Cns eeg?

[sbcy]

Has anyone had a "CNS EEG"? A new psychiatrist I recently saw had suggested considering getting this, claiming that it can help indicate which medications would be more likely to be efffective. Has anyone had any experience with this? Is it worth it? I've gotten an EEG in the past but it was looking for seizures, not CNS. I can afford it if it might do some good but no point in wasting money/time on something that is useless. Any input is greatly appreciated. Thanks!

[Flory]

I'd say its your choice....though I'm naturally skeptical about things that cost a lot of money and for myself would be more inclined to just trial drugs, you get a better feel for something over a period of a couple months than you would in a lab setting with a new drug/first try type deal but this is totally your shout

[Amtram]

There are no brain scans of any type that can be used to accurately diagnose ADHD. There are no tests of any type that can be used to inform prescriptions.

[James321]

I agree with Florence1989, this will cost you a lot of money...

I have a friend who did this test, I will ask him about it, and I will inform you when I do that...

[Greg1982]

Originally Posted by Amtram

There are no brain scans of any type that can be used to accurately diagnose ADHD. There are no tests of any type that can be used to inform prescriptions.

This is not entirely 100% true. There certainly are scans available to show us what parts of the brain are active/inactive.

There is one major center of the brain that is underactive in people with our condition. It's the part of the brain that makes executive decisions and is why we are impulsive. This is what they will most likely be scanning for.

Watch these two videos:

http://www.youtube.com/watch?v=aXFyU...feature=relmfu

http://www.youtube.com/watch?v=2utqm...feature=g-vrec

[Amtram]

No, Amen's SPECT scans can't be used for diagnosis, either, and the only doctors who say they can are trained by Amen. You can check the National Institute of Mental Health, and they have a complete writeup of what various scans measure, and what they're capable of. They can measure of lot of really interesting stuff, but they do not provide the type of information that qualifies as a diagnostic tool.

[alan1]

As others have noted above, assertions are not proof of anything. To my knowlege, there are no published studies in any professional journals that have shown any use for functional MRI, SPECT scans, eeg's etc. in the diagnosis and treatment of ADHD. While there are some who claim that they can "read" these, no one else seems to be able to reproduce their work which should make you very skeptical - especially if you are going to have to lay out big $$ for the test.

[Greg1982]

I was able to find some data in articles that showed effectiveness of an EEG to help confirm or dispute a diagnosis. As mentioned in the abstract though, there needs to be more research into using such a scan as a diagnostic tool, but if a Psychiatrist is "on-the-fence" regarding a diagnosis it seems possible that an EEG could be used in conjunction with the Psychiatrst interview to help confirm or deny diagnosis.

Increased EEG power density in alpha and theta bands
in adult ADHD patients

S. Koehler

Æ P. Lauer Æ T. Schreppel Æ C. Jacob Æ

M. Heine

Æ A. Boreatti-Hu¨mmer Æ A. J. Fallgatter Æ

M. J. Herrmann

Received: 10 July 2008 / Accepted: 31 October 2008 / Published online: 22 November 2008

Springer-Verlag 2008

Abstract

This study examined EEG abnormalities in

adults with attention deficit hyperactivity disorder (ADHD).

We investigated EEG frequencies in 34 adults with ADHD
and 34 control subjects. Two EEG readings were taken over
5 min intervals during an eyes-closed resting period with 21
electrodes placed in accordance with the international
10–20 system. Fourier transformation was performed to
obtain absolute power density in delta, theta, alpha and beta
frequency bands. The ADHD patients showed a significant
increase of absolute power density in alpha and theta bands.
No differences were found for beta activity. Our findings
indicate that abnormalities in the EEG power spectrum of
adults with ADHD are different than those described in
children. Reliable discriminators between patients and
healthy subjects in adulthood could be alpha and theta
power density. Based on our results, we suggest further
research involving longitudinal studies in ADHD patients to

investigate the changes of EEG abnormalities with age.

