QEEG Testing Can Discern Reason for Cognitive Disorder: Digital EEG Recordings of Brainwaves Can Determine TBI Etiology

By Gerald Tramontano Ph.D.

QEEG Brain Topography

Brain mapping works by allowing a neuropsychologist to compare diagnostic and nor- mal databases. Are the QEEG parameters, such as frequency, amplitude, coherence, and morphology, consistent with a traumatic brain injury? Or, are they consistent with a preexisting condition like lupus, dementia, attention deficit disorder, or schizophre- nia? We can determine with a high probability—more than 95 percent—whether the disorder is due to one or the other.

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young woman was referred orders such as Alzheimer’s disease, lupus, a to us by her attorney, who head injury, or multiple sclerosis. wanted to prove that his QEEG provides a digital reading from client’s dysexecutive syn- the scalp based on electrical patterns of the drome—a cognitive disorder cortex, which measures cortical electrical markedA by a limited ability to problem activity or brainwaves. It can help deter- solve, retrieve, and organize information, mine whether a cognitive injury is due to which impaired her ability to function both trauma or some preexisting neurological or at work and home—was the result of the psychiatric illness by taking the EEG infor- mild traumatic brain injury (TBI) she suf- mation and transforming every little wave fered in a car accident. and wiggle through a computer program The attorney, a savvy litigator, knew that into binary numbers or metrics. These are opposing counsel would readily accept the then run through databases to see what the findings of earlier neuropsychological test- probability of the overlap is with patients ing that revealed a brain disorder, i.e., cor- suffering from a specific disorder. tical pathology. However, he was convinced Though easy-to-use, non-invasive, afford- that his adversary would challenge whether able, and hardly an obscure test (with plen- or not the auto accident was the cause, con- ty of available literature), QEEG is proba- tending that the woman’s confusion was bly not widely used in forensics for the sim- just as likely to be the result of her ongoing ple reason that it is not found in every brain battle with systemic lupus erythematosus injury clinic or neuropsychology practice. Studies have shown that the very (SLE) as the head trauma she ostensibly In fact, I first came across QEEG quite earliest changes associated with received in the auto accident. accidentally ten or twelve years ago while Alzheimer’s dementia, such as This is exactly where the use of an effec- directing the brain injury program at retention and naming deficits, tive but underemployed test called QEEG, Kessler Rehabilitation Center, a renowned will correlate with a specific or Quantitative EEG (also known as brain brain injury center that did not offer this QEEG profile unique to the brain mapping), becomes critical. While hardly a kind of testing at the time. We needed to pathology due to a dementia of new modality—the observation of electri- explore baseline metrics for an intervention the Alzheimer’s type. This is the cal signals from the brain first occurred in called “neurofeedback” and, through my kind of sensitivity that can help the mid-nineteenth century and the elec- research, learned of the benefits of QEEG. differentiate among neurological troencephalograph (EEG) dates back to the The test is reimbursed by virtually all disorders such as Alzheimer’s 1920s—it was the advent of digital comput- major insurance companies as part of a disease, lupus, a head injury, or ers in the late 1960s and early 1970s that comprehensive central nervous system multiple sclerosis. first gave experts the ability to detect the assessment. Clients can be referred by their subtle and unique patterns in the brain- attorney for a QEEG workup as part of a Furthermore, the science and technical waves associated with different psychiatric neuropsychology evaluation. Note that even aspects of QEEG in measuring the effects and neurological conditions for the purpos- without insurance coverage the cost of the of neurological and psychiatric dysfunc- es of both treatment and diagnosis. testing is quite reasonable, on average $450. tion also match the Supreme Court stan- QEEG is an extremely sensitive measure QEEG is admissible in court by virtue of dards of “technical” and “other special- of the physiological changes of the brain. the Daubert criteria of the scientific ized” knowledge. Finally, it has been According to the American Academy of method, which replaced the Frye standards shown that QEEG scientific knowledge Neurology, it is defined as the “mathemati- of “general acceptance” in establishing the and “technical” and “other specialized” cal processing of digitally recorded EEG in standards for admissibility of evidence in knowledge meet the standards of Supreme order to highlight specific waveform com- federal court in a 1993 Supreme Court Court rulings in support of QEEG’s admis- ponents, transform the EEG into a format decision. Since 1923, the Frye test had held sibility as a clinically valid method in the or domain that elucidates relevant informa- that expert testimony that is based upon a evaluation of the nature and extent of neu- tion, or associate numerical results with the scientific testimony is inadmissible unless rological and psychiatric disorders. EEG data for subsequent review or compar- the technique is “generally accepted in the Brain mapping works by allowing a ison.” Studies have shown that the very ear- scientific community.” neuropsychologist to compare diagnostic liest changes associated with Alzheimer’s The Daubert guidelines for scientific and normal databases. Are the QEEG dementia, such as retention and naming validity are 1) hypothesis testing, 2) esti- parameters, such as frequency, ampli- deficits, will correlate with a specific mates of error rates, 3) peer-reviewed publi- tude, coherence, and morphology, consis- QEEG profile unique to the brain patholo- cation, and 4) general acceptability in the tent with a traumatic brain injury? Or, are gy due to a dementia of the Alzheimer’s scientific community. The peer-reviewed lit- they consistent with a preexisting condi- type. This is the kind of sensitivity that can erature of Quantitative EEG meets all of the help differentiate among neurological dis- Daubert standards of scientific knowledge. (Please see next page)

