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Quantitative Electroencephalography
(QEEG)
Article QUICK LINKS :
What is a Quantitative Electroencephalograph? /
What are the advantages of QEEG in comparison to routine EEG's? /
Some Examples of Functional Imaging of the Brain Include /
For whom would a QEEG be appropriate /
What is the client's experience? /
Clinical Topographic EEG Methodology /
What information is received from the QEEG? /
The History of QEEG testing and neurofeedback /
If QEEG and Neurotherapy are so good, why aren't more clinicians using it? /
Further Reading Suggestions / Links / References

WHAT IS A QUANTITATIVE ELECTROENCEPHALOGRAPH?

Quantitative Electroencephalography (QEEG) is the measurement, using digital
technology, of electrical patterns at the surface of the scalp which primarily
reflect cortical activity or "brainwaves". A multi-electrode recording of brain
wave activity is recorded and converted into numbers by a computer. These
numbers are then statistically analysed and are converted into a colour map of
brain functioning.

Digital EEG techniques have grown rapidly in both technology and popularity
since the early 1980's for recording, reviewing, and storing EEG data.

WHAT ARE THE ADVANTAGES OF QEEG IN COMPARISON TO

ROUTINE EEG'S?
Quantitative EEG (QEEG) analysis techniques can provide additional
measurements and displays of EEG in many different ways that are not possible
with analogue paper EEG recordings.

Several QEEG techniques, commonly called "EEG brain mapping", include

topographic displays of voltage or frequency, coherence, asymmetries and
statistical comparisons to normative values ("Z" scores), as well as discriminant
analysis of:

• Learning Disabilities

• Attention Deficits

• Brain Injury
Montage, filter, and gain settings can be changed retrospectively during record
review.

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Digital EEG recordings are extremely flexible in the way they display the EEG
tracings, unlike analogue paper EEG.

Sample from Neuroguide System

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 SOME EXAMPLES OF FUNCTIONAL IMAGING OF THE BRAIN INCLUDE

A CT Scan An fMR image An MR image SPECT

PET PET/MRI MEG QEEG

(Multi-Modal) (Superimposed on
MRI)

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Compared to other systems, QEEG is a non-invasive procedure and offers a
superior temporal (time) resolution compared with fMRI, SPECT and PET imaging
techniques.

MEG systems, though providing a high temporal and spatial resolution, are a
relatively expensive means of monitoring the brain compared with QEEG
arrangements.

Furthermore, EEG apparatus is less cumbersome than other imaging equipment

(MEG, fMRI, SPECT and PET devices typically monopolise an entire room)

In terms of brain imaging techniques, QEEG looks at metabolism and function,

whereas MRI’s and CT scans reflect structure. Multiple-electrode recordings
(19 sites) following the International 10/20 System of EEG electrode placement
are converted to numbers using digital technology and these numbers are
statistically analysed against normative data bases allowing subject to data base
comparisons in order to show the location and extent of brain dysfunction, in
specific frequency bands and under particular task conditions.
(e.g. during math’s, reading etc.).

Focal or generalised cerebral dysfunction is presented as coloured brain maps or

graphs making QEEG an effective tool for differentiating between organic and
functional brain disorders. Signature patterns discriminate between different
disorders (unipolar vs. bipolar depression). Symptoms directly correlate to brain
wave activity, providing a tangible & effective method of predicting and
monitoring the response to medication without the need for extended trials or
guesswork.

"New three-dimensional QEEG imaging methods offer an economical

alternative to other functional brain imaging modalities…..

During the last decade more than 500 EEG and QEEG papers have
reported well designed studies, concurring that EEG and QEEG
abnormalities are found in a high proportion of psychiatric patients".

Source : Hughes, JR & Roy John, E (1999): Conventional and Quantitative

Electroencephalography in Psychiatry. Journal of Neuropsychiatry and Clinical
Neurosciences 11:190-208. May. American Psychiatric Press Inc.

