Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-13T04:07:19.190Z Has data issue: false hasContentIssue false
  • English
  • Français

The forsaking of the clinical EEG by psychiatry: how justified?

Published online by Cambridge University Press:  02 August 2017

Nash N. Boutros
Nash N. Boutros*
Affiliation:
University of Missouri in Kansas City, Kansas City, Missouri, USA
*
*Address correspondence to: Nash N. Boutros, Department of Psychiatry, University of Missouri–Kansas City, 1000 East 24th Street, Kansas City, Missouri 68108. (Email: boutrosn@umkc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Despite decades of publications attesting to the role of the clinical EEG in diagnosing and managing psychiatric disorders, the procedure remains highly underutilized in the practice of psychiatry. The visually inspected EEG (vEEG) can detect various forms of abnormalities, each with its own clinical significance. Abnormalities can be paroxysmal (i.e., suggestive of an epileptic-like process) or stationary. The most important unanswered question remains the value of detecting epileptiform activity in a nonepileptic psychiatric patient in predicting favorable responses to anticonvulsant treatment. Despite the many shortcomings of vEEG, the available evidence suggests that in the presence of paroxysmal activity in a nonepileptic psychiatric patient a trial of a psychotropic anticonvulsant may be warranted if standard treatment has failed. More research on the contribution of paroxysmal EEG abnormalities to the problem of episodic psychiatric symptoms (e.g., panic attacks, dissociative episodes, repeated violence) is sorely needed. It is postulated that at least some of these conditions may represent an epilepsy spectrum disorder. Similarly, the significance of the presence of a slow-wave activity (whether focal or generalized) also deserves further well-designed research to ascertain the exact clinical significance. Nonetheless, the available data suggest that further medical workup is necessary to ascertain the nature and degree of the pathology when present.

Keywords

Psychiatryelectroencephalogram (EEG)isolated epileptiform discharges (IEDs)magnetoencephalography (MEG)epilepsy spectrum disorders
Type
Review Articles
Information
CNS Spectrums , Volume 23 , Special Issue 3: Theme: Neuropsychiatry , June 2018 , pp. 196 - 204
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Shelley, BP, Trimble, MR, Boutros, NN. Electroencephalographic cerebral dysrhythmic abnormalities in the trinity of nonepileptic general population, neuropsychiatric, and neurobehavioral disorders. J Neuropsychiatry Clin Neurosci. 2008; 20(1): 7–22.Google Scholar
2. Boutros, NN, Kirollos, S, Pogarell, O, Gallinat, J. Predictive value of isolated epileptiform discharges for a favorable therapeutic response to antiepileptic drugs in nonepileptic psychiatric patients. J Clin Neurophysiol. 2014; 31(1): 21–30.Google Scholar
3. Struve, FA, Boutros, NN. Somatic implications of generalized and/or focal slowing in psychiatric patients. Clin EEG Neurosci. 2005; 36(3): 171–175.Google Scholar
4. Coburn, KL, Lauterbach, EC, Boutros, NN, Black, KJ, Arciniegas, DB, Coffey, CE. The value of quantitative electroencephalography in clinical psychiatry: a report by the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatr Clin Neurosci. 2006; 18(4): 460–500.Google Scholar
