1. What is unique about Neuro-Therapy Clinic, P.C.?
2. What exactly is Dr. Hoffman’s specialty in neuropsychiatry?
3. Does Dr. Hoffman do any therapy or counseling?
4. Does the clinic do neuropsychological testing?
5. What is the medication philosophy used at Neuro-Therapy Clinic, P.C.?
6. What is a neurocognitive assessment?
7. What is a QEEG?
8. What is an rEEG?
9. What is a
SPECT Scan and does the Neuro-Therapy Clinic, P.C. perform them?
10. My child does not have ADD/ADHD, but has difficulty in school. Can the Neuro-Therapy Clinic, P.C. help?
11. What is a neurofeedback or neurotherapy?
12. How has N.A.S.A. technology changed neurofeedback?
13. Will the QEEG show such conditions as bipolar disorder?
14. Do I have to have a QEEG in order for Dr. Hoffman to make a diagnosis?
15. What costs will my insurance cover?
1. What is unique about the Neuro-Therapy Clinic, P.C.?
The Neuro-Therapy Clinic, P.C. is a center for highly-advanced testing and treatment of neuropsychiatric problems, including learning, attentional and behavior challenges, mild head injuries, as well as depression, anxiety, bipolar and all other common psychiatric disorders. Because recent technological developments allow brain imaging to assess patterns previously “invisible” to the clinician, we discovered that many patients were being incorrectly diagnosed. Without knowing the correct brain signature, treatments were generalized instead of being patient-specific. We believe that precise diagnosis leads to better intervention and results.
2. What exactly is Dr. Hoffman’s specialty in neuropsychiatry?
Neuropsychiatry bridges the gap between traditional “talk” psychotherapy and the medical aspects of behavior and learning. With the explosion of technology offering significant improvements in Neuro-Imaging and objective testing, we now are able to understand more about how the brain works. By evaluating brain structure and functioning, we can see how behaviors are affected.
3. Does Dr. Hoffman do any therapy or counseling?
Although Dr. Hoffman is trained in psychotherapy and has done it for most of his career, with time constraints imposed by managed care insurance, as well as with developments in the neurosciences, most of his professional time is spent on neuropsychiatric advancements. These include state-of-the-art assessment techniques, the latest in medication management and research towards advancing “evidence-based” psychiatry. We do have psychotherapists on staff that work closely with Dr. Hoffman and provide psychotherapy services to our clients.
4. Does the clinic do neuropsychological testing?
Our clinic does not perform traditional neuropsychological test batteries.
5. What is the medications philosophy used at Neuro-Therapy Clinic, P.C.?
It is important for you, and for Dr. Hoffman, that you understand his unique approach to his patients’ medical care. Dr. Hoffman continues his quest for state-of-the-art data and knowledge in order to offer his patients the most advanced medical care. Psychiatry has not been in the forefront of medical specialties in its ability to objectively understand the unique neurophysiology of a patient’s symptoms. Traditionally, psychiatrists have given a diagnosis based on the history and then treated with medications approved for that disorder. However, as it turns out through recent research, many medications are not clearly used for only one diagnosis (i.e., antidepressants are used for Panic and Anxiety, anti-psychotic medications are used to treat Obsessive-Compulsive Disorders and anti-epileptics are used to treat Bipolar Disorders - to name a few). Realizing how imprecise this process of diagnosis and treatment is, Dr. Hoffman has sought new methods of testing to more accurately and objectively diagnose the problem. To this end, he utilizes the brain’s unique electrical patterns to help guide him in his treatment recommendations. Dr. Hoffman’s goal is to be an unbiased consultant who can offer many different treatment options, once he understands your unique needs. If medications are the treatment of choice, it is very important that you work as a team with Dr. Hoffman to understand your choices, the possible side effects and any long-term consequences. Dr. Hoffman expects that as a part of this team you will follow appropriate recommendations, discussing any concerns you have with him before making any changes. Some medications take awhile to work most effectively, or you may have to go through some initial side effects before feeling better. Other medications may have little or no side-effects. Dr. Hoffman’s approach is to work slowly with medications to allow the highest probability of the best outcome.
6. What is a neurocognitive assessment?
A neurocognitive assessment will mean different things for different people, depending upon the history and needs of each person. The first step in the assessment process is obtaining a detailed history in order to understand the particular complaint of the patient. It is at this point in the evaluation that the need for further testing is determined and in what manner our services may help in diagnosing and treating the presenting problem. At the same time, it is an opportunity for you, the patient, to learn about options available for your particular brain neurophysiology or neurochemistry (that is, how the brain is actually physically performing). Various tests may be required. They consist of: 1) standardized questionnaires for attention, learning styles, learning modalities, sub-typing of problems based on the latest research in brain blood flow studies (SPECT Scan), assessment of symptoms of behavior or mood disorders, evaluation of medical conditions and medication responses. 2) testing how the brain recognizes and tracks a visual and auditory signal to determine if the root cause of the symptom relates to how the brain processes different types of input. 3) a Quantitative or Digital EEG (Electroencephalogram), which measures the brains electrical activity and how it changes under different conditions, such as resting, reading or listening. The EEG can then be compared to a database of normal control subjects the same age. 4) a referenced EEG, which when submitted to a newly released database, gives the probability of which medicines would help to normalize the brain being tested. This is much different than current practices, which can often feel like “throwing different medications against the wall to see which stick”.
