Functional Neurology: Part 1
Written & Edited By: Caroline Griffin, BA
Special Guest: Dr. Lauren DeStephano, DC, DACNB
Date Published: March 15, 2022
We reached out to Dr. Lauren DeStephano to discuss her work as a Functional Neurologist with a focus on whole-person healing. She responded with incredible insight into the functions of the brain that we'll break into two articles. Part 1 explores topics like depression, chronic illness, underlying conditions, patient education and empowerment, and how the eyes can provide insight into brain functionality. Stay tuned for Part 2, where we'll dive into Dr. DeStephano's insights on migraines, covid long-haul symptoms, and recommendations for further education and resources. Enjoy!
Dr. Lauren DeStephano is a Functional Neurologist practicing at Chicago Neuro Chiropractic in Chicago, Illinois. After earning her Bachelor of Science in Human Biology from Indiana University, Dr. DeStephano obtained her Doctorate of Chiropractic at Parker University in Dallas, Texas. Following further training in Functional Neurology from the Carrick Institute, Dr. DeStephano launched her career with the drive to help people who were looking for effective answers to unresolved health issues.
“I always knew I wanted to become a doctor” Dr. DeStephano shared in our interview. “I love helping people and I wanted to be the person with answers for people who were lost in their healthcare journey.”
Dr. DeStephano was initially introduced to Functional Neurology by her father, Dr. Ralph DeStephano.
“It checked every box on my future career checklist: help people, educate them on their health and how to maintain a healthy lifestyle, and treat them effectively.”
Dr. DeStephano saw how Functional Neurology met complex conditions with simple and effective solutions.
“It was fascinating to me.” She said. “ I wanted to get into the field to spread the word because so many people don't know there is this non-invasive, safe, and effective option for healthcare.”
The majority of patients who seek help from Functional Neurologists have exhausted every option Western medicine has to offer but still don’t feel fully recovered. While Western Neurologists can rule out things like “physical lesions such as tumors, brain bleeds, etc.”, they often “leave patients without a next step” when the root cause can’t be determined but the symptoms persist.
“During school and training, the best part was watching patients articulate their successful progress, especially (and commonly) after not seeing any results from Western medicine. That's how I knew I would be making a difference in the world through functional neurology.”
The Interview
HC: For those of us who are just discovering this practice, what is Functional Neurology and how does it differ from traditional Western Neurology?
Dr. DeStephano: This is actually a tough question for me to answer, as functional neurology is hard to describe. I like to think of it as physical therapy for the brain. Functional neurologists treat neurological conditions, like a regular neurologist, but without the use of drugs or surgery. Meaning we use non-invasive techniques such as eye exercises, balance training, oxygen therapy, and more to treat these conditions.
One of the main differences between the two is in the name: function. A functional neurologist assesses and treats the brain functionally, meaning we utilize physical exam techniques and diagnostic testing that looks at how the brain is functioning rather than looking for structural or ablative lesions. Usually, by the time patients find us, they have ruled out physical lesions such as tumors, brain bleeds, etc. However, something is still not quite right. Western Neurology often leaves these patients without a next step. They’ll say “The MRI or CT looks fine, so you should be fine!” Or “here, take this pill for the pain!”, but provide no treatment for the underlying cause.
While there is nothing wrong with medication when needed, such as when a patient is in excruciating pain or severely depressed, medication does not address the root cause of the problem. It just masks the symptoms, like pain and depression. Let’s look at depression, for example. An SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant allows more serotonin (the happy neurotransmitter) to cycle in the brain. However, our brain functions on feedback loops; if the brain senses enough serotonin is present, it signals the gut to stop making serotonin. This is why people cannot just stop taking these types of medication. Depression is very rarely caused by lack of serotonin – there is usually an underlying cause. Taking an SSRI masks the symptoms, but once you take the medication away, you are still depressed.
Functional neurology targets the underlying cause of these symptoms. By rehabbing the brain and making it function better, these secondary symptoms will resolve. Giving your brain more serotonin won’t make you less depressed, making your brain and body function better will regulate your serotonin activity, making you less depressed.