5. Bonanni, L, Franciotti, R, Nobili, F, et al. EEG markers of dementia with Lewy bodies: a multicenter cohort study. J Alzheimers Dis. 2016; 54(4): 1649–1657.Google Scholar
6. Hegerl, U, Hensch, T. The vigilance regulation model of affective disorders and ADHD. Neurosci Biobehav Rev. 2014; 44: 45–57.Google Scholar
7. Grossi, E, Olivieri, C, Buscema, M. Diagnosis of autism through EEG processed by advanced computational algorithms: a pilot study. Comput Methods Programs Biomed. 2017; 142: 73–79.Google Scholar
8. Boutros, NN, Bowyer, S, Wang, J, Urfy, MZ, Loeb, JA. Epilepsy spectrum disorders: a concept in need of validation or refutation. Med Hypotheses. 2015; 85(5): 656–663.Google Scholar
9. Boutros, NN, Torello, M, McGlashan, TH. Electrophysiological aberrations in borderline personality disorder: state of the evidence. J Neuropsychiatr Clin Neurosci. 2003; 15(2): 145–154.Google Scholar
10. Boutros, NN, Galloway, MP, Ghosh, S, Gjini, K, Bowyer, SM. Abnormal coherence imaging in panic disorder: a magnetoencephalography investigation. Neuroreport. 2013; 24(9): 487–491.Google Scholar
11. Elisevich, K, Shukla, N, Moran, JE, et al. An assessment of MEG coherence imaging in the study of temporal lobe epilepsy. Epilepsia. 2011; 52(6): 1110–1119.Google Scholar
12. Engel, J Jr. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001; 42(6): 796–803.Google Scholar
13. Boutros, NN, Gjini, K, Moran, J, Chugani, H, Bowyer, S. Panic versus epilepsy: a challenging differential diagnosis. Clin EEG Neurosci. 2013; 44(4): 313–318.Google Scholar
14. Boutros, NN, Gallinat, J, Pogarell, O. Isolated epileptiform discharges in nonepileptic psychiatric patients: to treat or not to treat? J Clin Neurophysiol. 2014; 31(4): 395.Google Scholar
15. Toni, C, Cassano, GB, Perugi, G, et al. Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy. Compr Psychiatry. 1996; 37(2): 125–133.Google Scholar
16. Hoffman, EJ, Mathew, JS. Anxiety disorders: a comprehensive review of pharmacotherapies. Mount Sinai J Med. 2008; 75(3): 248–262.Google Scholar
17. Hill, D, Watterson, D. Electroencephalographic studies of psychopathic personalities. J Neurol Psychiatry. 1942; 5(1–2): 47–65.Google Scholar
18. Williams, D. Neural factors related to habitual aggression: considerations for differences between those habitual aggressive and others who have committed crimes or violence. Brain. 1969; 92(3): 503–520.Google Scholar
19. Howard, RC. The clinical EEG and personality in mentally abnormal offenders. Psychol Med. 1984; 14(3): 569–580.Google Scholar
20. Boutros, NN, Lajiness-O’Neill, R, Zillgitt, A, Richard, AE, Bowyer, SM. EEG changes associated with autistic spectrum disorders. Neuropsychiatr Electrophysiol. 2015; 1: 3.Google Scholar
21. Gillberg, C, Schaumann, H. Epilepsy presenting an infantile autism? Two case studies. Neuropediatrics. 1983; 14(4): 206–212.Google Scholar
22. Hollander, E, Dolgoff-Kaspar, R, Cartwright, C, Rawitt, R, Novotny, S. An open trial of divalproex sodium in autism spectrum disorders. J Clin Psychiatry. 2001; 62(7): 530–534.Google Scholar
23. Chez, MG, Chang, M, Krasne, V, Coughlan, C, Kominsky, M, Schwartz, A. Frequency of epileptiform EEG abnormalities in a sequential screening of autistic patients with no known clinical epilepsy from 1996 to 2005. Epilepsy Behav. 2006; 8(1): 267–271.Google Scholar