7. What is a QEEG?
A Quantitative or Digital EEG is a computerized data collection of the electricity the brain produces (brainwaves). A cap (like an old fashioned bathing cap) has a series of sensors inside to measure the brainwaves. Tasks, such as reading, resting or listening may be performed so that when the data is analyzed, processed and submitted to databases, variations from normal can be objectively measured. The testing is non-invasive and only collects brainwaves – no electricity is ever put into the brain. This data can be helpful in finding the nature of attentional or learning problems since many patients are misdiagnosed based only on their symptoms. For example, anything that affects the functioning of the frontal lobes of the brain can cause difficulties with focus and attention, yet only 60-70% of those diagnosed with ADD or ADHD actually have the brainwave pattern of ADD/ADHD as the true cause of their symptoms. Not only is this test helpful diagnostically, but it can help direct treatment decisions – whether through correct medication choices or other non-pharmacological treatments. In the case of one of these alternatives, Neurofeedback, the QEEG actually directs where and how to treat the patient in order to try to resume normal firing of the brain’s neurons.
8. What is an rEEG?
Once data has been collected in the digitized or computerized form, it can be sent to a lab where it is submitted to a database for a complex analysis known as referenced EEG (rEEG). This has the potential of determining which medications (or combination of medications) – and at what statistical probability – that particular brain has of responding. Unfortunately, psychiatry is unique among medical specialties that lack such physiologic measurement. This database took over 16 years to establish with over 2,500 patients and 10,000 medication trials. By matching brainwave patterns with known medication responses, the results offer a patient a form of objective evidence for the choice of drug treatment. This is originally based on known clinical responses of other patients with at least 2 years of follow-up. In medication treatment resistant cases, this testing has redirected treatment to a different class of drugs or a specific combination of medications that ordinarily would not have been chosen. It often points out that the diagnostic label can mislead a medication selection, since response based on brainwaves may be very different than current psychiatric classifications would suggest.
9. What is a Spect Scan and does the Neuro-Therapy Clinic, P.C. perform them?
No. A SPECT Scan is a form of neuro-imaging which looks at brain blood flow. Usually there are two different scans done on separate days with injection of a radioisotope. These studies have produced significant advancement in understanding the sub-typing of different disorders, like Attention Deficit Disorder. Although we do not perform SPECT Scans, our evaluations use questionnaires developed to correlate with the results of the SPECT Scan work to predict what the results would be if one were to have been performed. If a SPECT Scan is required, we would make an appropriate referral to an outside clinic.
10. My child does not have ADD/ADHD, but has difficulty in school. Can the Neuro-Therapy Clinic, P.C. help?
Yes. It is our strong conviction that many symptoms are misdiagnosed, mostly because only recently have objective neuro-imaging studies become available to distinguish differences in brain processing. Therefore, through the various tests offered at Neuro-Therapy Clinic, P.C. we strive to find the reason for the school difficulty.
11. What is a neurofeedback or neurotherapy?
Some clients whose brainwaves demonstrate certain abnormal patterns may receive a recommendation for neurofeedback. The process consists of normalizing the brainwaves. The patient, with sensors placed on the scalp, sits in front of a computer screen. These sensors monitor the brain’s electrical activity and transmit the data to the computer. The brainwaves are converted into pictures – like an F14 Fighter Jet – for example, and, the patient has to fly the plane. This is accomplished through focus and concentration on the task, without joysticks or control pads – like Yoda in Star Wars. When the brain masters the computer game, the training parameters are made more difficult. The brain is continually challenged throughout the training process until a plateau is reached, thereby refocusing and reshaping the brainwaves into the desired patterns, which correlate with improvement of the patient’s symptoms. This is actually no different than learning how to ride a bicycle or learning to swim. The brain has the capacity to adjust how it “fires” its neurons in order to accomplish a task, it just needs to be trained to do so.
12. How has N.A.S.A. technology changed neurofeedback?
N.A.S.A. took the Neurofeedback technology that has been used for decades and modified it for their astronauts and pilots. As a result, a “wireless” electrode as well as a home training unit will be available for certain treatment protocols. If the patient qualifies, treatment can now be done with standard video games and video game machines (e.g., X-Box and PlayStation).
13. Will the QEEG show such conditions as bipolar disorder?
While there is no definitive pattern agreed upon for Bipolar Disorder, QEEG can rule out other disorders that often get confused with Bipolar Disorder or which co-exist with Bipolar Disorder, such as Attention Deficit Disorder.
14. Do I have to have a QEEG in order for Dr. Hoffman to make a diagnosis?
It depends on the purpose of the visit. Having seen and treated hundreds of patients with and without these results, Dr. Hoffman feels that before he prescribes medication for ADD/ADHD, he needs to see the results of more objective testing. In other disorders, a QEEG, if recommended, is purely the choice of the patient.
15. What costs will my insurance cover?
It depends - insurance will usually cover the time with Dr. Hoffman, any therapist that is on the insurance panel and some of our testing. Generally, they do not cover QEEG’s, rEEG’s or Neurofeedback. We are happy to discuss all costs before any commitment to testing or treatment and will try to work out payment arrangements that consider individual needs.