The amount of data generated by multi-electrode recording is so enormous that

it is difficult for clinicians to interpret all the data. QEEG's address this data
analysis and summarisation of data in the form of coloured topographic maps of
the brain, spectral analysis and graphs. Other advantages are:

DATA BASE COMPARISONS

A patient's / client's performance can be statistically compared to that of a large
population data base. Such comparisons allow the clinician to determine whether
or not brain functioning is abnormal, to what degree, in what locations and in
which frequency bands.

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PHARMACOLOGICAL ACTIVATION TEST DOSE
The QEEG provides a simple, tangible way to determine whether or not a
client/patient will benefit from a psychotropic medication without the need for an
extended trial. Recent research demonstrates that medication responsivity can
be improved and side effects minimised through the use of QEEG techniques
aimed at guiding the physician in choice of prescription.

DISCRIMINATING FUNCTIONAL AND ORGANIC DISORDERS

QEEG's can also serve as an effective tool for differentiating between organic
and functional brain disorders. This functional data provides an excellent
supplement to data obtained from CT scans and MRI's.

For instance, QEEG is a useful tool for differentiating between physiological and
functional causes of depression and hyperactivity. It has also been helpful in the
identification of schizophrenia and dementias.

This procedure can also be employed to identify cases of cerebral atrophy

associated with alcoholism or drug abuse as well as determining whether a child
is presenting with neurologically based attention deficit disorder or one of
psychogenic origin.

In a legal sense, the QEEG has been used (In the United States) as a tool to
determine whether a person is malingering or not.

Statistical data base comparisons and specialised software allow discriminant

function in such things as brain injury and learning disabilities.

SIMPLICITY OF THE PROCEDURE

The procedure has the advantage of being non-invasive safe and dynamic
(temporal); quick - usually requiring no more than an hour of
preparation/administration and reliable (1 minute of clean data is 94% reliable,
2 minutes is 96% reliable).

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COLOURED DYNAMIC BRAIN MAP

Sample from Skil Topometric System

The coloured dynamic brain map generated by a computer makes it easy for
clients / patients to visualise the problems that are being explained. Thus it
facilitates communication and improves the client's (and family's) understanding
of their conditions.

NEUROFEEDBACK
The sister technology to QEEG is EEG biofeedback (also known as neurofeedback
or neurotherapy).

Neurotherapy is EEG biofeedback based on operant conditioning of EEG

characteristics.

The QEEG provides the "targeting" information by telling us where and under
what conditions (reading, listening, maths etc.) the problem is worse.
This analysis allows accurate electrode placement for feedback and suggests
tasks that should be used during training. The EEG feedback (both visual and
auditory cues) signals the client when their brain is in fact in a more activated
state, indexed by decreased delta (0.5-3Hz) and theta (4-7Hz) brain wave
amplitudes and increased alpha (8-12Hz) and beta (12-18Hz) amplitudes.

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Functional neuro imaging studies carried out on individuals with ADHD have
shown abnormal functioning of the anterior cingulate cortex (ACC) during tasks
of selective attention. QEEG findings of abnormal brainwave activity in the
anterior cingualte cortex of children with ADHD are now being confirmed with
neuroimaging studies. In a recent fMRI study (2006) the effect of neurofeedback
training on the neural substrates of selective attention in children with ADHD
was investigated. Fifteen un-medicated ADHD children who had no other
comorbidities (co-existing conditions) were randomly assigned to the
neurofeedback training group (experimental group) and the other five children
were assigned to the control group (no neurofeedback training). The children
were scanned (fMRI) while they performed the Counting Stroop test. Prior to
neurofeedback training activation was evident in the left superior parietal lobule
in all the children. After neurofeedback training, only those in the experimental
group showed significant activation of the right anterior cingulate cortex, the key
neural substrate of selective attention. (Johanne Levesquea et al, Neuroscience
Letters, Vol 394, Issue 3, 20 February 2006, p 216-221)

Further reading suggestion:

• QEEG and Neurofeedback - diagnostic and training modalities for the
enhancement of CNS functioning in ADHD and other disorders
A brief but informative and up to date article citing case studies and statistics.

