Referenced EEG (rEEG) Question

[MaddieMay]

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Has anyone had any contact or experience with this test?

In short, this company called CNS Response claims that they can predict what meds a disordered person should take by comparing the patient's EEG to a database of other disordered people's EEGs. The db has 1600 EEGs.

Here's more info but no actual data and their stuff has only been published in "Clinical Psychiatry News" and other silly publications...

cnsresponse.com

It sounds like an interesting idea but they claim to have been doing this for 20 years, yet they have no studies published in reputable, peer-reviewed journals.

Anyone know anything about the rEEG?

Thank you!

 

[slope]

I have never heard of referenced EEGs and I did pass a national exam in EEG. All I can think of is referential montage, which deals with the way the electrodes are being referenced to, usually, the mastoids. There are many ways various drugs can influence the EEG of a person while awake or asleep, but to go to such length as to state that by looking at someone's EEG, you could determine what Rx the person is on or should take, reflects poor understanding of the EEG.

 

[MaddieMay]

the other difficult thing about it is you have to be completely off all your meds before you have the EEG done. The period of time you have to be off meds differs depending on what you're on; for prozac you have to be off for 37 days, for Geodon you have to be off for 34 hours, for Vicodin, you have to be off for 12 hours.

So basically you have to suffer the effects of your disorder for a period of time so they can get an accurate EEG on you, which would obviously result in decreased functioning, especially for people whose disorders are severe. Panic Disorder, ADHD, and chronic pain leap to mind as being especially uncomfortable as you might suffer some withdrawl along with the return of your symptoms.

 

[erg923]

This group is well known on quackwatch.com. Right up there with Dr. Amen.

 

[shrinkdoc]

This test has been in development for almost 20 years by rigorous scientists. There have been several pilot studies and poster sessions as well as a few peer-reviewed journal articles. Currently a national study on treatment resistant depression patients is going on at Harvard, Cornell, Stanford, UCI, and 8-10 other academic and commercial sites. The scientific advisory board is made of the the top leaders in psychiatry. The company has deliberately kept a low profile in order to get the academic support and practitioner support needed for a successful launch. I have done over 700 rEEG's and can say that it would be hard to practice neuropsychiatry "blinded" now that I have found that many brains do not respond to the phenotypic presentation. All the combined meta-review of the studies show an impressive ~70% success rate on the most difficult to treat population. At APA a presentation was made on extremely ill Eating Disorder patients with a 2 year pre and 2 year post follow up in which changes were nothing less than remarkable from such non-intuitive recommendations like Stimulants for anorexics. QuackWatch has one reference to this on a list of things to watch from 2006 - I wouldn't call this "well-known" to them. There are other groups doing similar types of QEEG work like the BRITE study which looked at medication prediction within a few days of taking a SSRI. I believe this is something to be taken seriously and flip comments without knowing the facts does not help advance truth.

 

[MaddieMay]

I didn't mean to be flip, but I don't know where else to find information about the procedure than the company that does the comparing, CNS Response. I don't know if you looked at their website but it's terrible and I can't find the studies you mentioned. Do you know what journals they were published in? Why would cnsresponse.com not have these studies in big flashing lights on their homepage? All I can find, as I said, is an article in Clinical Psychiatric News and an article in Newsweek.

The streaming videos they have with experts talking about it all get cut off long before the end of the topic. The 70-85% success rate they talk about constantly, according to the website, is the percent of people who changed their meds after getting the EEG, not the percent who experience a lessening of their symptoms. And they certainly don't talk about long term lessening of symptoms.

Can you give me some references, you sound like an expert yourself.

 

[shrinkdoc]

Shoot - I just wrote a long response to you and my connection got lost and so did the response. I'll recap...
I am sorry for the misunderstanding but I wasn't referring to you as the one being flip. Your questions are very appropriate.

The company's priority is not the website which is just beginning to be developed. There is a url that gets to the research, but I don't know what it is. I'm not sure how you got the idea that the % was people who changed their meds. It fact, it is the % of patients who improved to a CGI-I score of 1 or 2. The initial follow up was for 2 years with the average for the dataset of over 400 days.