HC: What parts or systems of the body do you consider and work with that a Western Neurologist might not address?
Dr. DeStephano: There are several ways to assess the brain including imaging (MRI, CT, MRA), eye movements, balance and gait, coordination, and EEG to name a few. Western Neurology utilizes all of these methods, but not all the time or maybe not altogether.
Most of our patients who have seen Western Neurologists before seeing us have had an MRI or CT of their brain done, which almost always comes back normal. Sometimes they also come with a comprehensive neurological exam report as well, that includes an assessment of the eyes, balance, coordination, etc. The problem is, they only tell the patient what is wrong, but not why it’s wrong. Functional neurologists utilize all of these systems to determine the function of the brain.
We usually don’t need to do imaging unless it’s indicated and often patients have already had them done. To be clear, I am always supportive of imaging. Nothing wrong with ruling something more serious out. However, the function of the brain does not show up on imaging. It shows up with eye movements such as tracking, fast eye movements, optokinetic response, and convergence. It shows up in how patients walk, how their arms swing, and their balance. It shows up in the symptoms they experience. We use the patient's function through subjective and objective findings to assess their condition, and then create a treatment plan based on their specific results.
That’s another important point with functional neurology and neurology in general – no two cases are the same. What works for one concussion patient may not work for the next. Frontal lobe stimulation may have helped one patient sleep better, but it didn’t really impact the other. Every case is unique. That’s something I believe Western Neurology fails to address sometimes. Many neurologists just have a concussion protocol or an anxiety protocol, but they never work for every patient. Some of our patients have come with failed experiences from places with universal protocols like that. We utilize our assessment tools to make personalized treatment plans for each patient, and that includes changing treatment when things aren’t working.
HC: What kinds of conditions or symptoms can a patient seek your help for?
Dr. DeStephano: The beauty of functional neurology is that everyone can benefit from it. It’s non-invasive and all it aims to do is improve the current function of your brain – something we could all use!
No one wants to come to the doctor when they don’t feel sick, of course. Most of our patients are post-concussion/TBI, post-stroke, ADHD, anxiety/depression, OCD, dyslexia, Autism, vertigo, balance issues, memory loss, cognitive issues, autonomic dysfunction (i.e. POTS/dysautonomia), and more recently, post-covid or covid long haulers. Symptoms vary from patient to patient, but overall, these people just don’t feel right.
They used to be able to handle life but since an injury (which can be physical, chemical, emotional, or infectious) to the brain, suddenly, life feels so much harder. Sometimes we never find out the specific moment or injury that caused all these symptoms to occur, and usually, it's more than one! All that matters is their brain isn’t functioning properly, and they need help.
Concussions and TBI symptoms can be classic such as headaches, dizziness, sensitivity to light and sound, etc., but those often go away with time after the injury. When these people come to see us, it is sometimes weeks, months, or years after an injury and they are starting to experience anxiety, anger issues, poor sleep, poor memory, gut issues, and more. More often than not, the injury doesn’t truly start to affect these people until later.
Take football players for example. They hit their heads, take a few days off, but once the headache and dizziness go away, they are ready to get back on the field. Fast forward 15-20 years later, they can’t sleep, they can’t focus, they’re always angry, they have IBS, and so on. It’s no coincidence when these things happen. Symptoms like that don’t just show up for no reason. Somewhere along the way, after several hits to the head, the wiring of the brain gets messed up. Again, the imaging looks fine, but it’s the neural connections and networks that have become dysfunctional. The damage has flown under the radar for years, but it eventually catches up to them.
While we see a lot of concussion patients right after their injuries, we also see a lot of patients like this who have this array of symptoms that have gotten progressively worse years after an injury. Sometimes they’ve already seen several other doctors that couldn’t help, sometimes they’ve just let it get to this point, and most of the time they’ve just never heard of functional neurology! But either way – they find us, and we can help.
HC: How do you approach a new patient? What tools, insights, and tests do you utilize to assess their condition?
