Nov 18 2010

Brain Balance

I was recently interviewed for an article on Brain Balance, a franchise that promises to treat a variety of neurological disorder from autism to ADHD. Their website claims:

This proprietary, non-medical program has been successful in helping hundreds of children reach their physical, social/behavioral health and academic potential. We work with children who suffer with ADD/ADHD, Dyslexia, Tourette’s, Asperger’s and Autism Spectrum Disorders.

The program has all the red flags of a pseudoscientific clinic. First it claims there is one underlying problem for a host of separate disorders:

Called Functional Disconnection—an imbalance in the connections and function between and within the hemispheres (sides) of your child’s brain—this condition is responsible for a host of behavioral, academic, and social difficulties.

This notion takes a small slice of our understanding of brain function, completely out of context of our broader understanding, and elevates it to a position not warranted by the evidence. It then bypasses the clinical studies that would be necessary to document a specific application of this theory, and makes direct clinical claims. In short – it bypasses the long process of research, clinical studies, peer review, and replication and goes directly to a franchise.

A History of Disconnectionism

The historical context of the underlying claim is interesting, and like many pseudosciences there is a kernel of real science inside the “brain balance” paradigm. If we go back a couple hundred years, neuroscientists were engaged in a fundamental debate about brain structure and function. On the one side there were the phrenologists, who claimed that each part of the brain subsumed a specific neurological function (and further that, with use and ability, these areas would hypertrophy, expanding the overlying skull, and allowing for the “reading” of neurological function through the measurement of bumps on the skull). The other school of thought held that the brain was a homogenous and undifferentiated organ, with functions widely distributed throughout.

The phrenologists actually won this debate, and their views held sway over 19th century neuroscience. Phrenology as a practice eventually died out (it was little more than an astrological cold reading), but not until the 20th century. Looking back from the contemporary perspective, however, it is interesting that the phrenologist were on the right side of the original debate – the brain does have discrete regions with specific functions.

As part of this “localizationist” approach to neuroscience, there was added the concept that connections among specific brain regions are also important. It was recognized that the brain is an information processing organ, and therefore communication of this information is important to function. Many disorders of higher neurological function were explained as “disconnection syndromes” between various localized brain centers.

In the first half of the 20th century this view, however, fell out of favor. Localizationism and disconnectionism were viewed less and less as viable explanations for brain function and neurological disorders, and again the brain was viewed as an undifferentiated organ. Clinicopathological correlation fell out of favor as well. I am not sure, but it is possible that this may have been partly a backlash against phrenology, which was popular among clinical neurologists right up to this time and was not purged from mainstream neurology until the early 20th century.

However, it was also at least partly due to the fact that we did not have the technology to precisely map cortical function and connections. Further, the complexity of the brain frustrated attempts at consistently correlating lesions and syndromes, and this led to the somewhat nihilistic conclusion that perhaps localization was not just difficult, fundamentally impossible.

Then in the mid 20th century came a neuroscientist named Norman Geschwind. He revived the “disconnectionist” paradigm, and set neuroscience back on the path to our modern understanding. For the next thirty years brain disorders and individual deficits were explained as lesions of specific brain centers and their connections to other brain centers.

This is getting closer to the modern synthesis of neuroscience, but the history of our scientific understanding of complex systems, like the brain, is one of initial oversimplification and eventual synthesis of greater and greater complexity. In this mode Geschwind oversimplified his disconnectionist model in two primary ways: he assumed that brain areas were discrete to one function, and he explained all disorders as a consequence of decreased connectivity.

Beginning in the 1980s and through to today our understanding of brain anatomy and function has followed the Geschwind model but has become progressively deeper and more complex. In the last decade this process has been helped by technologies which allow us to better map the connecting pathways within the brain. This reveals another theme in science – how technology constrains our understanding. When we had the tools to map brain regions, we emphasized local brain region function. Now that we have the techniques to better map connections, our understanding of these connections and their role in disorders is likewise increasing.

Our current view can be summarized as follows – brain function if a product of specialized brain regions, both in the cortex and in subcortical regions that largely act as relay centers in the brain. There are multiple types of interconnections in the brain, feeding forward information, but also providing feedback connections. Connections exist both in serial and in parallel. Further, specialized regions can be further divided into subregions with further specialized functions – and in fact cortical regions are collections of subregions with related functions.

While brain regions are specialized and subspecialized, their function also depends upon the various network of connections in which they participate. A brain region may specialize in a certain type of information processing, but specific functions will depend upon the specific network of connections in which it participates.

Further, connections are made between primary sensory areas and sensory association areas, between these areas and subcortical relay areas, and between the hemispheres. The number and types of cortical pathways are many, and our knowledge of them is increasing rapidly. Our understanding of brain disorder is also increasing, and we now understand that there are not only disorder of decreased connections, but also of hyperconnectivity and hyperactivity or sensitivity of specific brain regions.

Brain Balance

With that as a context of the evolution of our understanding of brain function and dysfunction, the brain balance paradigm wants to roll back the clock of our understanding about half a century. The paradigm is that of pure disconnectionism, and further of only a very specific type – of an inbalance between the two hemispheres. This idea in itself may have some merit, and may explain certain disorders. I am not convinced that it has been established as a recognizable disorder, but it is a reasonable hypothesis.

However, it must be put into the context of the current level of complexity of our understanding of brain function. To argue that a broad range of neurological disorders all come down to one narrow subtype of one type of brain dysfunction is pseudoscience – it is good for marketing your one therapy, but not for actually helping people or understanding neuroscience.

In terms of the clinical evidence, there, is not much. I found one paper that is little more than proposing the hypothesis that autism can be explained as a disconnection syndrome between the two hemispheres. It should be noted, however, that over the last two centuries, proponents of every kind of neuroscience theory had no difficulty explaining neurological disorders within their paradigm. “Explaining” is not very compelling. Astrologers can “explain” all events within the paradigm of astrology.

There is also a study looking at: The effect of hemisphere specific remediation strategies on the academic performance outcome of children with ADD/ADHD. They found improvement in cognitive function after a 12 week program, but this study was not blinded or controlled, and so there is no way to rule out non-specific effects (training, attention, etc). Therefore this uncontrolled clinical study cannot be used as evidence to support the underlying hypothesis of hemispheric imbalance.

I also note that these two papers are both by the same group – Mellilo and Leisman from the FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience. Robert Mellilo is a chiropractor, not an MD. He and the Carrick clinic promote “chiropractic neurology” (which probably deserves its own post at a later time) – which, as far as I can tell, suffers from its own “disconnection syndrome” – it is disconnected from the history and evidence of actual neuroscience. And, of course, Mellilo is the owner of Brain Balance.

So even though this one study appears in the peer-reviewed literature (via an obscure journal), it is really just an in-house uncontrolled study promoting a franchise.

Harriet Hall has more to say about this in her article on science-based medicine on the topic.

Conclusion

While presenting itself as a genuine neurological theory of disease, “brain balance”, in my opinion, is nothing more than a marketing strategy within the pseudoscience of “chiropractic neurology.” The claims are simplistic, not evidence-based, and seem blissfully unaware of the long and complex history of the relevant ideas.

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