Presentation is loading. Please wait.

Presentation is loading. Please wait.

EEG and QEEG as Predictors of Medication Response Thomas F. Collura, Ph.D., QEEG-D, BCN-A July 11, 2012 BCIA-Sponsored Webinar copyright 2012 T. F. Collura.

Similar presentations


Presentation on theme: "EEG and QEEG as Predictors of Medication Response Thomas F. Collura, Ph.D., QEEG-D, BCN-A July 11, 2012 BCIA-Sponsored Webinar copyright 2012 T. F. Collura."— Presentation transcript:

1 EEG and QEEG as Predictors of Medication Response Thomas F. Collura, Ph.D., QEEG-D, BCN-A July 11, 2012 BCIA-Sponsored Webinar copyright 2012 T. F. Collura

2 Overview Factors Influencing EEG EEG Considerations re: medication for: – ADD/ADHD – Depression – Migraines General Recommendations copyright 2012 T. F. Collura

3 Factors Influencing EEG copyright 2012 T. F. Collura

4 Concentration/Relaxation Cycle

5 Phenotypes Diffuse Slow Focal Abnormalities, not epileptiform Mixed Fast & Slow Frontal Lobe Disturbances – excess slow Frontal Asymmetries Excess Temporal Lobe Alpha Spindling Excessive Beta Generally Low Magnitudes Persistent Alpha “Epileptiform” (requires visual inspection of EEG waveforms) Faster Alpha Variants, not Low Voltage (requires live z-score for peak frequency) + Diffuse Alpha deficit copyright 2012 T. F. Collura

6 Common EEG Deviations Depression – Asymmetric frontal alpha – Also beta excess or deficit variants OCD – Excess orbitofrontal, temporofrontal alpha ADHD – Frontal slowing, frontal theta, excess central alpha – Also low-voltage variants copyright 2012 T. F. Collura

7 Drugs and EEG copyright 2012 T. F. Collura

8 EEG changes due to medications Opioids / Cannabis / PCP / Antidepressants – Increase slow wave activity Barbiturates – Rhythmic 18 to 26 Hz activity Neuroleptics / Tranquilizers – Increase coherence, decrease beta Anxiolytics – Decrease alpha, increase beta SSRI’s – Increase fronto-central beta copyright 2012 T. F. Collura

9 Atypical Antipsychotics Dopamine and Serotonin agonist Side effects: constipation, extrapyramidal, sedation, tremor, restlessness Anecdotal reports of seizures, convulsions Arora and Arndorfer (2007) reported twitching, spells with Aripiprazole (Abilify) EEG revealed “generalized epilepsy,” “seizure activity” in 13 YO male / copyright 2012 T. F. Collura

10 General Principles Record, classify EEG and/or QEEG Identify particular markers or traits Associate with likely mechanisms Consider effects of drugs on EEG Assess likelihood of positive outcome for – Medication – Neurofeedback – Other Therapies copyright 2012 T. F. Collura

11 ADD/ADHD At least 5 subtypes identified Distinct EEG signatures Prognostic for EEG Biofeedback Prognostic for Stimulant Effectiveness May point to alternative medications copyright 2012 T. F. Collura

12 Depression Two basic forms: – Left/Right Frontal Asymmetry Davidson, Rosenfeld, Baehr – Localized or General Beta Excess/Deficit Hirshberg / Brown / Tufts / Harvard copyright 2012 T. F. Collura

13 Anxiety Various EEG manifestations – Excess beta – Excess alpha – Alpha deficit copyright 2012 T. F. Collura

14 General EEG-Based Pharmacotherapy Phenotype-Based – Arns et al. ADD/ADHD subtyping QEEG-Based – DeBattista, Hoffman, CNS Response copyright 2012 T. F. Collura

15 Migraines Walker (2011) compared EEG with Medication Effectiveness EEG Biofeedback Effectiveness copyright 2012 T. F. Collura

16 Bolwig et al. (2007) copyright 2012 T. F. Collura

17 Arns et al. (2012) copyright 2012 T. F. Collura

18 Arns et al. (2012) ADHD patients with excess frontal theta EEG power and excess frontal alpha EEG power are more likely to respond to stimulant medication Low-voltage EEG occurs more often in ADHD than in controls These three subgroups reflect “lower and more instable vigilance regulation” Contrast to “vigilance auto-stabilization (Hegerl, Sander) which are less responsive to stimulants copyright 2012 T. F. Collura

