QEEG and ERP in Clinical

Psychiatry Practice
Dr Dona Biswas
Zen Waves Clinic, Blacktown
The truth about our classificatory
systems
 Current classification is based on consensus about clusters of clinical
symptoms, rather than objective laboratory measures.
 The strength of such a system is reliability, but it lacks in validity.
 DSM and ICD assume ‘diagnosis, thus treatment’; however they do not
yield optimal treatment efficacy following diagnosis.
 Classification is based on behaviour, but the linkage from genetics to
behaviour is indirect.
 The intermediate step between genetics and behaviour is phenotype,
which has important treatment implications, rather than treatments based
on behaviour alone.
Neuroimaging in Psychiatry

 Structural brain imaging

– CT scan
– MRI
- DTI
 Functional brain imaging
– fMRI
– SPECT/PET
– QEEG
 Quantitative EEG
 QEEG refers to quantitative signal analysis of the digitized electroencephalogram.
 EEG ( electroencephalography) is a measurement of the brain electrical activity
generated by pyramidal neurons ( postsynaptic potentials) in cerebral cortex.
 EEG ( electroencephalography) has been widely used in clinical practice since
1935 ( Gibbs et al. 1935)
 Classically, EEG frequency bands are divided into:
– Gamma: >30 HZ
– Beta: 12‐30 Hz
– Alpha: 8‐12 Hz
– Theta: 4‐7Hz
– Delta: 0.1 ‐4Hz
Thatcher: Neuropsychiatry and Quantitative Electroencephalography in the 21st Century, 2011
Value of QEEG

 QEEG is distinguished from regular EEG with the latter showing low reliability
( 0.2 to 0.29) and poor inter‐rater agreement for non‐epilepsy evaluation.
 In contrast, QEEG is greater than 0.9 reliable and remains stable with high
test retest reliability over many weeks and even years‐ 1‐3 years. (Fein,
Galin, Yingling, Johnstone & Nelson, 1984; Thatcher “Validity and reliability
of quantitative electroencephalography (QEEG)” 2010)
 QEEG reveals " . . . a level of specificity and sensitivity that is comparable to
sonograms, blood tests, MRIs and other diagnostic measures commonly
used in clinical practice.“ (Thatcher, R., Moore, R., John, R., Duffy, F., et.
al.,1999)
 The scientific literature demonstrates significant correlation between QEEG
and independent measures : MRI, SPECT and PET.
Relevance of EEG/QEEG in Psychiatric
illnesses
 Prior studies using EEG have documented “clusters” of EEG/qEEG features
within psychiatric populations
 Diagnoses have multiple “EEG subtypes”, but they ARE NOT SPECIFIC TO THE
DIAGNOSIS
 Frontal alpha in ADD
 Frontal alpha in depression
 Frontal alpha in early dementia
 Frontal alpha in anxiety
 Frontal alpha in OCD
 Relevance of EEG/QEEG in Psychiatric
illnesses
 A limited set of phenotypic divergence patterns can characterize the bulk of the
variance of the EEG and predict effective treatment:
Epileptiform
Transient spike/wave, sharp waves, paroxysmal EEG
Anticonvulsant medication
Generally low magnitudes (fast or slow)
Metabolic support (LVS), nutraceuticals
Faster alpha variants, not low voltage
Alpha frequency greater than 12 Hz over posterior cortex.
GABA related medication (slightly slows the EEG frequencies)
Spindling excessive beta
High frequency beta with a spindle morphology, often with an anterior emphasis.
Anticonvulsants
Persistent alpha with eyes open
Lack of appreciable alpha blocking with eye opening, generally this is slower alpha
SNRI or amphetamine
Relevance of EEG/QEEG in Psychiatric
illnesses
Diffuse slow activity, with or without low frequency alpha.
Increased delta and theta (1-7 Hz) with or without slow posterior dominant rhythm
Stimulant
Mixed fast and slow
Increased activity below 8 Hz., lack of alpha, increased beta frequency activity
Combine across classes, e.g. stimulant + anticonvulsant
Frontally dominant excess theta or alpha frequency activity
Antidepressant, stimulant
Frontal asymmetries
Variable asymmetry L>R or R>L, primarily at F3, F4.
Antidepressant
Excess temporal lobe alpha
Increased alpha activity generated in temporal lobe
Stimulant