I do agree that using functional scans is something that I haven't been able to find a replication of outside of Dr. Amen, and I certainly haven't found any data to suggest that using an EEG could help prescribe an appropriate course of treatment. I posted more here on the subject:http://www.addforums.com/forums/show...74#post1340874

[Amtram]

The fact that nobody outside of Amen and his subsidiary providers have supported this imaging as a diagnostic tool and that nobody (including Amen) has been able to produce any evidence that shows its value as a diagnostic tool should raise a lot of red flags. If nothing else, Amen could have provided some research for peer review and publication, but instead he relies on his own anecdotes of success. If the person who promotes it doesn't even perform research to support his claims, what does it say about the reliability of his claims?

[Dizfriz]

I will repeat here what I just posted in another thread on the subject.

Not a big point but the EGG is not a brain scan. It is a method that records brain electrical activity.

From http://en.wikipedia.org/wiki/Electroencephalography

Electroencephalography (EEG) is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain

Some of these, especially the QEEG, show some real promise as I understand it but are not yet validated for primary diagnostic purposes. Hopefully they may prove out in the future.

Dizfriz

[Plognark]

Not enough data or proper studies to use this as a diagnostic tool yet.

Sort of like a polygraph tests for lie detecting; it can point in a general direction, but there's a reason they don't allow lie detector results in court.

The dysfunction of the cortex and shunting activity to the amygdala fits a lot of high level theories of how ADHD works, but the data isn't there yet. And it's certainly not at the point where it can inform which medication will be most effective. We can't even accurately correlate specific genes with medications yet.

Not saying this technology won't be useful in the future, it just needs a lot more research.

[sbcy]

Lol, no offense but it's hard not to question Dr. Amen's validity...I mean look at how much stuff he pushes so hard to sell on his site?

[Greg1982]

Originally Posted by Amtram

The fact that nobody outside of Amen and his subsidiary providers have supported this imaging as a diagnostic tool and that nobody (including Amen) has been able to produce any evidence that shows its value as a diagnostic tool should raise a lot of red flags. If nothing else, Amen could have provided some research for peer review and publication, but instead he relies on his own anecdotes of success. If the person who promotes it doesn't even perform research to support his claims, what does it say about the reliability of his claims?

There are more people doing research into using scans/tests than just Dr. Amen. This one specifically mentions using EEG's and a consistency index, and was not done by him.

A Psychophysiological Marker of Attention
Deficit/Hyperactivity Disorder (ADHD)—Defining the
EEG Consistency Index

Boris Kovatchev,

1;5 Daniel Cox,1 Rebecca Hill,2 Ronald Reeve,2 Raina Robeva,3

and Tim Loboschefski4

This study continues our research to further validate the idea that ADHD (Attention Deficit/Hyperactivity Disorder) interferes with transition from one task to another and
this interference can be quantified by a Consistency Index (CI) derived from a specific

mathematical representation of EEG data. We reanalyze 32 previously reported data sets

present new data for 35 boys and girls, ages 7–12, ADHD or control. Each data set contains

EEG, recorded and digitized while participants perform consecutive 10-min tasks:

video, reading, and math. For boys, the CI in ADHD was four times lower than in controls,

p < .005, for girls this difference was two times, p < .05. ADHD/control classification based on the CI coincided with the DSM-IV criteria for 88% of the boys and for 67% of the girls. Post hoc analysis indicated that the classification utility of the CI diminished with age. A CI below 40% could be a discriminating, reliable, and reproducible marker of ADHD in

young boys.

He also has submitted information for peer review and publication on both SPECT imaging research and stimulant medication research. There may be more but this was just a quick search.

Preliminary Evidence Differentiating ADHD Using Brain SPECT Imaging in Older Patients[dagger]

Amen, Daniel G, MD; Hanks, Chris; Prunella, Jill. Journal of Psychoactive Drugs40. 2 (Jun 2008): 139-46.