19 Arns et al. (2012) Another subgroup: excess beta or beta spindling (Arns, Chabot, Serfonetin, Clarke) Lack of improvement on impulsivity and inattention in response to stimulants. Slowed individual Alpha Peak Frequency (iAPF) also do not respond to stimulant medication. Non-specific trait; also non-responsive to antidepressants and rTMS copyright 2012 T. F. Collura

20 Arns et al. (2012) copyright 2012 T. F. Collura

21 Arns et al. (2012) copyright 2012 T. F. Collura

22 Arns et al. (2012) copyright 2012 T. F. Collura

23 DeBattista et al. (2010) copyright 2012 T. F. Collura

24 DeBattista et al. (2010) copyright 2012 T. F. Collura

25 DeBattista et al. (2010) copyright 2012 T. F. Collura

26 DeBattista et al. (2010) copyright 2012 T. F. Collura

27 DeBattista et al. (2010) copyright 2012 T. F. Collura

28 Iosifescu (2011) copyright 2012 T. F. Collura

29 Pizzagalli (2001) copyright 2012 T. F. Collura

30 Walker (2011) copyright 2012 T. F. Collura

31 Walker (2011) copyright 2012 T. F. Collura

32 Walker (2011) copyright 2012 T. F. Collura

33 Walker (2011) copyright 2012 T. F. Collura

34 Summary ADD/ADHD – Subtyping, differential response to stimulants – Slow-wave variants respond to stimulants Depression – Frontal Asymmetry type responds to antidepressants – Avoid SSRI’s when excess or spindling beta present Migraines – Medication of limited long-term value – EEG can be used to select NF copyright 2012 T. F. Collura

35 References Arns, M., Gunkelman, J., Breteler, M., & Spronk, D. (2008) EEG phenotypes predict treatment outcome to stimulants in children with ADHD. Journal of Integrative Neuroscience, 7(3), Arns, M. Gunkelman, J., Olbrich, S., Sander, C., & Hegerl, U. (2011) EEG vigilance and phenotypes in neuropsychiatry: implications for intervention. In R. Coben and J. Evans (Eds.). Neurofeedback and Neuromodulation Techniques and Applications. Amsterdam: Elsevier. Arns, M., Drinkenburg, W., & Kenemans, J.L. (2012) The effects of qeeg-informed neurofeedback in ADHD: an open- label pilot study. Appl Psychophysiol Biof. March published online. copyright 2012 T. F. Collura

36 References Lansbergen, M., Arns, M., van Dongen-Boomsma, M., Sprink, D., & Buitelaar, J.K. (2011) The increase in Theta/Beta ratio on resting state EEG in boys with attention-deficit/hyperactivity disorder is mediated by slow Alpha peak frequency. Progress in Neuro- Psychopharmacology & Biological Psychiatry, 35, Sander, C., Arns, M., Olbrich, S., & Hegerl, U. (2010). EEG-Vigilance and response to stimulants in pediatric patients with attention deficit/hyperactivity disorder. Clinical Neurophysiology, 121, copyright 2012 T. F. Collura

37 References Bares, M., Brunovsky, M., Kopecek, M., Novak, T., Stopkova, P., Kozeny, J., et al. (2007). Changes in QEEG prefrontal cordance as a predictor of response to antidepressants in patients with treatment resistant depressive disorder: A pilot study. Journal of Psychiatric Research, 41(3-4), Bares, M., Brunovsky, M., Kopecek, M., Novak, T., Stopkova, P., Kozeny, J., et al. (2008). Early reduction in prefrontal Theta QEEG cordance value predicts response to venlafaxine treatment in patients with resistant depressive disorder. European Psychiatry, 23(5), Benedetti, F., Colombo, C., Pirovano, A., Marino, E., & Smeraldi, E. (2009). The catechol-o-methyltransferase val(108/158)met polymorphism affects antidepressant response to paroxetine in a naturalistic setting. Psychopharmacology, 203(1), copyright 2012 T. F. Collura

