National Institute for Health and Clinical Excellence (NHS NICE) has published final guidance recommending the use of brain monitoring technology

The healthcare guidance body NICE (National Institute for Health and Clinical Excellence (NHS NICE) has published final guidance recommending the use of brain monitoring technology such as the Bispectral Index (BIS, Covidien), E-Entropy (GE Healthcare) and Narcotrend-Compact M (MT MonitorTechnik GmbH & Co).  These EEG-based depth of anaesthesia monitors should be considered as positive options in patients receiving total intravenous anaesthesia (TIVA) and in patients who are considered at higher risk of adverse outcomes during any type of general anaesthesia, such as seniors, those with high body mass index, and those with cardiovascular and liver disease.

EEG based Brain Monitoring Systems helps clinicians assess patient consciousness levels through measuring the electrical activity in the brain. This includes patients who are at higher risk of unintended awareness (anesthesia too light) and also those patients who are at higher risk from excessively deep anaesthesia.

Superior surgical outcomes, the low cost of the testing and the ease of use of these technologies all contribute to the recommendations.

You can access these documents through ASET (www.ASET.org)

Move up to modern de-artifacting

There is an on-going dispute regarding de-artifacting methods used in qEEG.  Though there are vested interests counseling against the use of modern techniques to remove artifact while leaving the underlying EEG intact, there are also those who have specialized in the area that can provide a detailed reply to the vested interests.  Just such a reply was posted recently in a commercial list server, and we got the author’s permission to re-post the discussion on the qEEGSupport.com website in a non-commercial publicly accessible form for all to see.

It specifically points to the fact that the phase changes seen are due to removal of artifact, not the distortion of the underlying EEG, which has residual subtle artifacts remaining if processed with classical approaches.

If you cut time segments out of the EEG to remove artifacts, you also remove the underlying connectivity information, splicing discontinuous microstates together destroys the underlying time series.

In the give and take of the real world of neuroscience, the need to provide a valid time-series showing the connectivity of the neural networks, yet free of artifact, is driving the need to switch to more modern techniques than snipping out segments of time.  If you want to distort the timeline of the EEG (phase) just cut and paste lots of EEG together in one second chunks.

The neuroscience community will undoubtedly continue to discuss these issues, but the need for clean valid EEG is driving the field to these newer techniques, and they are performing well under the scrutiny.

Jay Gunkelman

Read moreMove up to modern de-artifacting

EEG Complexity as a Biomarker for Autism Spectrum Disorder Risk

William Bosl1,2*, Adrienne Tierney3,4, Helen Tager-Flusberg5, Charles Nelson1,4

Abstract


Background: Complex neurodevelopmental disorders may be characterized by subtle brain function signatures early in life before behavioral symptoms are apparent. Such endophenotypes may be measurable biomarkers for later cognitive impairments. The nonlinear complexity of electroencephalography (EEG) signals is believed to contain information about the architecture of the neural networks in the brain on many scales. Early detection of abnormalities in EEG signals may be an early biomarker for developmental cognitive disorders. The goal of this paper is to demonstrate that the modified multiscale entropy (mMSE) computed on the basis of resting state EEG data can be used as a biomarker of normal brain development and distinguish typically developing children from a group of infants at high risk for autism spectrum disorder (ASD), defined on the basis of an older sibling with ASD.
Methods: Using mMSE as a feature vector, a multiclass support vector machine algorithm was used to classify typically developing and high-risk groups. Classification was computed separately within each age group from 6 to 24 months.

Read moreEEG Complexity as a Biomarker for Autism Spectrum Disorder Risk

House Again Passes Thompson’s Bipartisan Amendment to Improve TBI, PTSD Treatment For Troops & Veterans

Washington, DC, Jul 18 – Congressman Mike Thompson (CA-1), co-chair of the bipartisan Military Veterans Caucus, today again secured the passage of his bipartisan amendment with Congressman Pete Sessions (TX-32) to expedite new and innovative treatments to our nations’ veterans and active duty soldiers suffering from Traumatic Brain Injuries (TBI) and Post-Traumatic Stress Disorder (PTSD). This is the second time the House has passed the amendment. In May, the TBI treatment expansion initiative was adopted as a House amendment to the National Defense Authorization Act (NDAA) for Fiscal Year 2013 (H.R. 4310), however the Senate has yet to take up this bill. Today it was passed as an amendment to H.R. 5856, the Department of Defense (DOD) Appropriations Act for Fiscal Year 2013. The amendment passed by voice vote. The House will vote on H.R. 5856 later this week.

“Our troops and veterans have earned the very best treatment and care that we can provide,” said Thompson. “But sometimes the best treatments aren’t available at military and veteran medical facilities. My amendment will make sure that our heroes who return from combat with TBI or PTSD have access to the highest quality care our nation has to offer. I will keep introducing this legislation until it is law. It’s what our heroes have earned.”

“I am pleased that our colleagues have joined us in recognizing the importance of providing treatment options not currently available within military and veteran medical facilities to those who return from combat with TBI or PTSD,” said Sessions. “As we approach the Memorial Day holiday, I believe we can best honor our nation’s active duty soldiers and veterans by ensuring that their health is a top priority and that they have access to the most effective treatments available.”