24. Swatzyna, RJ, Tarnow, JD, Turner, RP, Roark, AJ, MacInerney, EK, Kozlowski, GP. Integration of EEG into psychiatric practice: a step toward precision medicine for autism spectrum disorder. J Clin Neurophysiol. 2017; 34(3): 230–235.Google Scholar
25. Frye, RE, Butler, I, Strickland, D, Castillo, E, Papanicolaou, A. Electroencephalogram discharges in atypical cognitive development. J Child Neurol. 2010; 25(5): 556–566.Google Scholar
26. Larsson, PG, Bakke, KA, Bjørnæs, H, et al. The effect of levetiracetam on focal nocturnal epileptiform activity during sleep: a placebo-controlled double-blind cross-over study. Epilepsy Behav. 2012; 24(1): 44–48.Google Scholar
27. Pressler, RM, Robinson, RO, Wilson, GA, Binnie, CD. Treatment of interictal epileptiform discharges can improve behavior in children with behavioral problems and epilepsy. J Pediatr. 2005; 146(1): 112–117.Google Scholar
28. Tharp, BR. Epileptic encephalopathies and their relationship to developmental disorders: do spikes cause autism? Ment Retard Dev Disabil Res Rev. 2004; 10(2): 132–134.Google Scholar
29. Kleen, JK, Scott, RC, Holmes, GL, Lenck-Santini, PP. Hippocampal interictal spikes disrupt cognition in rats. Ann Neurol. 2010; 67(2): 250–257.Google Scholar
30. Khan, OI, Zhao, Q, Miller, F, Holmes, GL. Interictal spikes in developing rats cause long-standing cognitive deficits. Neurobiol Dis. 2010; 39(3): 362–371.Google Scholar
31. Gallinat, J, Hegerl, U. Limbic ictus as a condition for anxiety attacks [in German]. Nervenartzt. 1999; 70(3): 206–215.Google Scholar
32. Brown, TM. Basic mechanisms in the pathogenesis of delirium. In: Stoudemire A, Fogel BS, Greenberg DB, eds. Psychiatric Care of the Medical Patient, 2nd ed. New York: Oxford University Press; 2000: 571–580.Google Scholar
33. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.Google Scholar
34 Tonkonogy, J, Geller, J. A neuropsychiatry service in a state hospital: Adolf Meyer’s approach revisited. Psychiatr Q. 2007; 78(3): 219–235.Google Scholar
35. Engel, GL, Romano, J. Delirium, a syndrome of cerebral insufficiency. J Chronic Dis. 1959; 9(3): 260–277.Google Scholar
36. Javanbakht, A, Amirsadri, A, Arfken, C, Dewald, O, Boutros, NN. Standard EEG study of acute psychiatric patients with difficult to assess mental status. Am Assoc Emerg Psychiatry. 2012; 10(1): 5–10.Google Scholar
37. Cascino, GD, Trennerry, MR, So, EL, et al. Routine EEG and temporal lobe epilepsy: relationship to long-term monitoring, quantitative MRI, and operative outcome. Epilepsia. 1996; 37(7): 651–656.Google Scholar
38. Leach, JP, Stephan, LJ, Salveta, C, Brodie, MJ. Which electroencephalogram (EEG) for epilepsy? The relative usefulness of different EEG protocols in patients with possible epilepsy. J Neurol Neurosurg Psychiatry. 2006; 77(9): 1040–1042.Google Scholar
39. Goodin, DS, Aminoff, MJ. Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet. 1984; 1(8381): 837–839.Google Scholar
40. Marsan, CA, Zivin, LS. Factors related to the occurrence of typical abnormalities in the EEG records of epileptic patients. Epilepsia. 1970; 11(4): 361–381.Google Scholar
41. Losey, TE, Uber-Zak, L. Time to first interictal epileptiform discharge in extended recording EEGs. J Clin Neurophysiol. 2008; 25(6): 357–360.Google Scholar
42. Chochoi, M, Tyvaert, L, Derambure, P, Szurhaj, W. Is long-term electroencephalogram more appropriate than standard electroencephalogram in the elderly? Clin Neurophysiol. 2017; 128(1): 270–274.Google Scholar