38 References Bruder, G.E., Sedoruk, J.P., Stewart, J.W., McGrath, P.J., Quitkin, F.M., & Tenke, C.E. (2008). Electroencephalographic Alpha measures predict therapeutic response to a selective serotonin reuptake inhibitor antidepressant: Pre- and post-treatment findings. Biological Psychiatry, 63(12), Bruder, G.E., Steward, J.W., Tenke, C.E., McGrath, P.J., Leite, P., Bhattacharya, N., et al. (2001). Electroencephalographic and perceptual asymmetry differences between responders and nonresponders to an SSRI antidepressant. Biological Psychiatry, 49(5), copyright 2012 T. F. Collura

39 References Chabot, R.J., di Michele, F., Prichep, L., & John, E.R. (2001). The clinical role of computerized EEG in the evaluation and treatment of learning and attention disorders in children and adolescents. The Journal of Neuropsychiatry and Clinical Neurosciences, 13(2), Chabot, R.J. & Serfontein, G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40(10), copyright 2012 T. F. Collura

40 References Clarke, A.R., Barry, R.J., McCarthy, R., & Selikowitz, M., (2001a). Age and sex effects in the EEG: Differences in two subtypes of attention-deficit/hyperactivity disorder. Clinical Neurophysiology, 112(5), Clarke, A.R., Barry, R.J., McCarthy, R., & Selikowitz, M., (2001b). EEG-defined subtypes of children with attention- deficit/hyperactivity disorder. Clinical Neurophysiology, 112(11), Clarke, A.R., Barry, R.J., McCarthy, R., Selikowitz, M., Brown, C.R., & Croft, R.J. (2003) Effects of stimulant medication on the EEG of children with attention-deficit/hyperactivity disorder predominantly inattentive type. International Journal of Psychophysiology, 47(2), copyright 2012 T. F. Collura

41 References Cook, I.A., Leuchter, A.F., Morgan, M., Witte, E., Stubbeman, W.F., Abrams, M., et al. (2002). Early changes in prefrontal activity characterize clinical responders to antidepressants. Neuropsychopharmacology, 27(1), DeBattista, C., Kinrys, G., Hoffman, D., Goldstein, C., Zajecka, J., Kocsis, J., et al. (2010) The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression. Journal of Psychiatric Research, 45(1), copyright 2012 T. F. Collura

42 References Iosifescu, D.V. (2008). Prediction of response to antidepressants: Is quantitative EEG (QEEG) an alternative? CNS Neuroscience & Theraputics, 14(4), Iosifescu, D.V. (2011) Electroencephalography-derived biomarkers of antidepressant response. Harvard Review of Psychiatry, 19(3), Iosifescu, D.V., Greenwald, S., Devlin, P., Mischoulon, D., Denninger, J.W., Alpert, J.E., et al. (2009). Frontal EEG predictors of treatment outcome in major depressive disorder. European Neuropsychopharmacology, 19(11), copyright 2012 T. F. Collura

43 References Johnstone, J. & Lunt, J. (2011) Use of quantitative EEG to predict therapeutic outcome in neuropsychiatric disorders. In In R. Coben and J. Evans (Eds.). Neurofeedback and Neuromodulation Techniques and Applications. Amsterdam: Elsevier. Korb, A.S., Hunter, A.M., Cook, I.A., & Leuchter, A.F. (2009). Rostral anterior cingulate cortex Theta current density and response to antidepressants and placebo in major depression. Clinical Neurophysiology, 120: Leuchter, A.F., Cook, I.A., Marangell, L.B., Gilmer, W.S., Burgoyne, K.S., Howland, R.H., et al. (2009). Comparative effectiveness of biomarkers and clinical indicators for predicting outcomes of SSRI treatment in major depressive disorder: Results of the BRITE-MD study. Psychiatry Research, 169(2), copyright 2012 T. F. Collura

44 References Pizzagalli, D., Pascual-Marqui, R.D., Nitchke, J.B., Oakes, T.R., Larson, C.L., Abercrombin, H.C. et al. (2001) Anterior cingulate activity as a predictor of degree of treatment response in major depression: Evidence from brain electrical tomography analysis. The American Journal of Psychiatry, 158(3), Pizzagalli et al. (2001) Anterior cingulate activity as s predictor of treatment resonse in major depression: evidence from brain electrical tomography. Am J. Psychiatry 158(3) copyright 2012 T. F. Collura


Download ppt "EEG and QEEG as Predictors of Medication Response Thomas F. Collura, Ph.D., QEEG-D, BCN-A July 11, 2012 BCIA-Sponsored Webinar copyright 2012 T. F. Collura."

Similar presentations


Ads by Google