QEEG Brain Mapping - Neurofeedback and Quantitative Electroencephalography

I have arranged many abstracts on QEEG here.

Contents
     What is an electroencephalogram (EEG)?
     What is quantitative electroencephalogram (QEEG)?
     How and why is QEEG used in Neurofeedback?
     How is QEEG performed?
     What is in a QEEG report?
     How do you interpret a QEEG report?
     Do QEEGs differ among practitioners?
     Has QEEG been scientifically validated?
     How much does QEEG cost?
     How to read a WinEEG Human Brain Index QEEG. [PDF]

Sample QEEG Reports:
     Parkinson's diseases misdiagnosed. [PDF]
     Possible radiation disease. [PDF]
     ADHD and hypersympathecotonia. [PDF]
     Synchronized mu and left sided weakness. [PDF]

What is an electroencephalogram (EEG)?

It has been known since at least the late 1800s that the brain produces electricity. In 1929 Hans Berger published the first modern looking tracing of a brain wave and he identified the most prominent waves that occurred with the eyes closed. These were called alpha waves and were observed to have a frequency of about 10 Hertz (Hz = cycles per second). By the 1930s investigators were learning to identify patterns associated with sleep, epilepsy, coma, brain infection and other conditions. Despite the invention in the late 1900s of other types of scans (MRI, CT, SPECT, PET), the EEG has remained a crucial clinical and research tool. And unlike other types of scans it does not require that the patient be exposed to external radiation or be injected with radioactive tracers. Until about the 1970s EEGs were recorded using ink on rolling paper with a device the size of a small desk. Usually 19 sensors are applied to standard locations on the scalp.

What is a quantitative electroencephalogram (QEEG)?

Starting in the 1970s it became possible to store the EEG signals on computer media for later analysis. As computers and electronic amplifiers became smaller and faster, and as mathematical methods developed, it has become possible to store 19 or more channels of EEG data on a laptop computer using an amplifier the size of hardback book. Often the sensors are attached to the inner surface of a cloth or mesh cap. The caps come in various sizes so that the sensors will be accurately placed on any size head. The computer is capable of recognizing many more and subtle patterns among the brain waves in various locations than the eye can possibly see. These patterns are then graphically displayed as colored brain maps, graphs, and charts. Despite the impressive ability to detect subtle significant patterns, the raw EEG must always be analyzed by a trained eye in order to avoid misinterpretation or ambiguity in the QEEG. A very special feature of modern QEEG is that all the data from a client's recording can be compared to several databases of 'normal' individuals brainwaves. This makes it much easier to spot statistically significant deviations. These deviations may or not be clinically significant. It is important to consider them in light of any complaints or conditions the client might have in order to better appreciate their significance, if any.

How and why is QEEG used in Neurofeedback?

Much of the groundbreaking work in neurofeedback was done without the aid of QEEG. Many practitioners still use protocols that are generally safe and provide the ability for most brains to develop flexibility and increased control. There are, however, other types of neurofeedback protocols that aim to specifically increase or decrease certain frequencies at certain locations on the cortex (outer layer of the brain). In these cases a QEEG can give valuable insight into which areas of the brain may need to be strengthened and which may need to be relaxed. The QEEG can also tell how well each of the 19 measured areas of the cortex communicate with each of the 18 remaining sites. These measures, which include such mathematical measures as 'coherence', 'comodulation', 'phase', etc., can also be compared to norms in a database. These 'network' operations of the brain may be trained as easily as amplitude abnormalities.

How is QEEG performed?

