qEEG

EEG based Personalized Medicine in ADHD

Neurophysiological studies in ADHD have shown a relatively uniform picture with regards to EEG – QEEG data (based on group data). Most studies find excess slow brain activity (theta) (Hermens et al., 2004; Mann et al., 1992; Chabot and Serfontein, 1996; Clarke et al., 1998, 2001; Lazzaro et al., 1998, 1999) and a decreased fast brain activity (beta) (Hermens et al., 2004; Clarke et al., 1998; Mann et al., 1992; Lazzaro et al., 1998, 1999). Theta EEG activity is often associated with an “inattentive” or a dreamy state, and beta activity is often seen when the brain is very busy with for instance solving a cognitive task. Figure 1 shows an example of this based on the data of the Brain Resource International Brain Database of 275 patients with ADHD. In this example the increased theta and decreased beta can be clearly seen, with a frontal localization.

group data
Theta                              Absolute Beta                     Relative Beta

Figure 1: This figure shows the average brain activity (quantitative EEG – QEEG) of 275 children with ADHD, compared to a control group. On the left the increased theta EEG activity (p<.0001) can be seen, in the middle the absolute beta EEG activity (p<.0001) and on the left the decreased relative beta EEG activity (p<.0001). This deviant brain activity has a fronto-central localization. This pattern is found in almost all ADHD studies.

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Traumatic Brain Injury Task Force Congressional Briefing

St Joseph’s Regional Medical Center on behalf of the participants of the International Conference on Behavioral Health and Traumatic Brain Injury invites you on March 12, 2009 at 11:00am to a Congressional Briefing.

The participants of the International Conference on Behavioral Health and Traumatic Brain Injury will be holding a Congressional Briefing hosted by:

Congressman Bill Pascrell and  Congressman Todd Platts

Co-Chairs, Congressional Brain Injury Task Force presenting recommendations to improve the care of our wounded warriors NOW!

In October of 2008, St Joseph’s Regional Medical Center hosted the International Conference on Behavioral Health and Traumatic Brain Injury. 100 doctors, researchers and scientists from around the globe discussed issues facing our wounded warriors, identified the barriers to treatment and strategized on the improvements for continuum of care. This briefing will present their reccomendations.

The meeting will be held @ the Capitol Visitors Center- Congressional Meeting Room South

RSVP – rsvp@susandavis.com

qEEG Artifacting

The qEEG represents the statistical manipulation of the raw EEG, so an understanding of these manipulations should precede any discussion of the qEEGs clinical indications for protocols. Without such knowledge any given finding may be misinterpreted.

Following the careful recording of the EEG, the quantitative analysis is begun with the sampling of the data to be used in the analysis by the Fourier transform. The Fourier analysis assumes there are no transients (epileptic discharges, episodic voltage changes etc.) or state changes (light sleep, drug effect, mental task, etc.), so these must be avoided when selecting data for analysis in qEEG for eyes closed resting database comparison. There are some eyes open and task databases available more recently (Hudspeth, Sterman, Duffy etc.)

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Why do a qEEG for Neurotherapy?

There are many in the field of Neurotherapy who do not perform qEEGs prior to designing a clinical intervention. These people are currently practicing well within the standard of practice for this rapidly evolving field. Many within this group have standard protocols which are used on all clients, with various alterations to respond to the client’s reported experiences during the treatment.

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Patterns seen in the qEEG and their indicated interventions

Diffuse slowing, with slower alpha

The ascending reticular activating system stimulates the diffuse thalamic projection system and sets the general arousal level of the brain. With an increase in the CNS arousal level, there is an increase in the mean frequency of alpha and a decreased slowing. With decreases in arousal there is a slowing of the alpha, as well as eventually an increase in diffusely distributed slowing ( a mixture of diffuse lower voltage delta and theta, usually with a weak vertex prominence in linked ear montages).

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Dementia & Alzheimer’s Disease (AD)

I often get questions about Alzheimer’s Disease (AD) and the EEG.

Whenever a client presents with the question of dementia, all other forms of
dementia need to be ruled out before you are left with the diagnosis of AD.
There are many EEG signatures of various forms of dementia, all of which are
helpful in evaluating a client’s presentation of dementia.

Done by experts in EEG in dementia, the EEG and qEEG may be of substantial
additive value in the differential diagnosis puzzle that all cases of
dementia represent clinically.

One EEG pattern seen in dementia is the presence of periodic triphasic
slowing in the EEG, which is actually diagnostic of subacute sclerosing
panencephalitis (SSPE). SSPE is a “spongiform encephalopathy” where the
brain becomes like “Swiss cheese”, with holes scattered throughout. This
periodic triphasic finding is differentiated from MULTIFOCAL triphasics
which are diagnostic of Crutzfeld-Jacob Syndrome (CJD), which in lay terms
is a form of mad cow disease in humans.

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EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research. Part 2

P300 Abnormalities in Cocaine, Methamphetamine, Heroin Addiction, and Alcoholism

The P300 component of the ERP, occurring 300–600 ms post-stimulus, is the most widely used ERP in psychiatry and other clinical applications (Polich et al. 1994; Polich and Herbst 2000; Pritchard 1981, 1986; Pritchard et al. 2004). The amplitude of the P300 reflects the allocation of attentional resources, while the latency is considered to reflect stimulus evaluation and classification time (Katayama and Polich 1998; Polich and Herbst 2000). The P300 is usually obtained in an oddball paradigm, wherein two stimuli are presented in a random order, one of them frequent (standard) and another one rare (target) (Polich 1990). A modification of the oddball task has been used where a third, also rare stimulus (distracter), is presented along with standard and target stimuli. It was reported that these infrequent distracters elicit a frontocentral P300, so called P3a, whereas the rare targets elicit a parietal P300, so called P3b (Katayama and Polich 1996, 1998). The P3a is recorded at the anterior scalp locations and has been interpreted as reflecting frontal lobe activity (Gaeta et al. 2003; Knight 1984). Though the P300 response in general is thought to represent ‘‘context updating/closure,’’ in a three-stimuli oddball task the P3a is interpreted as ‘‘orienting,’’ and the P3b is viewed as an index of the ability to maintain sustained attention to target (Na¨a¨ta¨nen 1990). The anterior P3a indexes the contextual salience of the rare stimuli, whereas the posterior P3b is indexing task-relevance of the stimuli (Gaeta et al. 2003).

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EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research. Part 1

T. M. Sokhadze – email: tato.sokhadze@louisville.edu
Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA

R. L. Cannon – email: rcannon2@utk.edu
Department of Psychology, The University of Tennessee, Knoxville, TN 37996, USA

D. L. Trudeau – email: trude003@maroon.tc.umn.edu
Department of Family and Community Health, School of Health Sciences, University of Minnesota, Minneapolis, MN, USA

Abstract

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.

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