This article was downloaded by: [Australian National University] On: 18 January 2015, At: 10:28 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
The Effects of Hypnosis on a Parkinsonian Tremor: Case Report with Polygraph/EEG Recordings a
a
Harold J. Wain Ph.D. , Dan Amen & Bahmann Jabbari
a
a
Walter Reed Army Medical Center , USA Published online: 21 Sep 2011.
To cite this article: Harold J. Wain Ph.D. , Dan Amen & Bahmann Jabbari (1990) The Effects of Hypnosis on a Parkinsonian Tremor: Case Report with Polygraph/EEG Recordings, American Journal of Clinical Hypnosis, 33:2, 94-98, DOI: 10.1080/00029157.1990.10402910 To link to this article: http://dx.doi.org/10.1080/00029157.1990.10402910
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS
VOLUME 33, NUMBER 2, OerOBER 1990
Downloaded by [Australian National University] at 10:28 18 January 2015
The Effects of Hypnosis on a Parkinsonian Tremor: Case Report With Polygraph/EEG Recordings! Harold 1. Wain, Dan Amen, and Bahmann Jabbari Walter Reed Anny Medical Center Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.
(Mclrowell, Lee, & Sweet, 1978). Surprisingly, there is little reported on the use of hypnosis to promote relaxation in these disorders in standard neurology and psychiatry textbooks (Selby, 1968; Mcfrowell, Lee, & Sweet, 1978; Kaplan & Sadock, 1985). Bird (1948) and Buell and Biehl (1948) were among the first to show improvement of a Parkinsonian tremor with hypnosis. A later report described a patient in whom this type of tremor ceased under hypnosis, allowing the patient to remain still, awake, and communicative with the neurosurgeon during chemical pallidectomy (Crasilneck & Jenkins, 1958). Doshay (1960) reported that self-hypnosis improved the symptoms of three Parkinsonian patients; however, in two of these
It is well known that most movement disorders (Parkinson's Disease, extrapyramidal system reactions, Tourette's Syndrome, etc.) are improved with relaxation and exacerbated by anxiety
Requests for reprints should be sent to Harold J. Wain, Ph.D., Professor, Department of Psychiatry, Uniformed Services, University of the Health Sciences, Director, Psychiatry Liaison Consultation Clinic, Walter Reed Army Medical Center, Washington, D. C. 20307·5001. Received March 30,1987; revised May 1, 1990; accepted for publication July 2, 1990. 'The views expressed in this paper are those of the authors and do not necessarily reflect those of the U. S. Government. ""-,
I
"II"
.... .. ..,.. ..
...
a
b Figure 1 Polygraphic recording - baseline and after induction
A. A baseline polygraphic recording shows well-organized 9-10 Hz alpha rhythm over occipital regions. Note that the tremor of the hand and foot are slightly out of phase but display the same frequency. B. The tremor of the left hand ceases a few seconds after induction.
LEFT HAND
L EYE EDG R EYE EDG ~~."-~~"-~.---A.-,,-~~,-,,-,,-~,-'C~~,--'-'\...-v'--~--J,./'---''--'\.---J,./'---'~--J,./'---'V\..-~. ...........
_
......
EMS (CHIN)
III
,t
••
,t
II .... 1'
oW, •
... ,
"'
T,
• II.
Figure 2 Polygraphic recording during deep trance A deep hypnotic trance achieved by time distortion abolishes the tremor of the left foot (Hypnotist: "Now one minute seems as long as one hour, 2 minutes as long as 2 hours"). Note persistence of the alpha rhythm over posterior head regions.
all tremors (Fig. 2). He was able to visualize and describe time speeding or slowing. Silent calculations did not have a significant effect, while calculating aloud
or speaking invariably resulted in reappearance of the left-sided tremor. The tremor returned upon cessation of the hypnotic trance after each session.