43. Boutros, N, Mirolo, HA, Struve, F. Normative data for the unquantified EEG: examination of adequacy for neuropsychiatric research. J Neuropsychiatry Clin Neurosci. 2005; 17(1): 84–90.Google Scholar
44. Hughes, JR, Wilson, WP, eds. EEG and Evoked Potentials in Psychiatry and Behavioral Neurology. Boston: Butterworths; 1983.Google Scholar
45. Hughes, JR. EEG in Clinical Practice, 2nd ed. Boston: Butterworth–Heinemann; 1994.Google Scholar
46. Boutros, NN. Introduction to controversial sharp waves or spike patterns. In: Standard EEG: A Research Roadmap for Neuropsychiatry. New York: Springer Science; 2014: 151–157.Google Scholar
47. DeLong, GR, Rosenberger, PB, Hildreth, S, Silver, I. The 14- & 6-associated clinical complex: a rejected hypothesis revisited. J Child Neurol. 1987; 2(2): 117–127.Google Scholar
48. Boutros, NN, Hughes, JR, Weiler, M. Psychiatric correlates of rhythmic midtemporal discharges and 6/second spike and wave complexes. Biol Psychiatry. 1986; 21(1): 94–99.Google Scholar
49. Hughes, JR, Gruener, G. Small sharp spikes revisited: further data on this controversial pattern. Clin Electroencephalogr. 1984; 15(4): 208–213.Google Scholar
50. Anderson, RL, Vanderspek, HG. Psychomotor variant status epilepticus. Clin Electroencephogr. 1974; 5: 129–132.Google Scholar
51. Krauss, GL, Abdallah, A, Lesser, R, Thompson, RE, Niedermeyer, E. Clinical and EEG features of patients with EEG wicket rhythms misdiagnosed with epilepsy. Neurology. 2005; 64(11): 1879–1883.Google Scholar
52. Small, JG. Small sharp spikes in a psychiatric population. Arch Gen Psychiatry. 1970; 22: 277–284.Google Scholar
53. Small, JG, Milstein, V, Medlock, CE. Clinical EEG findings in mania. Clin Electroencephalogr. 1997; 28(4): 229–235.Google Scholar
54. Struve, FA, Saraf, KR, Arko, RS, Klein, DF, Becka, DR. Relationship between electroencephalographic dysrhythmia and suicide ideation and attempts in psychiatric patients. In: Shagass C, Gershon S, Friedhoff AJ, eds. Psychopathology and Brain Dysfunction. New York: Raven Press; 1977: 199–221.Google Scholar
55. Boutros, NN. The history of the Electrophysiology and Clinical Neuroscience Society (ECNS), part II: The American Psychiatric Electrophysiology Association (APEA): history and mission. Clin Electroencephalogr. 2000; 31(2): 67–70.Google Scholar
56. Boutros, NN. Philosophical differences in standard EEG interpretation between neurology and psychiatry: a historical perspective. In: Standard EEG: A Research Roadmap for Neuropsychiatry. New York: Springer Science; 2014: 3–15.Google Scholar
57. Bowyer, SM. Coherence a measure of the brain networks: past and present. Neuropsychiatr Electrophysiol. 2016; 2: 1.Google Scholar
58. Noebels, JL. The biology of epilepsy genes. Annu Rev Neurosci. 2003; 26: 599–625.Google Scholar
59. Aarts, JH, Binnie, CD, Smit, AM, Wilkins, AJ. Selective cognitive impairment during focal and generalized epileptiform EEG activity. Brain. 1984; 107(Pt 1): 293–308.Google Scholar
60. Fisch, BJ. Interictal epileptiform EEG activity: diagnostic and behavioral implications. 2002 ACNS presidential address. J Clin Neurophysiol. 2003; 20(3): 155–162.Google Scholar
61. Pogarell, O, Hegerl, U, Boutros, N. Clinical neurophysiology service in psychiatry departments. Psychiatr Serv. 2005; 56(7): 871.Google Scholar
62. Boutros, NN. Diffuse electroencephalogram slowing in psychiatric patients: a preliminary report. J Psychiatry Neurosci. 1996; 21(4): 259–263.Google Scholar