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

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.

EEG biomarkers in depression: paving the way for stratified psychiatry

“…But further research is necessary to understand the mechanisms that may be underlying the differential effects of treatments. In the past, the importance of EEGs in psychiatry was suggested (Boutros, 2018;Inui et al, 1998;Shelley & Trimble, 2009;Yasuhara 2010). However, despite prior findings and those in the current paragraph, the EEG still barely has any clinical applications in psychiatry that are sufficiently science-based.…”

“…As the frequency of IEDs is highly variable and in part modulated by sleep (Askamp & van Putten, 2014;Geut et al, 2017), our short EEG recordings will have limited sensitivity to detect IEDs (Boutros, 2018). However, the most observed abnormalities in this sample, diffuse and focal slow activity, have a relatively high chance of being observed in one recording session as these findings are relatively stationary.…”

“…However, the lack of a biological basis for mental disorders contributed to the expansion of psychoanalytical psychiatry, ultimately ending in the definitive split between neurology and psychiatry in the 20 th century (Baker et al, 2002). As a result, EEGs are rarely investigated or deployed in psychiatry (Boutros, 2018). This, to the dissatisfaction of professionals who regard the division between neurology and psychiatry not a realistic one, and advocate a more integrated approach to diseases and disorders (Boutros, 2018;Reilly, 2015).…”

“…As a result, EEGs are rarely investigated or deployed in psychiatry (Boutros, 2018). This, to the dissatisfaction of professionals who regard the division between neurology and psychiatry not a realistic one, and advocate a more integrated approach to diseases and disorders (Boutros, 2018;Reilly, 2015).…”

“…Abnormal EEG activity is not exclusively associated with disorders such as epilepsy and may occur without obvious clinical signs or symptoms. However, it has been hypothesized that particular EEG abnormalities are associated with multiple mental disorders (Boutros 2018;Inui et al, 1998;Shelley & Trimble, 2009;Yasuhara 2010), opting the possibility that patients with an abnormal EEG may benefit from medication targeting both the mental disorder and the EEG abnormalities. Assessing pre-treatment EEG abnormalities therefore, could both benefit prognosis reliability and treatment outcome and would adhere to the standards set by the NIMH with the Research Domain Criteria framework ([RDoC] Insel et al, 2010, under Arousal (Physiology)).…”