assist the attorney referral sources, and the trier of fact in answering specific questions related to an individual’s pre and post-injury status (e.g., level of functioning).  Neuropsychological test results provide information to assist in childhood, adult, and geriatric neurocognitive and behavioral conditions, particularly when neurologic, radiologic, and laboratory data are inconclusive (e.g., MTBI, post-concussive syndrome).  Forensic neuropsychological assessment also establishes an objective baseline of function, which can be later compared with re-assessment results, that is invaluable in determining the course of cerebral dysfunction.  The contribution of a patient’s personality and mood to his or her symptoms is also estimated via formal assessment.  Furthermore, neuropsychological test data assists in predicting a patient’s short and long-term prognosis.

In summary, the purpose of a forensic neuropsychological assessment is briefly described below:

• To describe the degree of cognitive impairments and explain the reasons of their existence.
• To measure behavioral impairments that result from brain injury.
• To establish a baseline of function that allows for comparisons over time
• To provide a plan for cognitive and behavioral rehabilitation treatment.
• To guide the planning and development of remedial education or vocational rehabilitation.
• To calculate the individual’s ability to resume his/her premorbid lifestyle.
• To provide documentation for litigation concerned with the functional impact of documented or suspected brain injury on cognitive and behavioral functioning.

In legal proceedings, the neuropsychologist as expert will assist both plaintiff and defense attorneys, as well as the tier of fact, in understanding neuropsychological evidence as referenced above.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900