Downloaded by [Australian National University] at 10:28 18 January 2015
PARKINSONIAN TREMOR
However, the patient subjectively stated that he felt more relaxed and was bothered less with the tremor and rigidity of the left side for several hours after each hypnotic session. He learned self-hypnosis and performed it three to four times daily for approximately 3 minutes each time in conjunction with taking medications. Overa follow-up period of 6 months, he repeatedly stated that his gait, stiffness, and tremor were improved after this mode of therapy. Discussion Although Parkinsonian tremors typically disappear during sleep, the effects of hypnosison this type of movement disorder have been generally ignored (Selby, 1968; McDowell, Lee, & Sweet, 1978; Birkmayer & Hornykiewicz, 1976). The mechanisms by which hypnosis improves Parkinsonian tremors are not well understood. Hypnosis and sleep may alter the ongoing activity of neural systems which maintain the rhythmicity and persistence of the Parkinsonian tremor. Such functions have been attributed to cortico-pallidal fibers (Denny-Brown, 1962) and to the ventral posterolateral nucleus of the thalamus. Jasper and Bertrand (1966), who promoted the latter view using microelectrodes, were able to record rhythmic discharges from the neurons of this nucleus which correspondedwith the frequency of the patient's resting tremor. Neurophysiologically, however, hypnosis and sleep display significant differences; EEG findings in hypnosis resemble wakefulness (Schwartz, Bickford, & Rasmussen 1955). This patient's EEG also showed persistence of alpha rhythm during hypnosis (Fig. 2). Further investigation into the mechanisms underlying the effectsof hypnosis in tremor disorders may prove to be significant in understanding
97
the results of this investigation and earlier anecdotal reports. Long-term follow-up of patients and their monitored use of selfhypnotic procedures may help to decrease the side effects of Parkinsonian pharmacological regimens. Also of significance is the motivation of this patient who, despite low hypnotic capacity, was able to obtain positive results. His self-hypnotic procedure consisted of visualizing a relaxing scene of the past and expediting the time. The patient's capacity to regain some self-control over what was perceived to be lost had significant psychological value for him in his overall treatment and the enhancement of the quality of his life. The results obtained reinforce the tenet suggesting that screening procedures are probability statements only and should be used for strategy development rather than acceptance for treatment. This patient's tremor grew worse after a decade of Ldopa therapy. The favorable response obtained suggests the value of self-hypnosis in the era of modern antiparkinsonian drugs. Multimodal or comprehensive approaches with these patients benefit not only the physical process, but enhance our patients' sense of self in a world of drugs and procedures. References Bird, H. W. (1948). Varying hypnotizability in a case of Parkinsonism. Bulletin of the Menninger Clinic, 12,210-217, 1948. Birkmayer, W. & Hornykiewicz, D. (1976). Advances in Parkinsonism. Basel: Roche. Buell, F. A. & Biehl, J. P. (1948). The influence of hypnosis on the tremor of Parkinson's Disease. Diseases of the Nervous System, 10, 210. Crasilneck, H. B. & Jenkins, M. T. (1975). Further studies in the use of hypnosis as a method of anesthesia. Journal of Clinical and Experimental Hypnosis, 6, 152-158.
Downloaded by [Australian National University] at 10:28 18 January 2015
98
Denny-Brown, D. (1962). The basal ganglia and their relation to disorders ofmovement. London: Oxford University Press. Doshay, L. J. (1960). The psychotherapy of paralysis agitans. Journal of the American Medical Association, 172, 1347. Jasper, H. H. & Bertrand, G. (1966). Recording from microelectrodes in stereotactic surgery for Parkinson's Disease. Journal of Neurological Surgery, 24, 219-221. Kaplan, H. I. & Sadock, B. J. (Eds.) (1985). Comprehensive textbook of psychiatry (4th ed.). Baltimore: Williams and Wilkins. McDowell, F., Lee, J. E., & Sweet, R. D. (1971). Extrapyramidal disease. In A. B. Baker & P. J. Baker (Eds.), Clinical Neurology, Vol. 2. Philadelphia: Harper & Row.
WAIN, AMEN, AND JABBARI
Schwartz, B. E., Bickford, R. G., & Rasmussen, W. C. (1955). Hypnotic phenomena including hypnotically activated seizures studied with the electroencephalogram. Journal ofNervous and Mental Disease, 122, 564-574. Selby, G. (1968). Parkinson Disease. In P. J. Vinken and G. W. Bruyn (Eds.), Handbook of clinical neurology, Vol. 6, Diseases of the Basal Ganglia, pp. 173-217. Amsterdam: North Holland. Speigel, H. (1972). An eye roll test for hypnotizability. American Journal of Clinical Hypnosis, 15, 25-28. Wain, H. J. (1979). Hypnosis in a consultation-liaison psychiatry service. Psychosomatics, 20, 679.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
The Effects of Hypnosis on a Parkinsonian Tremor: Case Report with Polygraph/EEG Recordings a
a
Harold J. Wain Ph.D. , Dan Amen & Bahmann Jabbari
a
a
Walter Reed Army Medical Center , USA Published online: 21 Sep 2011.