Here is a starter list of references (BTW Suffin is currently the Chief Clinical Pathologist for Quest Labs for America and is both a renowned pathologist and in the middle of his career took a residency in psychiatry to develop this database):
1. Suffin SC, Emory WH. Neurometric subgroups in attentional and affective disorders and
their association with pharmacotherapeutic outcome. Clin EEG & Neuro.1995;26:76-83.
2. Prichep LS, Mas F, Hollander E, et al. Quantitative electroencephalographic subtyping of
obsessive compulsive disorder. Psychiat Res: Neuroimaging.1993;Apr;50(1):25-32.
3. Ohashi Y. The baseline EEG traits and the induced EEG changes by antidepressant
medication in patients with major depression. Seishin Shinkeigaku Zasshi.1994;96(6):444-460.
4. Schiller MJ, Emory WH, Suffin SC. rEEG in the treatment of eating disorders. Presented
at NIMH’s 44th NCDEU Conference, 2004.
5. Greenblatt J, Sussman C, Jameson M, Kasumova G. Referenced-EEG guided medication
predictions in treatment-refractory eating disorder patients. Presented at APA, 2008.
6. Suffin SC, Emory WH, Gutierrez G, et al. A QEEG database method for predicting
pharmacotherapeutic outcome in refractory major depressive disorders. J of Am
Physicians and Surgeons.2007;12(4):104-108.
7. Schiller MJ, Emory WH, Shaffer J, et al. EEG guidance of psychopharmacologic treatment:
multi-site experience. Presented at APA ,2005.
8. Shaffer JH, Milner JE, Schiller MJ. rEEG guided pharmacotherapy for severely ill dually-
diagnosed patients. Presented at APA, 2005.
9. Schiller MJ. Referenced-EEG guided pharmacotherapy of dually-diagnosed patients.
Presented at College on Problems in Drug Dependence annual meeting, 2008.

In addition you should check on Andrew Leuchter and Ian Cook's work on Cordance (out of UCLA), which is the basis for the BRITE study. They, along with other Harvard authors like Maurizio Fava who was lead author of the STAR*D study and several of is other colleagues are deeply involved with a similar product. Brain Resources out of Australia is internationally known. REEG is getting international attention and is right in the path of the FDA's interest in Personalized Medicine and Biomarkers. This all is part of the new wave of the next movement in Psychiatry and will change the face of how it is practiced.

 

[MaddieMay]

Thanks, shrinkdoc!

I'd like to get ahold of transcripts of the presentations to the AMA. How does one go about getting them?

Similarly, how might I learn about Andrew Leuchter and Ian Cook's work on Cordance?

And last, what is your theory as to why hardly anyone else has commented on this topic if it is the future of psychiatry?

Are you working in or specializing in rEEGs? How did you come about your knowledge of rEEGs? There's not much solid research via google, so I'm curious how you came to know so much about it.

 

[shrinkdoc]

There was no presentation at the AMA. There were several at the American Psychiatric Association. You'd have to go to their site to see if they publish the abstracts for Poster Sessions - but there is no such thing as a transcript. Abstracts are published, but I don't know if they would have them available online or not. The other authors you can Google or use Google Scholar, just as you'd research any publication.

This has not been rolled out, as I mentioned before, since the company wants to get the academic publications and support behind them first. They still need to work on production so they can handle the load. A few hundred psychiatrists have been exposed to this at some point and many are fairly regular users. People in the world of Quantitative EEG are the ones who know more about this - general psychiatrist not exposed to this literature have probably not heard of it yet. Remember, this is the beginning of a new technology poking its head out of Research and Development. Approximately 7500 patients have had a rEEG since inception.

I have been part of the clinical EEG field and societies since the early '80's and was present when this was first presented in 1995 at the Clinical EEG society meeting. Pioneering work becomes an overnight success after about 20 years, sort of like Hollywood stars or any rollout as per the book "The Tipping Point". rEEG is at the tipping point now.