The client's head is measured to determine which size sensor cap will be used. I use the "Comby Caps" by Pamel in Croatia www.pamel.hr. They are comfortable and it is easy and quick to prepare them to record a high-quality signal. The cap is plugged into a 32 channel Mitsar amplifier which is controlled by the WinEEG software www.novatecheeg.com. The sensors in the cap are optically isolated from the power to avoid any risk of shock. Once the EEG is obtained it can be analyzed further with the WinEEG software and the Human Brain Index database www.mitsar-medical.com or exported to be analyzed with the Neuroguide database www.appliedneuroscience.com or the Sterman-Kaiser SKIL database www.skiltopo.com. Every step of the process requires technical expertise. The cap and its sensors must be positioned according to the International 10-20 system; the sensors must be prepped with special conductive gel and the connection of each sensor with the scalp must be within a narrow band of conductivity values; the client must be comfortable and watched for any unnecessary muscle or cable movements; the EEG tracing must be carefully examined by eye in order to remove just those sections that are affected by eye blink, movement or other artifacts; the many analyses and database comparisons in the software must be skillfully selected and performed in order to create a written report that carries the most important clinical information about the recording. The skill and experience of the analyst is of crucial importance in creating a readable, useful, and accurate QEEG report that can be used, along with other observations, to understand the client's clinical picture and provide safe and effective neurofeedback protocols. During a single session the EEG is usually recorded once or twice each under the following conditions: 1) eyes open, 2) eyes closed, 3) reading, 4) doing math. The reading and math stress recordings allow us to compare the patterns of activation in the client's cortex with the patterns observed in normal and high functioning cortices. Most databases contain sets of normal values adjusted for age.

Above: Selecting correct size cap and positioning it on the head. It is then plugged into the amplifier.

Above: Electroencephalogram (EEG) acquisition from amplifier using WinEEG software.

Above: Quantitative EEG (qEEG) prepared by comparison to SKIL normative databases.

Above: Quantitative EEG (qEEG) prepared by comparison to Neuroguide normative databases.

What is in a QEEG report?

You can see some of my sample QEEG reports by returning to the index at the top of this page.

QEEG reports typically run from 12 to 30 pages in length. Usually there is a brief description of the client, the methods used to collect the EEG and prepare the report, a description of the quality of the recording, a description of the findings (normal and abnormal) and then an interpretative report. There are several types of brain activity shown in the description of findings. For each of the 19 cortex regions under the electrodes you can see the voltage and power measurements (loosely called amplitude measurements, and you can compare them with the voltages and powers of each of the 18 other cortical areas. For each area you can also see several measurements (coherence, comodulation, phase) that describe how closely or loosely it follows the waves in each of the other areas. These are often called network measurements. Each of the amplitude measurements and network measurements is calculated for each of the frequencies of interest. The frequencies are often organized into what is called clinical bins or bands. The usual clinical bands (groupings of frequencies) are described in terms of their frequencies in Hertz (Hz) (meaning cycles per second). They are: 1) Delta (1-4 Hz), 2) Theta (4-8 Hz), 3) Alpha (8-12 Hz); 4) SMR (12-15 Hz); 5) Beta (12 Hz and above), and 6 ) Gamma (35 Hz and above). The beta a gamma bands are often subdivided into smaller bands (e.g., Beta Lo, Beta Med, Beta Hi) according to the needs of the investigator. These findings are displayed in a variety of formats such as tables, graphs, charts, and colored topographic maps. It is the appearance of the topographic maps that has lead to the term brain mapping to describe this entire procedure. All the amplitude findings and the network finds for all the frequency bands of interest are then compared to one or more of several commercially published databases to see how far away from "normal" they are, and see whether or not there are any patterns of deviation that are known to be associated with clinical conditions.

How do you interpret a QEEG report?

The raw data going into the report software contains information on the client's brain amplitude and network activity at and among the 19 sensor sites. In order to compare these data with normals it is essential that the raw waveforms be analyzed on the screen and that all regions displaying artifacts due to eye movements, muscle activity, and other transients, be removed. This process is called artifacting and is part of the art and science of EEG interpretation. If there is any evidence that the client might have epilepsy, recent brain trauma, or stroke, it is important to have the EEG examined by a medical doctor specializing in neurology. Often this is not necessary for determining neurofeedback protocols. Having a M.D. report is always an option with a QEEG since the raw digital data can be easily transmitted over the internet. After the data has been artifacted and checked for any obvious EEG abnormalities, the raw data is run through the database and mapping software. At this point the investigator can see the amplitudes of every frequency band at every electrode location. The investigator can also see measures of network communications between each site and the remaining 18 others. It is crucial to understand that it some cases unusual variations in amplitude and network measures may be normal for a particular client and may not provide useful information. It is also crucial to understand that in some cases "normal" looking brain maps may still correspond to a brain that is functionally or structurally abnormal and causing symptoms. The best situation is when the findings on the QEEG suggest the same dynamics that are suspected to be involved in the client's complaints. This allows us to do two very important things: 1) develop strategies for neurofeedback, and 2) get a QEEG baseline to use as a reference to a later QEEG to be obtained after neurofeedback.

