PharmacoEEG: Revolutionizing Mental Healthcare

The Power of qEEG: Why It Should Be Part of Your Brain Health Toolkit

Originally written by Kody Newman for iMediSync 25 Jan 2025- modified to include extra information

The field of mental health care is undergoing a significant transformation with the advent of new technologies that can help clinicians understand the brain and tailor treatments for each person. One such technology is quantitative electroencephalography (qEEG), a method that analyzes brainwaves to provide insights into brain function. This article explains qEEG, how it works, and why it should be considered as part of the assessment and treatment process for brain health.

What is qEEG?

Electroencephalography (EEG) is a test that measures electrical activity in the brain using electrodes placed on the scalp. The raw EEG data is then processed using mathematical calculations that transform the brainwave signals into numerical parameters, which can then be displayed as a topographical “map” of brain activity. This is known as quantitative EEG or qEEG. This process can identify patterns and areas of the brain that may not be functioning optimally.

• How is qEEG data acquired? EEG data is collected non-invasively using 19 electrodes placed on the scalp. Electrogel is applied to each site to ensure good signal conduction. The EEG is recorded while the patient is awake with eyes closed and eyes open. The data is then cleaned of artifacts such as movement, interference or noise, and processed using a fast fourier transform (FFT) to provide a spectral analysis which can then be compared to normative data.

Why is qEEG Important?

qEEG offers several advantages over traditional methods of assessing brain health. Here are a few key reasons why it should be considered in assessment and treatment:

• Personalized Medicine: qEEG allows for a personalized approach to treatment by identifying an individual’s unique neurophysiological profile. This is particularly important in psychiatry where a ‘one-size-fits-all’ approach often fails. Using qEEG, clinicians can select medications and treatments based on the specific needs of each patient.
• Objective Biomarker: Unlike subjective measures, qEEG provides objective, quantifiable data about brain function. This makes it a reliable biomarker for tracking treatment responses and making informed decisions about care.
• Predictive Accuracy: EEG metrics such as alpha peak frequencies and multivariate EEG patterns can reliably predict treatment outcomes across various psychiatric disorders. This predictive power helps clinicians avoid trial-and-error prescribing, which is common in psychiatry.
• Cost-Effectiveness: Compared to other neuroimaging technologies such as fMRI and sMRI, EEG is much more affordable and widely available, making it a practical option for both clinicians and patients.
• Clinical Utility: EEG has established clinical applications beyond psychiatry, including use for epilepsy, sleep studies, and neurofeedback.
• Understanding Refractory Cases: qEEG can be especially valuable for individuals who have not responded to standard treatments. Studies show that common electrophysiological abnormalities like encephalopathy, focal slowing, beta spindles, and transient discharges can be identified with qEEG in refractory cases. These abnormalities may not align with traditional diagnoses, but can help inform treatment decisions.
• Identifying Isolated Epileptiform Discharges (IEDs): qEEG can help identify IEDs, a form of seizure activity that does not manifest as a convulsion. Research suggests that treating non-epileptic patients with AEDs when IEDs are present may improve outcomes.

qEEG in Clinical Practice

The data provided by a qEEG can be used in several ways to guide treatment:

• Medication Selection: qEEG data can be used to inform medication selection for psychiatric disorders. Studies have shown that patients receiving qEEG-guided medication report significantly improved symptoms compared to those treated with traditional methods.
• Neurofeedback: qEEG is used to guide neurofeedback therapy, a non-invasive treatment that helps individuals regulate their brain activity. By identifying specific brainwave patterns, neurofeedback can help to improve focus, reduce anxiety, and improve overall brain function.
• Personalized Neurofeedback A personalized approach to neurofeedback, guided by qEEG analysis is more effective than a one size fits all approach.
• Monitoring Brain Ischemia qEEG can be used to monitor changes in blood flow and metabolism in the brain, making it a useful tool for detecting brain ischemia. qEEG can identify these changes in as little as 28-104 seconds, making it a useful tool to detect changes in cerebral perfusion. This can be critical for conditions like subarachnoid hemorrhage (SAH), where early detection of ischemia can improve outcomes.
• Identifying EEG phenotypes: qEEG can help in the identification of EEG phenotypes that have genetic correlates and can be used to predict treatment response. For example, the low voltage fast pattern has genetic correlates.

Bridging the Gap Between Research and Practice

Despite its potential, EEG and qEEG are still underutilized in mainstream psychiatry. This is due in part to a lack of funding compared to other imaging technologies such as fMRI. To better utilize the benefits of qEEG:

• Advocate for phenotype-driven protocols in clinical practice to personalize treatments based on the unique neurophysiological profiles of each patient.
• Invest in machine learning algorithms to refine EEG-based predictions and make them more accurate and clinically relevant.
• Educate practitioners and patients about the benefits of EEG-guided treatment to promote its adoption.

Conclusion

qEEG represents a significant advancement in the assessment and treatment of brain health. By providing objective data about brain function, qEEG empowers clinicians to make more informed decisions and tailor treatment plans to the individual needs of their patients. While further research and development are needed, the use of qEEG holds great promise for improving outcomes and transforming the way we approach brain health.