FOR WHOM WOULD A QEEG BE APPROPRIATE?

• QEEG's are initially performed to determine the presence of focal or
generalised cerebral dysfunction and as a baseline guide for neurofeedback.

• Following closed head injury, stroke, heart attack, pulmonary dysfunction

after hypoxia

• Where seizure disorders or tumours are suspected

• In suspected cases of ADHD, drug abuse, Learning Disabilities

• When pathological alterations in vigilance (narcolepsy, confusion, coma) or

acute nervous system processes (acute headache, vomiting, aphasia) have
been observed

• To investigate cerebrovascular disorders

QEEG'S CAN ALSO BE USED

• As follow-up to monitor organic brain syndromes, alcohol withdrawal,
chemotherapy / radiation treatment, withdrawal from psychotropic
medication or illicit drugs;

• To follow-up on infectious diseases such as encephalitis or meningitis

• To follow-up on post-operative status

• To monitor / follow up EEG biofeedback (neurofeedback)

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WHAT IS THE CLIENT'S EXPERIENCE?
An ECI electrocap is placed on the head to facilitate ease of administration and
consistency because it provides predetermined electrode placements. Then gel is
inserted in each electrode to make a good connection. There is no pain or
discomfort with this procedure. EEG recordings are then taken under four
conditions: eyes closed, eyes open, a visual spatial task and a maths test.

CLINICAL TOPOGRAPHIC EEG METHODOLOGY

A fitted electrode cap with leads placed according to the International 10/20
System is applied to achieve a standardized 19 channel EEG recording.
A referential montage is then obtained with linked earlobes.

Electrode impedance of less then 3 Kohms is required at all sites prior to the
initiation of recording. EEG signals are fed directly to a quantitative topographic
analysis system where they are digitized at a rate at or above 256 samples per
second. The data is band-pass filtered between 1 and 30 Hz and stored on a
hard disk for subsequent analysis.

The client is seated in a comfortable reclining chair placed approximately

3.5 meters in front of a video monitor screen and the legs rested on a small
ottoman in front of the seat.

A series of standardised tests, each lasting from 3-20 minutes depending upon
what the EEG is being conducted for, is administered. These tests may include:
1 Eyes closed;
2 Eyes open;
3 Reading for comprehension and
4 A mathematics test of graded difficulty.

Digitised data is subjected to a custom automatic artefact detection program

that identifies and deletes eye-blink and movement artefact. This is
supplemented by a visual review of the record by the clinician/EEG Technician
for removal of residual undetected eye and head movement artefact, as well as
muscle activity of potential consequence to the analysis. A manual cursor is used
to selectively identify and delete only those brief segments affected. Atypical
transients in the EEG signal are noted for subsequent analysis during this
procedure.

Corrected EEG data is then analysed for frequency content using the
Fast Fourier Transform.

Evaluation of these data employs various descriptive and statistical displays with
a variety of frequency band formats. These can include data tables, spectral
maps, individual frequency band topometric analysis (providing both within and
between state evaluation), topographic maps, coherence, asymmetry and
covariance analysis.

9 / 15
Statistical analysis compares subject data with a child to adult normative
database and may be corrected for significant time-of-day variations and state
transitions. Data is also evaluated for percentage change across states and
compared with a normative database for state modulation. Finally, topographic
maps showing covariance between all sites at relevant frequencies are compared
with a normative database to evaluate the status of functional cortical
interactions. A written report follows ten days to a fortnight later.

WHAT INFORMATION IS RECEIVED FROM THE QEEG?