Dr. DeStephano: Like any doctor, we start with a comprehensive history. This is the most important part of the process. This is where we get all the information about the patient and their condition. There is a lot of details in the history that will determine the treatment plan as well.
After the history, we move on to the physical exam. This includes cognitive assessment (testing memory, basic calculations, orientation), pupil response to light, eye movements, autonomic assessment (heart rate, blood pressure, etc.), gait, coordination, balance, and several other tests that assess different areas of the brain.
Then we move on to diagnostic testing, which includes a videonystagmography (VNG), balance test (CAPS), and EEG. The VNG is an eye movement test. The patient wears a pair of goggles that record their eye movements such as gaze stability, tracking (pursuits), fast eye movements (saccades), spontaneous nystagmus, and OPK response. We assess these in our physical exam but recording this allows us to show the patients what is going on. It also tracks the eye movements on graphs which gives us quantitative data as well.
The CAPS test involves patients standing on a force place that measures their balance. We do four variations of this test: eyes open flat surface, eyes closed flat surface, eyes open on a foam pad, eyes closed on a foam pad. This allows us to single out each system that controls our balance: vision, vestibular system (inner ears), and proprioception (sensors on our feet).
Finally, the EEG reads the patient’s brainwave activity. This is something we cannot do during the physical exam so it is a great addition to our diagnostic testing. The patient wears a helmet with multiple electrodes and we record their brain waves for about 10 minutes. Then we submit the EEG recording to our program that gives us a report on their brainwave levels and also how those brainwave patterns correlate to certain symptoms, such as depression, anxiety, OCD, memory function, sleep, TBI, etc. Between the history, physical exam, and these comprehensive diagnostic tests, we paint a very detailed and personalized picture of the patient’s condition.
HC: How many layers of the physiological and emotional systems are considered when treating a neurological condition or symptom?
Dr. DeStephano: Since we are looking at the functionality of the brain, physiologic and emotional systems are very important avenues of assessment and treatment because they give us a lot of output information on how the brain is functioning. For example, we always look at autonomic function when assessing the brain. Our autonomic (or automatic) nervous system controls our heart rate, pupil response, breathing rate, digestion, blood pressure, and more. All of these things are controlled subconsciously; we don’t need to tell our heart to beat or our lungs to breathe, they just do!
The autonomic nervous system is divided into two groups: sympathetic and parasympathetic. Sympathetic is our “fight or flight” response, which is activated during emergencies (think elevated heart rate and blood pressure, shallow quick breathing, pupils dilated, blood leaves the gut and goes to vital organs for survival, etc). The parasympathetic response is called “rest and digest”, which means the opposite symptoms occur (low heart rate and blood pressure, blood can stay in the gut to stimulate proper digestion, pupils constrict, etc.) We should be in “rest and digest” the majority of the time, as we aren’t experiencing constant threats to our survival on a daily basis.
When people have head injuries or brain dysfunction, these automatic functions start to become irregular and that sympathetic or “fight or flight” response is kicked up. The brain is not functioning right, so it subconsciously thinks it is in danger. The patient may not even notice it, but when we assess them we often find elevated seated heart rate or drastic changes in heart rate from seated to standing, constantly dilated pupils that don’t change with light stimulus, and we also see certain eye movement dysfunction that correlates with autonomic dysfunction.
There is also an emotional component with autonomic function. When our fight or flight response kicks on, we are more anxious and more irritable. This is just one example of one system. There are hundreds of other systems and areas of the brain that deal with emotions, and all of them obviously contribute to the physiology of the brain. Physiological neurology is the basis of functional neurology – not looking at the structure but the physiological function of the brain.
HC: What are some of the most common conditions you see in your office?
Dr. DeStephano: The most common condition we see is probably post-concussion and post-TBI. I think this field is best known for its post-concussion work because an injury is usually what gets people to the doctor. Like I said before, sometimes symptoms from a head injury don’t show up for years. People come into our office with all these symptoms and we find out they were in a really bad car accident 10 years ago and since then things started to go downhill. It’s not always that simple finding the cause, but it doesn’t matter. All that matters is there is hope for these people to regain optimal brain function.