To cite this article: Harold J. Wain Ph.D. , Dan Amen & Bahmann Jabbari (1990) The Effects of Hypnosis on a Parkinsonian Tremor: Case Report with Polygraph/EEG Recordings, American Journal of Clinical Hypnosis, 33:2, 94-98, DOI: 10.1080/00029157.1990.10402910 To link to this article: http://dx.doi.org/10.1080/00029157.1990.10402910
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS
VOLUME 33, NUMBER 2, OerOBER 1990
Downloaded by [Australian National University] at 10:28 18 January 2015
The Effects of Hypnosis on a Parkinsonian Tremor: Case Report With Polygraph/EEG Recordings! Harold 1. Wain, Dan Amen, and Bahmann Jabbari Walter Reed Anny Medical Center Although Parkinsonian tremors typically disappear during sleep and are reduced during relaxation periods, the effects of hypnosis on this type of movement disorder have been generally ignored. We observed a patient's severe Parkinsonian tremor under hypnosis and monitored it with EEG and EMG studies. The patient was taught self-hypnosis and performed it three to four times daily in conjunction with taking medication. The results suggest that daily sessions of self-hypnosis can be a useful therapeutic adjunct in the treatment of Parkinsonian tremors.
(Mclrowell, Lee, & Sweet, 1978). Surprisingly, there is little reported on the use of hypnosis to promote relaxation in these disorders in standard neurology and psychiatry textbooks (Selby, 1968; Mcfrowell, Lee, & Sweet, 1978; Kaplan & Sadock, 1985). Bird (1948) and Buell and Biehl (1948) were among the first to show improvement of a Parkinsonian tremor with hypnosis. A later report described a patient in whom this type of tremor ceased under hypnosis, allowing the patient to remain still, awake, and communicative with the neurosurgeon during chemical pallidectomy (Crasilneck & Jenkins, 1958). Doshay (1960) reported that self-hypnosis improved the symptoms of three Parkinsonian patients; however, in two of these
It is well known that most movement disorders (Parkinson's Disease, extrapyramidal system reactions, Tourette's Syndrome, etc.) are improved with relaxation and exacerbated by anxiety
Requests for reprints should be sent to Harold J. Wain, Ph.D., Professor, Department of Psychiatry, Uniformed Services, University of the Health Sciences, Director, Psychiatry Liaison Consultation Clinic, Walter Reed Army Medical Center, Washington, D. C. 20307·5001. Received March 30,1987; revised May 1, 1990; accepted for publication July 2, 1990. 'The views expressed in this paper are those of the authors and do not necessarily reflect those of the U. S. Government. ""-,
I
"II"
.... .. ..,.. ..
...
a
b Figure 1 Polygraphic recording - baseline and after induction
A. A baseline polygraphic recording shows well-organized 9-10 Hz alpha rhythm over occipital regions. Note that the tremor of the hand and foot are slightly out of phase but display the same frequency. B. The tremor of the left hand ceases a few seconds after induction.
LEFT HAND
L EYE EDG R EYE EDG ~~."-~~"-~.---A.-,,-~~,-,,-,,-~,-'C~~,--'-'\...-v'--~--J,./'---''--'\.---J,./'---'~--J,./'---'V\..-~. ...........
_
......
EMS (CHIN)
III
,t
••
,t
II .... 1'
oW, •
... ,
"'
T,
• II.
Figure 2 Polygraphic recording during deep trance A deep hypnotic trance achieved by time distortion abolishes the tremor of the left foot (Hypnotist: "Now one minute seems as long as one hour, 2 minutes as long as 2 hours"). Note persistence of the alpha rhythm over posterior head regions.
all tremors (Fig. 2). He was able to visualize and describe time speeding or slowing. Silent calculations did not have a significant effect, while calculating aloud
or speaking invariably resulted in reappearance of the left-sided tremor. The tremor returned upon cessation of the hypnotic trance after each session.
