Quantitative Electroencephalography

Aharon D. Shulimson, Ph.D. Attention Disorders Clinic Murray, Utah 801-281-3188

A number of brain imaging techniques have been used to study the relationship between mental illness and abnormalities in the brain. These methods include magnetic resonance imaging (MRI), positron emission tomography (PET), single proton emission computerized tomography (SPECT) and quantitative electroencephalography (QEEG). As noted by Hughes and John in their 1999 review of QEEG, Evidence from these brain imaging methods has unequivocally established that mental illness has definite correlates with brain dysfunction. More than 500 EEG and QEEG studies have demonstrated electrographic correlates of mental illnesses including ADD/ADHD, depression, ObsessiveCompulsive Disorder, Anxiety, schizophrenia, bipolar disorder and substance abuse. Clinical correlates of traumatic brain injury, learning disabilities and dementia have also been found. The purpose of a quantitative EEG is to compare a patients brain wave activity to that of the average person of his/her age and look for clinical correlates of ADD/ADHD and other conditions. A report is generated which includes diagnostic impressions and recommendations for neurofeedback, a form of therapy than can remediate EEG abnormalities. Implications for medication management, based on QEEG research, are also discussed. QEEG has many advantages over MRI, PET and SPECT. It is non-invasive, less expensive than the other brain imaging modalities and provides information on a much greater range of brain functioning. The test is performed in the providers office. QEEG data is recorded from 19 locations on the scalp, using the International 10-20 electrode placement system. The ears are used as references. Ten minutes of eyes closed and ten minutes of eyes open data are digitally recorded. Data can also be recorded during task conditions, such as while reading or doing math. The data files are edited to remove artefacts (eye blinks, eye rolls, EMG, drowsiness, eventrelated potentials, etc.). The Attention Disorders Clinic uses normative data bases to analyze QEEG data. These include NeuroGuide, NeuroRep, NxLink and LORETA. Statistical data, in table and topographic map formats, is reported on absolute and relative power in the four primary brain wave bands, amplitude asymmetry, phase and coherence. Discriminant function equations that look for signs of ADHD, TBI and other conditions are calculated by two of the databases. A typical QEEG produces over 100 pages of tables and maps for each patient.

Topographic maps display EEG data in the form of color coded Z-scores. EEG activity that is in the range of +/- 1.0 Zscores is considered to be within normal limits. Activity that is +/- 1.5 Z-scores or more is evaluated to determine if it is clinically significant when placed in the context of the patients history and current problem(s). This map, taken from the NeuroGuide database, shows normal relative power theta along with mildly elevated activity in the right occipital area. Brain Wave Bands There are four primary brain wave bands, which are measured in Hertz (Hz, waves per second). Beta (12-30 Hz), the fastest of the primary bands, is associated with external focus and concentration. Alpha (8-12 Hz) reflects the brain being in an idling or relaxed state. Theta (4-8 Hz) is associated with being highly internally focused at the upper end of the band (6-8 Hz) and with being drowsy and on the verge of falling asleep at the lower end (4-6). Delta (0-4 Hz), the slowest waves, are prominent during sleep. The brain produces all of these waves continuously, but the relative amount of each being produced changes depending on what activity the person is engaged in. Absolute Power Absolute power is a measure of the electrical activity occurring in each of the brain wave bands as compared to what is normal for a persons age. A patient can have a high power or low power brain and still function normally if there are no abnormalities in relative power. Relative Power Relative power is a measure of the balance of activity in each of the brain wave bands compared to the others. Clinical correlates of ADD/ADHD include elevated relative power amplitude in the theta, alpha and beta bands. Patients with elevated theta activity, particularly in combination with low beta, typically respond well to treatment with stimulant medications. Excess alpha can be treated with a stimulant or SSRI. Patients with the high beta type of ADD/ADHD respond to treatment with Tenex or a mood stabilizer. QEEG results frequently show that a patient has elevated amplitude in more than one of the bands, suggesting the need for multiple medications. Persons with a combination of elevated theta and beta often are successfully managed with a stimulant and mood stabilizer.

Elevated relative power theta and/or alpha is often seen following traumatic brain injury. High amplitude theta is also found in fibromyalgia patients who have fibro fog. Excess relative power beta activity is seen in patients with chronic pain. This example, which is from the NxLink database, indicates relative power theta amplitude that is between 2.0 and 3.0 Z-scores above average.

Power Ratios The ratio of power between brain wave bands can provide information that is helpful in making a diagnosis and treatment recommendations. For example, extensive research has shown that an elevated theta/beta ratio is indicative of a type of ADHD that is likely to respond well to treatment with stimulant medications. Amplitude Asymmetry Amplitude asymmetry is an indication of the relative balance of electrical power between parts of the brain. Frontal alpha asymmetry (left > right) is a clinical correlate of depression. Frontal beta asymmetry (right > left) is a correlate of anxiety. Coherence Coherence is a measure of shared electrical activity between sites on the cortex and is considered to be an indication of efficiency of brain functioning. Hypercoherent sites are working too closely with each other and are devoting too much brain resources to performing tasks. Hypocoherent sites are not working closely enough to perform efficiently. Coherence deviations are often seen in persons with traumatic brain injury and ADD/ADHD. This is an example of beta hypercoherence in a person who suffered a mild traumatic brain injury

Phase Phase is a measure of the speed with which electrical signals are traveling from one part of the brain to another. Phase deviations suggest abnormalities in information processing. Information that is moving too quickly or too slowly through the cortex cannot be processed effectively. An analogy can be drawn between phase and baseball. A pitch thrown at medium speed is easy to hit. When a fastball comes at you, you may not have enough time to react in order to connect with it. A high, slow pitch can be hard to get a fix on. Phase deviations can present as attention problems. The following pages contain samples of quantitative EEG topographic maps from patients with ADD/ADHD and other conditions with impaired attention.

The combination of high relative power Theta and low relative power Beta is the most common QEEG finding in ADHD patients and predicts a positive response to treatment with stimulant medications.

A high Theta/Beta ratio in an ADD/ADHD patient is a strong predictor of positive response to treatment with a stimulant medication.

The high frontal Beta subtype of ADHD has high amplitude relative power fast wave activity. This subtype responds to treatment with a mood stabilizer or Tenex.

High frontal Alpha subtype of ADHD. This subtype can be treated with a stimulant or SSRI.

High Alpha ADHD subtype patients typically have high Alpha/Beta and/or Alpha/High Beta ratios.

Examination of the single Hertz maps is necessary for planning neurofeedback therapy for ADD/ADHD. Some patients have EEG abnormalities in an entire brain wave band, while others are in a small frequency range. This patient's elevated Beta is between 13 Hz and 16 Hz. Neurofeedback therapy would focus on reducing 13-16 Hz activity.

High Beta ADHD subtype as seen on the LORETA database.

DB Relative Beta 4 (24-28 HZ)

Brodmann area 20 Inferior Temporal Gyrus

DB Relative Beta 5 (28-32 HZ)

Brodmann area 20 Inferior Temporal Gyrus

High amplitude Beta activity in the anterior cingulate gyrus is a common QEEG finding in patients with Obsessive-Compulsive Disorder.

DB Relative Beta 3 (20-24 HZ)

Brodmann area 24 Anterior Cingulate

Before Neurofeedback
Absolute Power Relative Power Theta/Beta Ratio

After 32 sessions of training to reduce 3-6 Hz activity at Cz

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