TWB is a 17-year-old male who presented with learning disabilities and inability to concentrate.

When his mother was pregnant, she developed a pulmonary embolus and as a result the placenta received less blood. She was subsequently on heparin throughout the rest of the pregnancy. TWB was born 4 weeks premature, at a weight of 1645 g, via an emergency C-section because his heart had stopped, but his lungs were fully developed. TWB reports that he has experienced no trauma to the head nor taken any antibiotics or orthodox medicine. He has experienced no childhood viruses that were out of the ordinary. TWB was evaluated for ADHD when 4 years old by a homeopathic physician, who found him to be within normal limits for his age.

TWB complains of blurry vision to close objects. He reports that he has not had his eyes checked in the past year. No balance problems were present. His concentration is interrupted every few minutes. Coordination is not up to par. Spicy and junk food gives him stomach trouble. He reports no headaches. Dizziness is felt occasionally throughout the day. Shoulder and rib pain is occasionally bilateral. He complains of achy bones lately, and also reports he may have a tendency towards obsessive–compulsive activities. TWB was extremely affected when his parents broke up. He was afraid he would not see his father again. His father believes that he has lost respect for women because of the break-up. TWB’s stepfather is verbally abusive towards his mother but not to TWB. It bothered TWB when his mother and stepfather got married.

A diagnosis of attention deficit hyperactivity disorder (ADHD) secondary to right cortical hemisphericity was made. To confirm the diagnosis, follow-up qEEG analysis was undertaken, where a large increase in theta:beta power ratio supported by decrease in absolute beta and high beta power over frontal and central regions particularly the vertex (Cz) was found. However, there was no significant increase in absolute theta power. Typical ADHD has these signs, as well as an increase in absolute theta, which is also present. Therefore the results of this qEEG are consistent with previous history-based diagnosis of ADHD with an associated learning disability. These conclusions were made from linked ears analysis and Laplacian (looking at default report settings enabling determination of power ratios).

A follow-up qEEG is planned to document any changes since therapy was instituted. It is expected that TWB will continue to improve in all areas of concern until his full potential is reached.

The pattern of signs and symptoms revealed during TWB’s functional neurological consultation provide an insight into the possible levels of dysfunction in the longitudinal and horizontal planes of the neuraxis. Localisation of the lesion is assisted by a comprehensive knowledge of the afferent and efferent connections throughout the neuraxis and an ability to ascertain the frequency of firing (FOF) and integrity of fuel delivery in different regions and systems. History and examination directed at localising the symptoms to a specific level of the neuraxis, including the following well-defined functional levels, is necessary:

Asymmetry or dysfunction in each of these components of the nervous system can directly or indirectly affect various motor, sensory, visceral, and mental functions or indicate a dysfunction in any of these modalities.

Most importantly from a functional neurological perspective, asymmetry or dysfunction in the most influential components of the nervous system should be considered:

In the case of TWB, he showed signs and symptoms of left cerebellar and right cortical dysfunction. This was expressed in the physical exam by his relative lack of coordination on the left, his pupillary TND on the right, Romberg’s test falling to the left, his lack of ability to concentrate, and the hyperresponsiveness of his right-sided reflexes, which indicates increased tone due to decreased activation of the PMRF ipsilaterally.

ADHD is thought to occur as a result of an inability of the individual to maintain attention on a primary task because of an inability to inhibit or suppress motor responses to incoming sensory stimuli (Barkley 1997). Some consistency has been found in people with dysfunctions of the right frontal cortex in that they express great difficulty in suppressing motor responses to incoming sensory stimuli (Sergeant 2000). The right frontal cortex functions in some manner to inhibit inappropriate motor responses in a normally functioning brain. The activity of the right frontal cortex relies heavily on the dentato-ponto-cortical and dentato-rubral-thalamo-cortical pathways. Asymmetric reduction in afferent information to the cerebellum because of asymmetric dysfunctional peripheral afferent pathways may cause diaschisis in functional circuits downstream from the cerebellum, in this case the contralateral cortex. In this case, the application of manipulation to increase the afferent stimulus received by the cerebellum and other therapies aimed at increasing the activation of the right frontal cortex were successful in reducing the patient’s symptoms and ultimately his state of disability.

RS initially presented to another practitioner with a chief complaint of low back pain. The other practitioner manipulated RS’s neck and he immediately felt light-headed and developed a left-sided paraspinal muscle spasm in the cervical spine. RS left the practitioner’s office but felt unstable while walking and developed nausea within minutes of leaving. One to two hours following the manipulation RS reported an increase in the nausea and flashing sensations in his left eye. He also reports feeling a sense of mounting confusion. The neck pain and spasm intensified as the night progressed to the point that RS screamed out in pain. At this point he also developed a headache and notes that his body felt cold.

RS reports that the following day he had a persistent headache, nausea, confusion, and visual disturbances in his left eye. He also reports that he had developed a tremor in his left hand. RS returned to the initial practitioner and explained his symptoms. The initial practitioner palpated RS and proceeded to adjust the co/occipital region. RS reports no change in symptoms following the adjustment.

RS attended the initial practitioner again the following day and he manipulated C1 bilaterally. RS noted immediate worsening of his symptoms and became increasingly unstable while standing and walking. RS was referred to my clinic for evaluation.

A left occipital headache, which changed sides occasionally, had been present since the first adjustment. RS still reported light nausea which was exacerbated by walking. He reported his left eye felt dry and larger than the right. The visual field of the left eye remained blurred, with spotted blacked-out areas noted occasionally. He still had difficulty focusing. RS still felt confused and noticed difficulty forming sentences. He had a noticeable tremor of his left hand that had gradually worsened. He reported a feeling of unsteadiness on his feet and walked with a wide-based gait pattern. Pain was still present in the left cervical region.