By Jay D. Tarnow, M.D. & Ron Swatzyna, Ph.D., LCSW
In early 2013, the National Institute of Mental Health (NIMH) launched the Research Domain Criteria project (RDoC). This is an effort to evolve the symptoms-based diagnosis process to a more scientific-based process by incorporating a multidisciplinary approach that relies not only on symptoms, but also on genetics, neuroimaging, and cognitive science. This movement away from traditional categorization of the Diagnostic and Statistic Manual (DSM) is a necessary step to shift the focus toward identifying the underlying cause of the observed symptoms. The Tarnow Center began this shift in eight years prior.
Under the direction of Dr. Jay D. Tarnow the Center has always been on the leading edge of innovative approaches to mental health. In January 2005, Child and Adolescent Psychiatric Clinics of North America published a journal on "Emerging Interventions" dedicated to the current research in quantitative EEG (qEEG) technology and neurofeedback treatment. This convinced Dr. Tarnow to start a new program at the Center. He came to Dr. Ron Swatzyna and they developed a collaborative plan. By April, 2005, Dr. Swatzyna completed additional training in doing EEG/qEEGs and neurofeedback and the first study was done that month.
Drs. Tarnow and Swatzyna realized early on that to be on the leading edge, they have to be supported by current research. So from the beginning, any recommendations for medication ot treatment were research based. In those first few years (2005-2009) the learning curve was steep. Dr. Tarnow found the EEG and qEEG results most helpful when treating those on multiple medications. In 2009, Dr. Swatzyna created an EEG/qEEG archival database in compliance with Institution Review Board (IRB) regulations. Each study since has been analyzed by an internationally renowned team.
Since April of 2009 every EEG has been read by neurophysiologist Dr. Meyer Proler. Meyer Proler, M.D. is a graduate of Baylor University, College of Medicine. Additionally, he is certified by the American EEG Society Board of Qualifications, as well as the American Board of Electroencephalography, with special competence in Quantified EEG. Dr. Proler has been a clinical assistant professor in the Department of Neurology at Baylor University for over 14 years and has had numerous scientific papers published.
The EEG data is also sent to a scientific team at the Human Brain Institute in Saint Petersburg, Russia to be quantified and compared to both the European and American (Dr. Robert Thatcher's Neuroguide) databases. Once the brain maps are made, they are analyzed by qEEG diplomate Jay Gunkelman. He is recognized as one of the top leaders in the field of EEG and QEEG, and has processed over 500,000 EEGs since 1972. Additionally he has conducted, published or participated in hundreds of research papers, articles, books and international meetings.
In 2013 Dr. Swatzyna assembled a team to study 386 clinical cases that had failed on at least two medication trials. The team included Dr. Tarnow, Dr. Vijayan Pillai (The University of Texas Arlington statistician) and Dr. Gerald Kozlowski (Saybrook University researcher). In 2014 they published their findings in two medical journals (referenced below).
Swatzyna, R.J., Kozlowski, G.P. & Tarnow, J.D. (2014). Pharmaco-EEG: A Study of Individualized Medicine in Clinical Practice. Clinical EEG and Neuroscience. Electronically published December, 2014.
Swatzyna, R.J., Tarnow, J.D., Tannous, J., Schieszler, C., Pillai, V.J. & Kozlowski, G.P. (2014). EEG/QEEG Technology Identifies Neurobiomarkers Critical to Medication Selection and Treatment: A Preliminary Study. Journal of Psychology and Clinical Psychiatry.
In 2014, the database contained 427 clinical cases with each having 380 variables. His "big data" database gained so much international attention that a distinguished researcher from Utrecht University the Netherlands, Dr. Martijn Arns requested the use for a particular study of interest. Dr. Arns formed a research team including Dr. Swatzyna, Dr. Sebastian Olbrich from the University of Munich and Jay Gunkelman. Their goal was to study one of the neurobiomarkers using a RDoC approach (reference below). This is the largest study, and one of the first, to be done in response to the NIMH request for research identifying neurobiological measures causing psychological symptoms.
Arns, M., Swatzyna, R.J., Gunkelman, J., & Olbrich, S. (pending publication 2015). Sleep Maintenance, Spindling Excessive Beta and Impulse Control: An RDoC Arousal and Regulatory Systems Approach? Neuropsychiatric Electrophysiology.
When Drs. Tarnow and Swatzyna started this effort ten years ago, they had no idea where it would lead. What they did not expect was that the same four findings (neurobiomarkers) would account for 99 percent of all medication failure cases. This was a very important finding because it:
- Explained why prior medications failed,
- Provided insight as to what class of medications would likely be more effective without adverse side effects
- Identified when medications would have limited effectiveness or should be avoided until more testing can be done.
The Tarnow Center has the distinction of being the first private practice in the United States to use scientific data to assist with medication and treatment selection. Using this data allows the clients to eliminate the “trial-and-error” method when it comes to medications. The results of the EEG/qEEG may help the psychiatrist choose a medication that will have less adverse side effects. This could not have been done without the collaboration of Dr. Swatzyna's research and Dr. Tarnow's clinical expertise. Because we are on the leading edge of research, we have to be very cognizant of our responsibility to provide research based, clinically correlated recommendations. This information is only useful under the direction and guidance of a psychiatrist with years of experience such as Dr. Tarnow.
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