Connecticut Lawyer March 2006 15

tion like lupus, dementia, attention Attorneys need to be aware that the vic- QEEG testing is critical in any evidentiary deficit disorder, or schizophrenia? We tim of a mild TBI may suffer not only from hearing regarding its admissibility. Plaintiff can determine with a high probability— cognitive disorders, such as dysexecutive or defense attorney should ask that expert more than 95 percent—whether the dis- syndrome or memory loss, but also from witnesses produce documents showing the order is due to one or the other. non-cognitive disorders like “Organic reliability of the QEEG samples. According Personality Syndrome,” (OPS) which, sim- to an April 2003 article in Clinical ply put, means that they don’t regulate their Electroencephalography, “An attorney Neuropsychological emotions or interpersonal world well or should ask any expert witness as to his or Testing: A Prerequisite make appropriate social judgments like her familiarity with the peer-reviewed scien- for QEEG they did before their injury. Depending on tific research in support of QEEG and TBI. the extent of brain damage, OPS can occur The expert must be familiar with the peer- In my opinion, a QEEG is to be used as with or without cognitive dysfunction. The reviewed literature, and preferably, also by part of a comprehensive neuropsychologi- typical OPS patient post-injury usually publishing peer-reviewed papers him/her cal assessment. Neuropsychological testing experiences a loss or decreased sense of self and having first-hand experience.”1 assesses cortical functions largely through smell, impulsivity, low frustration toler- Attorneys can search the National computerized and paper-and-pencil tests of ance, mood swings, and sometimes atten- Library of Medicine Web site2 using the various cognitive functions. Although there tion deficits. keyword “QEEG” to find a printed listing is overlap with traditional neurological and In the case of the young woman men- and determine the expert’s knowledge of psychiatric exams, neuropsychological exam- tioned above, the results of her neuropsycho- these articles. inations are much more sensitive to cortical logical testing were consistent with a proba- pathology, even when there is little if any ble mild TBI from a motor vehicle accident cognitive impairment or memory loss. For manifesting as a moderate to severe dysexec- Summary instance, neuropsychological testing may utive syndrome. However, as previously QEEG and other growing database reveal extensive personality, interpersonal, indicated, she also suffers from SLE. approaches used to assess cortical function- and behavioral changes that are consistent Patients with this condition can present with ing together with neuropsychological test- with an injury to certain brain structures a dysexecutive syndrome even without any ing have come a long way and continue to or systems, such as the orbital frontal past history of acute encephalopathy from evolve in diagnostic sensitivity and speci- structures of the brain. In fact, this is the lupus. The question in her case was whether ficity. Together, QEEG and neuropsycho- part of the brain most responsible for con- the dysexecutive syndrome was due to the logical testing permit us to detect subtle trolling emotion and social functioning, an accident, the preexisting condition, or both. changes in central nervous system (CNS) area where virtually no cognitive networks functioning associated with different psy- exist. Since cognition often remains intact, chiatric and neurological conditions. Not it cannot be diagnosed by traditional cog- The QEEG Test only have these advances helped clinicians nitive tests. In this woman’s case, neuropsychologi- in diagnosing and treating patients, but cal testing had been positive, showing a these cortical assessment tools can also help cognitive disorder. We then administered a attorneys litigate and defend for their QEEG, which takes no more than sixty clients. CL minutes and involves the patient putting on what looks like a bathing cap with elec- Dr. Gerald Tramontano, a clinical neuropsy- VOTED: “BEST ADR MEDIATION” trodes. We recorded the patient’s brain chologist, is the clinical director of the Neu- Connecticut Law Tribune Readers—October 2005 activity with her eyes open and closed and roRehab Institute, with offices in Mt. Arling- Largest Connecticut-based ADR Provider conducted various cognitive-challenging ton, Wayne, and Newark, NJ, as well as a clin- of Arbitration and Mediation Services tasks that provided additional information. ical assistant professor of psychiatry at I The computer compared her abnormal UMDNJ-Robert Wood Medical School and an Over 300 experienced Neutrals activity against databases for different clin- adjunct assistant professor of psychology in skilled in Construction, Contract, ical populations. We determined that the neuropsychology at St. John’s University. He Business/Commercial, Labor, can be contacted at gtramontano@neurore- probability that the abnormality had been Employment, and other matters habinstitute.com. I caused or at least significantly exacerbated Superior service by our highly by a TBI, rather than lupus, to be 99 per- experienced Case Administrators cent. This made for a very compelling piece Notes I of evidence. Located in the CBA Law Center 1. Thatcher, Robert W.; Biver, Carl J.; North, Hospitals and clinics offering QEEG Duane M.; “Quantitative EEG and the Frye 30 Bank Street, New Britain, CT 06051 testing can be found online. Finding and Daubert Standards of Admissibility,” (860) 832-8060, Fax (860) 223-1846 expert witnesses schooled in QEEG will Clinical Electroencephalography, April 2003. www.adrcenter.net be more difficult. 2. The National Library of Medicine Web site Documentation of the reliability of search is available at www.ncbi.nlm.nih.gov/ entrez/query.fcgi.

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