EEG Phenotypes Jay Gunkelman QEEGDiplomate QEEGJay SBCGlobal net

EEG Phenotypes Jay Gunkelman, QEEG-Diplomate QEEGJay @ SBCGlobal. net www. QPro. Worldwide. com A special thanks to the original paper’s co-authors: Jack Johnstone, Ph. D. ; Joy Lunt, R. N

DSM diagnosis and all the various EEG “subgroups” are a common though complex approach…. Or simply: Transcend the DSM using phenotypes

Prior studies using EEG have documented “clusters” of EEG/q. EEG features within psychiatric populations John ER, et al. Subtyping of Psychiatric Patients by Cluster Analysis of QEEG. Brain Topography 1992; 4: 321 -326). Chabot, R. J. , & Serfontein G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40, 951 -963. Prichep LS, Mas F, Hollander E, Liebowitz M, John ER, Almas M, De Caria CM, & Levine RH. (1993) Quantitative electroencephalographic subtyping of obsessive-compulsive disorder. Psychiatry Research, 50(1), 25 -32. Prichep LS, & John ER. (1992). QEEG profiles of psychiatric disorders. Brain Topography, 4(4), 249 -257. Suffin SC, & Emory WH. (1995). Neurometric subgroups in attentional and affective disorders and their association with pharmacotherapeutic outcome. Clinical Electroencephalography, 26, 76 -83.

The underlying assumption in the DSM is: “diagnosis, thus treatment” n n The DSM does not yield optimal treatment efficacy following diagnosis Diagnoses have multiple “EEG subtypes”, but they ARE NOT SPECIFIC TO THE DIAGNOSIS n n n Frontal Frontal alpha alpha in in in ADD depression early dementia anxiety OCD

The DSM is based on behavior n n n The linkage from genetics to behavior is indirect The intermediate step between genetics and behavior is the phenotype Behaviorally driven therapy can succeed, but is it optimized?

Phenotypic patterns are not isomorphic with the DSM categories Phenotypes have powerful implications for both medication, and Neurofeedback. Wright, C, & Gunkelman J. (1998). QEEG evaluation doubles the rate of clinical success. Abstracts of the 6 th Annual Conference, Society for the Study of Neuronal Regulation, Austin, TX. Suffin SC, & Emory WH. (1995). Neurometric subgroups in attentional and affective disorders and their association with pharmacotherapeutic outcome. Clinical Electroencephalography, 26, 76 -83. Johnstone, J. , Gunkelman, J. , & Lunt, J. . (2005). Clinical database development: Characterization of EEG Phenotypes. Clinical EEG and Neuroscience, 2, 99 -107.

Phenotypes have led to enhanced outcomes clinically n S. Suffin and H. Emory (attentional and affective, medication) n L. Prichep (OCD, medication) n Chabot, et al. (ADD/ADHD, medication) n C. Wright (ADD/ADHD, Neurofeedback) n M. I. N. D. (U. C. Davis, Autism) Databases for EEG are starting to include the genetic component (Brain Resource Company, Australia)

Some EEG patterns have strong genetics links n Low voltage EEG Enoch, MA, et al. (2002). The relationship between two intermediate phenotypes for alcoholism: Low voltage alpha EEG and low P 300 ERP amplitude. Journal of Studies on Alcohol, 63(5), 509 -17. Porjesz B, et al. (2002). Linkage disequilibrium between the beta frequency of the human EEG and a GABAA receptor gene locus. Proceedings of the National Academy of Sciences of the United States of America; 99(6): 3729 -3733. Gunkelman J. (2001). -2. n Low voltage or absolute power. Journal of Neurotherapy; 5: 1 Epileptiform bursts Kaneko S. , Iwasa H. , & Okada M. (2002). Genetic identifiers of epilepsy. Epilepsia, 43 (Suppl 9), 16 -20. Huag K, et al. (2003) Mutations in CLCN 2 encoding a voltage-gated chloride channel are associated with idiopathic generalized epilepsies. Nature Genetics; 33: 527 -532.

A limited set of phenotypic divergence patterns can characterize the bulk of the variance of the EEG These EEG phenotypes predict effective therapy (medication and NF) The following table is not a substitute for professional evaluation and consultation

Epileptiform Transient spike/wave, sharp waves, paroxysmal EEG Anticonvulsant medication Inhibit low and high frequencies over affected regions, reward SCP and/or SMR. Generally low magnitudes (fast or slow) Metabolic support (LVS), nutraceuticals Reward alpha activity posteriorly. (Penniston protocol for LVF) Faster alpha variants, not low voltage Alpha frequency greater than 12 Hz over posterior cortex. GABA related medication (slightly slows the EEG frequencies) Reward 9 -10 Hz alpha at Pz, shift alpha frequency lower with alpha/theta protocol Spindling excessive beta High frequency beta with a spindle morphology, often with an anterior emphasis. Anticonvulsants Inhibit beta frequencies, wide band inhibit, possibly Penniston if alpha levels are depressed. Persistent alpha with eyes open Lack of appreciable alpha blocking with eye opening, generally this is slower alpha SNRI or amphetamine Reward beta frequencies, inhibit alpha. Reward higher frequency alpha.

Diffuse slow activity, with or without low frequency alpha. Increased delta and theta (1 -7 Hz) with or without slow posterior dominant rhythm Stimulant Inhibit midline frontocentral activity below 10 Hz. , add reward anterior beta frequencies for increased effect Focal abnormalities, not epileptiform. Focal slow activity or focal lack of activity. Inhibit slow activity (<10 Hz) and reward higher frequencies(> 12 Hz). Mixed fast and slow Increased activity below 8 Hz. , lack of alpha, increased beta frequency activity Combine across classes, e. g. stimulant + anticonvulsant Inhibit slow frequencies, reward SMR. Frontally dominant excess theta or alpha frequency activity Antidepressant, stimulant Inhibit midline frontocentral activity below 10 Hz. , add reward anterior beta frequencies for increased effect Frontal asymmetries Variable asymmetry L>R or R>L, primarily at F 3, F 4. Antidepressant Reward F 3 beta, inhibit F 3 theta and alpha frequencies. Excess temporal lobe alpha Increased alpha activity generated in temporal lobe Stimulant Inhibit 9 -12 Hz activity over affected temporal region(s), + inhibit frontal slow activity.

Slow variant

Epileptiform (myoclonus)

Beta spindle

Failure of alpha blocking

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