Read moreHouse Again Passes Thompson’s Bipartisan Amendment to Improve TBI, PTSD Treatment For Troops & Veterans

Technical Details in EEG Diagnosis of Autism

Many have heard experts in the neurofeeback field state vehemently that the “ICA deartifacting ruins the EEG”, and that “remontaging to a Laplacian montage ruins coherence”. There are internet tutorials attempting to support these opinions. This self-publication on-line on a commercial site is not the same as peer review, and many publish bad opinions without an alternative approach even considered.

Rather than engage in the meaningless back and forth of mere opinions, I thought it was better to wait for the decision of the jury.. a jury of our peers inherent to the peer reviews in professional publications seen in the field of neuroscience. I comfortably accept the judgment of the field’s journal’s editors.

Harvard’s famous Electroencephalographer, Frank Duffy M.D. just published a large scale well designed study. Some of the key aspects in the paper are highlighted and discussed below:

“Remaining eye blink and eye movement artifacts, which may be surprisingly prominent even during the eyes closed state, were removed by utilizing the source component technique [42, 43] as implemented in the BESA (BESA GmbH, Freihamer Strasse 18, 82116 Gräfelfing Germany) software package”

Read moreTechnical Details in EEG Diagnosis of Autism

Head Impact Exposure in Youth Football

Ray W. Daniel1, Steven Rowson and Stefan M. Duma1

(1) Center for Injury Biomechanics, Virginia Tech-Wake Forest University, 440 ICTAS Building, Stanger St., Blacksburg, VA, 24061, USA
Steven Rowson Email: srowson@vt.edu

Received: 1 February 2012  Accepted: 3 February 2012  Published online: 15 February 2012

Associate Editor K. A. Athanasiou oversaw the review of this article.

Abstract

The head impact exposure for athletes involved in football at the college and high school levels has been well documented; however, the head impact exposure of the youth population involved with football has yet to be investigated, despite its dramatically larger population. The objective of this study was to investigate the head impact exposure in youth football. Impacts were monitored using a custom 12 accelerometer array equipped inside the helmets of seven players aged 7–8 years old during each game and practice for an entire season. A total of 748 impacts were collected from the 7 participating players during the season, with an average of 107 impacts per player. Linear accelerations ranged from 10 to 100 g, and the rotational accelerations ranged from 52 to 7694 rad/s2. The majority of the high level impacts occurred during practices, with 29 of the 38 impacts above 40 g occurring in practices. Although less frequent, youth football can produce high head accelerations in the range of concussion causing impacts measured in adults. In order to minimize these most severe head impacts, youth football practices should be modified to eliminate high impact drills that do not replicate the game situations.

Introduction

Sports related concussions have received increased public awareness, with many states considering or implementing laws directing the response to suspected brain injury. This is a result new research suggesting possible links to long-term consequences from repetitive concussions.13,21,22 Emergency department visits for concussions increased 62% between 2001 and 2009, and researchers estimate that between 1.6 and 3.8 million sports related concussion occur each year in the United States.5,19 Of all sports, football accounts for the highest incidence of concussion, and therefore receives the most attention.34 One of the leading thoughts to minimize the incidence of concussion in football is to limit players’ exposure to head impacts.9 Strategies to reduce a player’s exposure to head impact include teaching proper tackling techniques and modifying the rules of the game.  

Read moreHead Impact Exposure in Youth Football

Parkinsonism Disease or Not?

This last year we lost an old friend, Bill Hudspeth…. William J Hudspeth, PhD. He scientifically contributed to understanding the EEG of maturation, and his multivariate connectivity eigenvector work is still ahead of many others in modeling brain function. We lost a real contributor.

In his later years he was treated for hypertension with Reserpine. I recall Bill’s dehydration in Arizona at an ISNR meeting when I carried him out of the hall during a syncopal spell. He was not well conmtrolled on his diuretic. Reserpine is rarely used in the management of hypertension today, as it is a second-line adjunct agent for patients who are poorly controlled on a diuretic, when cost is an issue. It is an inexpensive and effective antihypertensive, though not without a substantial potential for side-effects, which has it banned in England.   

Read moreParkinsonism Disease or Not?

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

Martijn Arns • Wilhelmus Drinkenburg • J. Leon Kenemans

Abstract In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with EEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment.

This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.

Read the full text here The Effects of QEEG-Informed Neurofeedback in ADHD:
An Open-Label Pilot Study
– This article is published with open access at Springerlink.com Applied Psychophysiology and Biofeedback. doi: 10.1007/s10484-012-9191-4

QEEG-guided Neurofeedback: New Brain-based Individualized Evaluation and Treatment for Autism

by James Neubrander, MD, Michael Linden, PHD, Jay Gunkelman, QEEGd, and Cynthia Kerson, PHD

QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated. . . . Clinicians, including the authors, have had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

Read moreQEEG-guided Neurofeedback: New Brain-based Individualized Evaluation and Treatment for Autism