REEG (Reference EEG)
Medical treatment of mental disorders differs fundamentally from the treatment of all other health disturbances in one important way – psychiatrists or addiction specialists have no objective physiologic measurements to guide treatment of mental or addictive illness.
Twentieth Century technical advances provided x-rays to the orthopedist, EKGs to the cardiologist and CT scans to the neurologist, but did not lead to any analogous technology for psychiatrists. There is no physiologic brain measurement system available to assist the physician/psychiatrist.
Treatment choice primarily has relied on a diagnostic system that considers behavioral observations by the physician/psychiatrist and descriptions of emotion and behavior by patient or family members as the basis for prescribing medications.
Without the benefit of any physiology-based measurement tools, physicians/psychiatrists simply are making an educated guess at what effective therapy might be. Clinical treatment is neither efficient nor completely effective in most cases. Approximately 70% of patients have either no, or an incomplete, response to medications.
Melbourne MediBrain Centre is the only centre in Australia to collaborate with CNS Response in California, USA and utilize the technology of rEEG (reference EEG) which was developed by this company.
EEG is short for “electroencephalogram” and refers to recording the electrical activity of the brain. EEG is a standard medical diagnostic procedure available in most hospitals and clinics around the world generally used to evaluate epileptic seizures. The EEG is a measure of brain function, or physiology, rather than a measure of brain structure, or anatomy, like the MRI scan.
Referenced-EEG (“rEEG”) is a patented (issued September, 2003) proprietary technology of CNS that utilizes commonly used digital electroencephalography (EEG) in conjunction with a normative database and a proprietary clinical (symptomatic) database to identify abnormal patient physiology. Appropriate medications are then statistically selected specifically to normalize discovered abnormalities. This process has been correlated to treatment outcome in a database of over 1,600 patients and 10,000 medication trials. The results of the analysis for each patient are produced in a two-page report provided to the physician from the CNS reference laboratory.
Treatment directed by rEEG has led to positive outcomes in approximately 80% of the 2000+ patients who have previously failed to respond to traditional treatment efforts as indicated in retrospective and prospective trials as well as in pilot clinical programs.
- Psychiatric Interview
Referenced-EEG (rEEG) and Treatment Resistant Depression
A 25 year old, depressed, married woman with a reported history of unresponsiveness to prior medication treatment and psychotherapy presented to Melbourne MediBrain Centre specifically based upon interest in Referenced-EEG (rEEG).
She reported having more intense depression during her premenstrual period for the last year and was beginning to fantasize about cutting, a self-destructive behavior in which she had engaged as a teen. Previously tried medications included: fluoxetine, for three weeks which led her to feel panicky; sertraline, for three months which she indicated made her feel apathetic; and at presentation, she was on citalopram for approximately a month without any perceptible benefit.
She reportedly suffered from sleep onset insomnia though she could sleep for 12 hours after getting to sleep. She also reported variable appetite, frequent crying, decreased libido, and poor concentration. She was tapered off of citalopram over a period of two weeks and had rEEG testing.
rEEG findings indicated that this patient was most likely to respond to a stimulant and had an intermediate probability of response to an anticonvulsant. In this case, based in part upon the rEEG findings, her prior medication history, and her clinical presentation, she was started on a long-acting methylphenidate preparation initially.
She responded almost immediately and felt increasing energy and concentration, as well as greater mood stability as her dosage was increased over the course of approximately one month. There was still continued troubling depressed mood and the patient chose to start lamotrigine in addition to the stimulant.
Lamotrigine was titrated over the course of 8 weeks to a dose of 200 mg daily. The patient reported a significant improvement in her mood which continued consistently.
At the time of her final appointment, she stated that her treatment had been a “life transforming experience.” Had it not been for the rEEG, this combination of medications might not have been the next choice of medications.
It is my opinion that the application of rEEG in this case reduced the time in obtaining the desired therapeutic response.
- rEEG-STARD Clinical Trial Poster
- Greenblatt Poster
- Journal of Psychiatric Research Article