(qEEG, n: quantitative electroencephalography, the computerized analysis of brainwaves )
At Alpine Neurotherapy we provide comprehensive Neurotherapy solutions in-house. We also provide our brain mapping services to other clinics across the U.S.. This process may include EEG acquisition, qEEG brain mapping, and extensive qEEG report generation. Our practice is unique in that our certified qEEG technologist, Joe Castellano, individually inspects every patient's EEG and qEEG for abnormal findings and then provides an in-depth analysis that provides much more insight than a simple qEEG program output alone.
First, you will electronically receive intake questionnaires to provide us with a thorough understanding of your mental health history. This is essential to the process as it allows us to connect the dots between your brain map and symptom presentation. The brain map data is acquired during a 1 hour session where you will sit comfortably in a chair with a cap containing EEG sensors placed on the head. In order to obtain a clear signal, the sites will be cleaned and prepared with electrogel. Each of these 19 sensors will record brain activity at a distinct site on your brain. 2 additional sensors placed on the earlobes, areas of no electrical activity, will be used to provide a baseline. Next, your brain activity will be read for 10 minutes with eyes open, and 10 minutes with eyes closed.
At Alpine Neurotherapy, we utilize state of the art technology to provide an acquisition with incredible sensitivity and reliable data.
In the last several decades, studies using qEEG analysis and traditional assessment have allowed for the identification of specific electrical features observed in different mental health conditions. Network analysis provides novel insights into optimal and dysfunctional brain architecture such as deficits in engagement and access to large scale neuronal networks that play a prominent role in optimal functioning. This data provides a link between the brain and behavior, allowing for a disruptive and necessary shift in how treatment plans are crafted. Following removal of artifacts from the EEG using a program called WINEEG, the cleaned EEG file undergoes analysis not only with advanced software, but most importantly, with Joe’s visual inspection. Complex computation utilizing iSync include fast fourier transforms, power analysis, coherence measurements, independent component analysis, and Low-Resolution electromagnetic tomographic analysis (LORETA). This computation and firsthand inspection of the waveform allows for the identification of phenotypes, vigilance, and finally the formation of brain maps.
Once you have quantified the EEG (qEEG), you have values and pictures that have no information about wave morphology or about how frequently a particular waveform appears in the EEG. Spikes and waves are not evident in this information."
-Thompson and Thompson
Why is Visual Inspection of the Waveform Essential?
A thorough EEG analysis not only includes software computations, but also visual inspection. While these softwares provide advanced analysis of EEGs to produce colorful brain maps detailing connectivity, power, coherence, and statistical comparison, they fail to identify individual abnormalities in waveforms. A brain map is formulated based on averages of the total recording, and because of this, important individual wave features, that may only occur once over a recording period are missed. Concerning wave features that merit a neurological
or sleep lab referral are only identified via visual inspection. If a clinician is not visually inspecting the EEG, crucial information is excluded from the data. The brain map is an excellent tool that provides wonderful insights into functioning, but without visual inspection, it is less reliable.
Another example of missed information is in the case of muscle tension. If not identified during visual inspection, this artifact could be included in the data that is processed into a brain map. This will show up as excessive beta in the map, resulting in inaccurate assessment.
At Alpine, EEG data is thoroughly reviewed visually by our founder, Joe Castellano, who is not only certified in neurofeedback, but also in QEEG analysis.
Strategy for EEG Analysis
Using advanced computation methods, our team is able to create colorful brain map images and analyze metrics including brain connectivity and coherence. The findings from this statistical analysis are validated via visual inspection of the raw EEG. We utilize several platforms outlined below to provide an incredibly in depth analysis.
Fourier transforms allow the frequencies found in the EEG to be quantitatively measured and visualized (A). Coherence measurements provide insight on which parts of your brain are influencing others (B). Adaptive mixture independent component analysis (AMICA) can pinpoint where exactly certain frequency patterns originate and show up in the brain (C). Further frequency analysis can create brain maps that show how brains deviate from a normalized population (D). Low-resolution electromagnetic tomographic analysis (LORETA) gives us a closer look at locations and networks within the brain that deviate from the norm (E).
Following our analysis, you will have an appointment with Joe to review the map and ask any questions you may have. This review will result in an increased understanding of yourself, the root causes of your symptoms, and a comprehensive treatment plan.
At Alpine Neurotherapy we pride ourselves on our in-depth and well-researched reports. All of the analysis from the EEG and qEEG methods outlined above contribute to the creation of beautiful and informational reports including spectral displays, independent component analysis, functional connectivity maps and more, which will be thoroughly reviewed with you. This review is often quite validating as you begin to understand how your brain activity is contributing to your symptoms. We use this analysis and report to develop neurofeedback protocols and treatment recommendations. These reports can also be provided to therapists, doctors, neurologists, or psychiatrists.
What are phenotypes?
Studies of EEG in varying psychiatric populations have resulted in the identification of unhealthy EEG features. The subjective experience of a diagnosis can vary greatly, making the identification of subtypes within a diagnosis through EEG analysis a particularly attractive practice for the identification of root causes and formulation of effective treatment. EEG divergence patterns, or phenotypes, provide reliable indices of brain functioning. Behavioral groupings based on diagnoses do not reliably predict observed EEG phenotypes or treatment response.
Have you ever wondered why you have tried so many different treatments, with little to no success? The brain is a complex organ. Mental health diagnoses, such as depression, vary in their presentation. This is because symptoms of depression, and other diagnoses, have many potential root causes. Since a singular diagnosis presents itself in the brain with great variance, it's not surprising that treatment response also varies greatly. There is an indirect linkage between genetics and behavior, with an intermediate step. This intermediate step, the phenotype, is based on the expression of the genetics and other factors and constitutes the bridging between the person’s genetics and behavior (Gunkelman, 2005). By identifying the root cause of symptoms, we are able to treat the source of your symptoms. EEG phenotypes do not directly correlate with the Diagnostic and Statistic Manual of Mental Disorders (DSM), meaning that the same phenotype may be seen in several diagnoses. Instead, phenotypes cut across DSM categories, and unlike the DSM, phenotypes predict treatment response. Due to the treatment response prediction, phenotype identification was responsible for the doubling of clinical efficacy in the treatment of ADHD, as compared to behaviorally based interventions (Wright & Gunkelman, 1998).
At Alpine Neurotherapy, we base our treatment plan off hard-data acquired from live activity of your individual brain, removing much of the guesswork from neurotherapy.
What is Vigilance Modeling?
The brain transitions from alert wakefulness to deep sleep via several global functional states that are observed in the EEG. These states, or vigilance stages, correspond to differing levels of alertness and behavior. One’s alertness must be adaptive for healthy physiological regulation. An adaptive vigilance allows for harmonious transitions between stages in response to the environment and internal needs. For example, in times of danger a high vigilance allows us to ignite our mind and body into action. In contrast, when trying to relax, a lower vigilance is desirable. With a healthy, adaptable vigilance, the environment informs one’s state, however, the opposite is true as well: the environment one seeks out or creates for themselves is
determined by their internal vigilance. If the brain struggles to maintain a high vigilance, then it is common to seek out an environment that allows for sleep. Vigilance regulatory issues can be defined as rigid, labile, or an unstable mix of the two. Rigid regulation presents as an inability to switch stages while labile vigilance presents as an inability to maintain a vigilance level. An individual's regulation pattern, or lack thereof, impacts behavior as an individual seeks regulation of their state via their environment.
qEEG analysis allows for the determination of one’s ability to regulate their own vigilance, another important measure for determining treatment.
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