Do QEEGs differ among practitioners?

Currently, very few neurofeedback practitioners do their own full QEEGS. Often the price of the hardware and software is $15,000 or more. The extra training and experience is also a huge commitment. Most neurofeedback practitioners will still do a mini QEEG which can be as simple as an analysis of the amplitudes of various brain wave frequencies measured at a few sites on the scalp. Currently, the EEG amplifiers most commonly used for neurofeedback are the Mitsar (my choice), Deymed, Nexus, Caldwell, Lexicor, and a few others. They are very similar in terms of quality, but may differ in the upper and lower limits of the frequencies they can record. The major databases used are the SKIL (my choice), Neuroguide, NxLink, Novatech, Human Brain Institute and several others. Each of these databases has chosen a different set of people medically diagnosed as healthy to contribute to the brain wave databases. The number of people in the databases may vary from hundreds to 4 thousand. They may be recorded eyes open, eyes closed, during reading and during math. They may have built in corrections for age. Currently only the SKIL databases has built in corrections for time of day. Some QEEG reports may only state the obvious findings on the raw EEG and in the maps and database comparisons. This leaves every aspect of interpretation to the neurofeedback practitioner, regardless of her or his level of expertise. A few QEEG analysts may include references to the medical literature when significant or interesting patterns are observed. Including these references is very helpful to neurofeedback practitioners and theri clients when they want to investigate further into the mechanisms underlying a clients concerns.

Has QEEG been scientifically validated?

I have arranged over 400 abstracts on QEEG here.

First it must be said that QEEG is an add-on to standard EEG, although the skill of the interpreter can vary dramatically. One has only to search the databases, such as the U.S. National Institute of Health at www.pubmed.gov to verify that tens of thousands of scientific studies have been done concerning EEG interpretation. QEEG is different. Not only is it newer, but computerized analysis of the EEG may go by different names such as "quantitative EEG", "quantified EEG", "computerized EEG". There is a new and exciting subcategory called "rEEG" (referenced EEG} that is devoted to predicting an individuals reaction to various drugs based on computer analysis of the EEG. You can search these topics on the internet. Don't forget to also search at www.pubmed.gov.

How much does QEEG cost?

My price varies depending upon the level of research required for the final report. A simple recording and analysis with neurofeedback recommendations costs between $250 and $500. Make certain that the QEEG you get gives you the information you need.

Are you considering having a QEEG done?

If you already have a neurofeedback practitioner then it is important that she or he receives a QEEG that provides the information necessary to develop your neurofeedback protocol. You may want to print my sample report located here and take it to your practitioner, or refer him or her to my website, www.growing.com/mind. If your practitioner has not seen a QEEG report before, or is not used to QEEG reports containing scientific references, then my sample report may be of interest.

As always, if you have any questions, concerns, or ideas please contact me.
Douglas Dailey, L.Ac., BCB, BCN, QEEG-D
Santa Clara CA - San Francisco Bay Area, California, USA.
(408) 984-3333 or mind@growing.com
www.growing.com/mind
www.cortexercise.com

 Fin

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How to get neurofeedback: www.growing.com, where to get neurofeedback: mind@growing.com, how to get biofeedback: www.growing.com, where to get biofeedback: mind@growing.com. How to get a QEEG. How to get a brain map. www.growing.com/mind. Where to get a QEEG. Where to get brain maps: www.growing.com/mind. Sample QEEG report available at www.growing.com/mind. Example of QEEG report, example of brain map, sample brain map, what does a brain map look like, what does a qeeg look like. www.growing.com/mind.

End: April 2011