Downloaded by [Australian National University] at 10:28 18 January 2015
PARKINSONIAN TREMOR
However, the patient subjectively stated that he felt more relaxed and was bothered less with the tremor and rigidity of the left side for several hours after each hypnotic session. He learned self-hypnosis and performed it three to four times daily for approximately 3 minutes each time in conjunction with taking medications. Overa follow-up period of 6 months, he repeatedly stated that his gait, stiffness, and tremor were improved after this mode of therapy. Discussion Although Parkinsonian tremors typically disappear during sleep, the effects of hypnosison this type of movement disorder have been generally ignored (Selby, 1968; McDowell, Lee, & Sweet, 1978; Birkmayer & Hornykiewicz, 1976). The mechanisms by which hypnosis improves Parkinsonian tremors are not well understood. Hypnosis and sleep may alter the ongoing activity of neural systems which maintain the rhythmicity and persistence of the Parkinsonian tremor. Such functions have been attributed to cortico-pallidal fibers (Denny-Brown, 1962) and to the ventral posterolateral nucleus of the thalamus. Jasper and Bertrand (1966), who promoted the latter view using microelectrodes, were able to record rhythmic discharges from the neurons of this nucleus which correspondedwith the frequency of the patient's resting tremor. Neurophysiologically, however, hypnosis and sleep display significant differences; EEG findings in hypnosis resemble wakefulness (Schwartz, Bickford, & Rasmussen 1955). This patient's EEG also showed persistence of alpha rhythm during hypnosis (Fig. 2). Further investigation into the mechanisms underlying the effectsof hypnosis in tremor disorders may prove to be significant in understanding
97
the results of this investigation and earlier anecdotal reports. Long-term follow-up of patients and their monitored use of selfhypnotic procedures may help to decrease the side effects of Parkinsonian pharmacological regimens. Also of significance is the motivation of this patient who, despite low hypnotic capacity, was able to obtain positive results. His self-hypnotic procedure consisted of visualizing a relaxing scene of the past and expediting the time. The patient's capacity to regain some self-control over what was perceived to be lost had significant psychological value for him in his overall treatment and the enhancement of the quality of his life. The results obtained reinforce the tenet suggesting that screening procedures are probability statements only and should be used for strategy development rather than acceptance for treatment. This patient's tremor grew worse after a decade of Ldopa therapy. The favorable response obtained suggests the value of self-hypnosis in the era of modern antiparkinsonian drugs. Multimodal or comprehensive approaches with these patients benefit not only the physical process, but enhance our patients' sense of self in a world of drugs and procedures. References Bird, H. W. (1948). Varying hypnotizability in a case of Parkinsonism. Bulletin of the Menninger Clinic, 12,210-217, 1948. Birkmayer, W. & Hornykiewicz, D. (1976). Advances in Parkinsonism. Basel: Roche. Buell, F. A. & Biehl, J. P. (1948). The influence of hypnosis on the tremor of Parkinson's Disease. Diseases of the Nervous System, 10, 210. Crasilneck, H. B. & Jenkins, M. T. (1975). Further studies in the use of hypnosis as a method of anesthesia. Journal of Clinical and Experimental Hypnosis, 6, 152-158.
Downloaded by [Australian National University] at 10:28 18 January 2015
98
Denny-Brown, D. (1962). The basal ganglia and their relation to disorders ofmovement. London: Oxford University Press. Doshay, L. J. (1960). The psychotherapy of paralysis agitans. Journal of the American Medical Association, 172, 1347. Jasper, H. H. & Bertrand, G. (1966). Recording from microelectrodes in stereotactic surgery for Parkinson's Disease. Journal of Neurological Surgery, 24, 219-221. Kaplan, H. I. & Sadock, B. J. (Eds.) (1985). Comprehensive textbook of psychiatry (4th ed.). Baltimore: Williams and Wilkins. McDowell, F., Lee, J. E., & Sweet, R. D. (1971). Extrapyramidal disease. In A. B. Baker & P. J. Baker (Eds.), Clinical Neurology, Vol. 2. Philadelphia: Harper & Row.
WAIN, AMEN, AND JABBARI
Schwartz, B. E., Bickford, R. G., & Rasmussen, W. C. (1955). Hypnotic phenomena including hypnotically activated seizures studied with the electroencephalogram. Journal ofNervous and Mental Disease, 122, 564-574. Selby, G. (1968). Parkinson Disease. In P. J. Vinken and G. W. Bruyn (Eds.), Handbook of clinical neurology, Vol. 6, Diseases of the Basal Ganglia, pp. 173-217. Amsterdam: North Holland. Speigel, H. (1972). An eye roll test for hypnotizability. American Journal of Clinical Hypnosis, 15, 25-28. Wain, H. J. (1979). Hypnosis in a consultation-liaison psychiatry service. Psychosomatics, 20, 679.
