QEEG Comes of Age By Jay Dennis Tarnow, M.D.
For many years, practitioners have claimed that brain functioning can be altered (and improved) through QEEG neurofeedback. Most of the scientific studies attempting to support this claim suffered from methodological weaknesses and in the absence of hard proof, many, including myself, preferred to await better evidence of efficacy and a more rigorous theoretical framework.
A host of recent MRI studies and the emergence of QEEG have provided much of the information that was lacking and have brought neurofeedback into the realm of evidence-based treatment and diagnostic protocols.
Some of this proof emerged almost by accident when a group of adults with bipolar disorder were given EP-MRSI (echo-planar magnetic resonance spectroscopic imaging) diagnostic scans. The test subjects reported significant mood improvement immediately following the scan. A study was designed, making use of sham and control groups, to investigate this phenomenon and, it was concluded that the EP-MRSI did improve mood.
Based on that study, others developed research protocols to investigate whether subjects could gain some control over brain functions through the use of real time MRI imaging. The research supported the contention and patients were able to gain active control over specific areas of brain functioning. These studies bear out what neurofeedback practitioners have been arguing, that patients can make use of real-time information about brain functioning to alter and enhance that function.
These developments did not make EEG neurofeedback immediately useful because while it was clear that EEGs were measuring something, it was not clear what that something was. This is where the significance of QEEG comes into play. QEEG, (with the Q standing for quantitative) quantifies the EEG signal, which allows for comparison with an extensive database of existing QEEGs. This ability to compare individual QEEG results with a vast normative database has provided substantial evidence of a significant relationship between QEEG abnormalities and a variety of disorders of behavior, emotion, thinking, learning and development. For the first time, we are gaining an insight into what it is that QEEGs are measuring and this insight has allowed QEEG technology to be employed not only as a neurofeedback technique, but as a powerful diagnostic aid.
Recent studies, amply cross-validated using other neuroimaging techniques, have shown that the QEEG signal is a good indicator of patterns of cortical stimulation that play a role in many forms of psychiatric disorder. It is particularly useful in distinguishing among disorders which may present similarly from a symptomalogical point of view, but which arise from divergent dysfunctions, helping the clinician choose the most effective treatment approach.
ADHD has been a significant area of study for QEEG researchers, who have demonstrated a distinctive QEEG pattern among individuals with the disorder.
An article by Laurence M. Hirshberg, Ph.D., Sufen Chiu, MD, PhD, and Jean Frazier, MD. in the January 2005 issue of Child & Adolescent Psychiatric Clinics of North America, reports: The bulk of QEEG research into child and adolescent psychiatric disorders has been done with ADHD. Multiple QEEG studies have demonstrated a pattern of electrophysiological abnormality among individuals with this disorder. Discriminant function analysis using QEEG variables has shown very high levels of sensitivity and specificity in identifying ADHD participants in several studies. In fact, in two studies, a single ratio of theta/beta power recorded from a single site resulted in sensitivity levels of 86% and 90% and specificity levels of 94% and 98%. Some experts have recommended that neuroimaging studies be included in the routine assessment of ADHD. This research would suggest that QEEG should be the preferred means, since validity and reliability are high and cost is relatively low.
As a result of the relative maturity and more robust scientific basis of QEEG neuroimaging, the Tarnow Center has begun working with Dr. Johnathan Walker, a Dallas-based neurologist and world-renowned expert in the field of QEEG. Dr. Walker will work with the Center to provide diagnostic support and to develop EEG therapy protocols.
Dr. Walker has done ground-breaking research into QEEG therapy and diagnostics, and has amassed a normative database with over a million data points. This is significant, because the value of QEEG both as a diagnostic and therapeutic tool, depends heavily on the database used to evaluate individual results and also on the clinical experience and expertise of the evaluator. Dr. Walker will evaluate all QEEG results from the Tarnow Center and, for neurofeedback patients, will develop individual therapeutic neurofeedback protocols that will be implemented by Tarnow Center clinicians.
An article on page 3 in this newsletter by Dr. Ron Swatzyna and Lesley Solomon discusses this treatment modality. They will begin accepting QEEG patients this summer. They will work directly with Dr. Walker in developing this diagnostic and treatment program.
I know that EEG and neurofeedback has been viewed skeptically by some in the mental health community, but recent advances and evidenced-based treatment protocols have, in my opinion, changed the outlook for this branch of brain science. I would be more than happy to share with anyone the research that I have found so persuasive. I welcome questions and discussions in this exciting new avenue of therapeutic and diagnostic science.