A Father Finds A Solution: Z-Score Training Mark Smith, LCSW

This article comes from Neuroconnections, Summer 2008. Mark Smith’s entry can be found on pages 22-24!
(Once you finish reading that article, check out the article from Tom Collura on pages 12 and 15 titled “Whole-Head Normalization using Live Z-Scores for Connectivity Training”)

Disclaimer: The content below was generated with the assistance of AI and then reviewed and edited by BrainMaster Technologies, Inc. It is provided for educational and informational purposes only and does not constitute medical advice.

Summary #

This narrative clinical case report describes the experiences of a family whose three-year-old son, Jack, developed rapidly worsening cryptogenic benign rolandic epilepsy. The article details the progression of symptoms, challenges with conventional treatment, and the eventual introduction of qEEG-guided neurofeedback and Z-score–based training as part of the care approach.

Early Symptoms and Diagnostic Journey #

Jack initially presented with unusual falls, balance disruptions, frequent stubbing injuries, increasing bruising, and episodes of incontinence. These symptoms progressed to atonic (drop) seizures, myoclonic events, and absence seizures. Clinical evaluation confirmed cryptogenic benign rolandic epilepsy, a form linked to spike activity near the sensory-motor cortex.

Decline in Motor Skills and Behavior #

As seizure frequency increased, Jack experienced loss of coordination and athletic ability, withdrawal from physical play, and significant personality shifts including irritability, emotional lability, and aggression. Despite medication escalation to weight-based limits, seizures continued daily.

Introduction of Neurofeedback #

Neurofeedback was introduced after conventional medication approaches provided limited benefit. Collaboration with an experienced clinician helped Jack achieve intermittent periods of reduced seizure activity. However, gains were inconsistent, and seizure recurrence often followed attempts at coherence-based neurofeedback training.

qEEG Findings and Treatment Challenges #

Repeated qEEGs revealed large inter-ictal epileptiform discharges, sometimes reaching 300–400 microvolts. Traditional coherence training at times appeared to worsen symptoms, while magnitude-based inhibit protocols alone lacked lasting effect.

Introduction of Z-Score Neurofeedback #

In 2006, Z-score training became available and was adopted into Jack’s program. Initial attempts aimed to normalize coherence toward zero, though this occurred infrequently. Subsequent adjustments using Z-score-based coherence training were associated with improved stability.
Sequential qEEGs showed:

• Increased hypocoherence following traditional coherence training.

• Improved patterns and more sustained seizure control after Z-score coherence intervention.

Key Illustrations (as described in the document) #

1. EEG maps showing severe inter-ictal activity, followed by normalization the day after first inhibit-based training.

2. Comparative qEEG maps reflecting worsening hypocoherence after linear coherence training and improvements after Z-score coherence training.