Other than physical injuries, some other common conditions in our office include anxiety, depression, OCD, post-stroke, vertigo, BPPV, PPPD, cognitive decline/early Alzheimer’s, ADHD, Autism, POTS, dysautonomia, migraines, and autoimmunity.
HC: How much do you work with the eyes to reach the brain? Can you tell us more about that?
Dr. DeStephano: The eyes are one of our best windows into the brain! They are one of our main sources of assessment and treatment in functional neurology. Different eye movements are controlled by different parts of the brain, so doing a specific eye movement can help stimulate that area of the brain.
For example, our frontal lobe initiates our saccades or fast eye movements, but our cerebellum also gaits this action to make sure we move our eyes precisely to the target. Pursuits are controlled by the parietal lobe, but the vestibular system also helps this process. Convergence (eyes coming inward together/looking at something close) is a midbrain function, but the midbrain also controls our autonomic functions, so convergence and autonomic function are directly related. The list goes on!
So for therapy, we can use these eye movements to stimulate those areas of the brain. Saccades are good for the frontal lobe, so a patient struggling with frontal lobe dysfunction, including depression/anxiety, lack of focus or concentration, poor memory, or decreased overall executive function, would benefit from doing saccade exercises.
Convergence is good for autonomic function, so those exercises would benefit someone with anxiety, dysautonomia, POTS, or concussions. The best part is, these eye movements are good for just about every patient. Our brain is one big network; working on one area affects several others.
One specific eye exercise actually helps the entire brain function better, but will also wake up some areas more directly than others. We find what eye movements are deficient to find what areas of the brain are deficient and need to be rehabbed.
If we find saccades are poor, we know frontal lobe activation most likely will be beneficial, so treatment would include saccadic eye movements and other frontal lobe therapies such as transcranial magnetic stimulation (TMS), alpha wave therapy, and brain games that require multi-tasking and decision making.
HC: Do supplements, detoxing, or medications ever interfere with the diagnosis or treatment process?
Dr. DeStephano: Supplements and detoxing usually do not affect diagnosis, and we recommend supplements to our patients all the time. Medication can affect more diagnosis and treatment but it never gets in the way. Many patients come to us on medication with the goal of weaning off, which has been very effective with functional neurology. Prescription medication such as antidepressants, anxiolytics, stimulants, etc. are not a solution to the problem and are not meant to be on long term. There is of course and time and a place for medication, and I am in no way against medication, but there is no reason someone should be on Prozac for 30 years. As chiropractors, we cannot tell patients to decrease their dose of medication, but functional neurology helps them to become less dependent on it so they can talk with their primary care physician about lowering their dose and eventually stopping completely. We have successfully helped many patients get off medication they have relied on for years. The whole point of functional neurology is to improve the function of the brain so that the patient does not need medication.
HC: What aspect of your work excites you the most or brings you the most fulfillment?
Dr. DeStephano: Watching people progressively get better over time. This type of treatment does not yield results as quickly as medication or surgery; it takes time to change the brain functionally. We always tell patients at the beginning, give us about a month. After that first month, they should start to see something: better quality in sleep, more energy, better focus, less anxiety, a general decrease in symptoms. They won’t be completely better in a month, but that small improvement at least tells me we are on the right path and that functional neurology can help them.
Very rarely do patients not see anything after a month, but it has happened. In those cases, there is usually something else going on that requires other professional intervention. But for the most part, people start to see small changes in their condition within that first month. That is honestly one of my favorite parts of this job. Watching people see themselves start to make improvements in a few short weeks. Even though there’s still much work to be done, it gives them hope.
A lot of people have never heard of functional neurology before seeing us, and often it is their last resort. Showing them this type of holistic, safe, functional, and EFFECTIVE method of neurological treatment is the most fulfilling aspect of this job. I love opening this new door to patients who have almost lost all hope.
Stay tuned for Part 2!