Abstract (summary)

The objective of this study was to differentiate ADHD patients from a healthy comparison group using high resolution brain SPECT imaging in older patients. Using extensive chart reviews of structured interviews, DSM-IV criteria, and psychiatrist-given diagnoses, we identified 27 patients over age 50 with ADHD, either combined or inattentive types. Patients were compared to an age-matched group of healthy subjects with brain SPECT imaging at rest and during concentration using semiquantitative visual readings. Significantly lower cortical activity is noted in the ADHD group, particularly in the prefrontal poles, orbits, and parietal lobes. Older ADHD patients can be discerned from healthy subjects using brain SPECT. The results support the executive dysfunction model of ADHD.

Predicting Positive and Negative Treatment Responses to Stimulants with Brain SPECT Imaging

Amen, Daniel G, MD; Hanks, Chris; Prunella, Jill. Journal of Psychoactive Drugs40. 2 (Jun 2008): 131-8.

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Abstract (summary)

The goal of this study was to test whether clinician-rated regional cerebral blood flow (rCBF) as rendered by SPECT imaging is a meaningful predictor of patient response to CNS stimulants. Chart reviews were used to identify patients who reported prior significant positive and negative responses to CNS stimulants. Each patient in the study had received resting and concentration SPECT scans using Tc99m exametazime. Differences in cerebral blood flow for frontal regions of interest were assessed in three conditions (resting, concentration, and their difference, or "delta") using ANCOVAs and age-matched ANOVAs. Prefrontal pole deltas were found to be highly sensitive and specific predictors of response to CNS stimulants, with pole activation predicting adverse responses and pole deactivation predicting good responses. Positive and negative predictive values were greater than .75 for both poles. We conclude that SPECT renderings of rCBF, particularly in the prefrontal cortex, are a potentially powerful clinical tool for anticipating response to stimulant medications, both positive and adverse. [PUBLICATION ABSTRACT]

__________________________________________________ _______

Originally Posted by Plognark

Not enough data or proper studies to use this as a diagnostic tool yet.

Originally Posted by Plognark

Sort of like a polygraph tests for lie detecting; it can point in a general direction, but there's a reason they don't allow lie detector results in court.

The dysfunction of the cortex and shunting activity to the amygdala fits a lot of high level theories of how ADHD works, but the data isn't there yet. And it's certainly not at the point where it can inform which medication will be most effective. We can't even accurately correlate specific genes with medications yet.

Not saying this technology won't be useful in the future, it just needs a lot more research.

I 100% agree. I haven't found any evidence to suggest otherwise and I hope they continue their research. I'm not suggesting any tests/scans can be the only method for diagnosis. The data above was only intended to help explain why a Psychiatrist may want to see an EEG. There is good data to "suggest" that this test could help to affirm a diagnosis that the Psychiatrist may not be entirely sure of.

Originally Posted by sbcy

Lol, no offense but it's hard not to question Dr. Amen's validity...I mean look at how much stuff he pushes so hard to sell on his site?

This is true and you should always be somewhat skeptical of anything you read, watch, hear, etc. I always read any study, article, etc myself with cinicism. That said, a person can be a good salesman and also a good doctor as well. I don't know Dr. Amen to say whether he's both or not, but plastic surgeons are great at sales and so are many others while being good doctors.

We sell supplements to our patients ater weight loss surgery. It can easily be confused as a "cash cow" money racket because after surgery some patients absolutely have to take supplements sometimes for the rest of their lives. I'm not saying people don't take advantage of an opportunity to double dip like this, but for us our motivations are:

• We can sell them cheaper than retail to save the patients some cost
• We know the supplements will do what they are intended to do nutritionally and medically

I agree that it should raise red flags, but hopefully it doesn't lead to closedmindedness. That sentence wasn't directed to anyone personally. Just a general statement as devil's advocate.

[ADHDGenius]

Originally Posted by Amtram

No, Amen's SPECT scans can't be used for diagnosis, either, and the only doctors who say they can are trained by Amen. You can check the National Institute of Mental Health, and they have a complete writeup of what various scans measure, and what they're capable of. They can measure of lot of really interesting stuff, but they do not provide the type of information that qualifies as a diagnostic tool.

There are many other doctors in California who aren't trained by Dr. Amen, but are using SPECT scans in their practice.