The SKILTM Topometric QEEG provides information on brain functioning and its
impact on cognition and learning. Computerised EEG results are compared to
age-related norms of the QEEG database providing information about whether
the client has a deviation in qEEG functioning which varies significantly from the
norm. It indicates what locations, the amplitude and frequency of waves of
interest, and under what conditions the abnormality manifests itself. Advanced
artefact removal, time of day correction, multiple data and statistical displays,
and state comparison analysis differentiate the SKILTM from other QEEG
systems. The information is visually summarised in five graphical displays:
topographic maps, spectral plots, topometric distributions, covariation maps and
tables.

A hyperlink to the SKILTM Topometric website is provided at the end of this

article in the links section for more information on the capabilities of this
software package.

The NeuroguideTM software offers the clinician multi-functional qEEG analysis

including coherence, phase and asymmetries; and 3 dimensional source
localisation; a birth - 82 years of age normative data base with Traumatic Brain
Injury Discriminant, Learning Disability Discriminant and a Predictive
Neuropsychological Scores value based upon the EEG.

A hyperlink to the Applied Neuroscience website is provided at the end of this

article in the links section for more information on the capabilities of this
software package.

QEEG as a neurophysiological investigation does not substitute for

neuropsychological evaluation, however as an adjunctive investigation, QEEG
can be quite revealing and of course is necessary if one is to utilise
neurophysiological intervention to its best advantage.

THE HISTORY OF QEEG TESTING AND NEUROFEEDBACK

Quantitative analysis of the human EEG was achieved as early as the 1930's
(Berger, 1931). The 1970's and 80's were decades of exploration and
experimentation with QEEG. The American Medical EEG Association (AMEEGA)
Adhoc Committee on QEEG has stated "QEEG is of clinical value now and
developments suggest it will be of even greater use in the future". The use of
the QEEG in assisting the diagnosis of mild traumatic brain injury, ADHD,
learning disabilities, stroke, and epilepsy is well documented.

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Neurotherapy (a method of neurophysiological intervention) is based on the
work of Professor M. Barry Sterman of the UCLA School of Medicine,
Departments of Neurobiology and Behavioural Psychiatry.

Professor Sterman recognised how brain function can be altered and normalised
by operant conditioning of the EEG. QEEG and neurotherapy has been endorsed
by the American Psychological Association as within the venue of psychologists
with appropriate training. Neurotherapy training to decrease slow wave activity
and increase fast desynchronised EEG activity has been used for over 20 years
to ameliorate ADHD and epilepsy and is well documented in the scientific
literature. More recently EEG operant conditioning has been successfully applied
to patients with mild traumatic brain injury.

IF QEEG AND NEUROTHERAPY ARE SO GOOD, WHY AREN'T

MORE CLINICIANS USING IT?
As a specialist field, most psychologists and physicians simply have not been
educated in the clinical applications of EEG biofeedback and are unaware of the
existing research and clinical literature, in spite of the fact that the applications
to anxiety, epilepsy and attentional deficits date back to the 1970's.

Furthermore, the instrumentation is expensive and requires serious study and

training to use competently.

An estimated 700 clinicians are using neurotherapy and QEEG in the U.S.A.
Although relatively new to Australia, a growing number of psychologists and
psychiatrists are now beginning to use these tools each year to assist in client
evaluation and thus in choosing appropriate treatment modalities.

QEEGs allow neurofeedback therapists to address the physiological basis of

psychological, psychiatric, and neurological problems without medication. It and
can also be used in conjunction with medication.

"An overview of the findings reveals numerous consistent and

concordant conventional EEG and QEEG findings among studies within
the same DSM (III & IV) diagnoses"

Source : Hughes, JR & Roy John, E (1999): Conventional and Quantitative

Electroencephalography in Psychiatry. Journal of Neuropsychiatry and Clinical
Neurosciences 11:190-208. May. American Psychiatric Press Inc.

For more information or to make an appointment please contact

us on (02) 9637 9998 during business hours.

11 / 15
FURTHER READING SUGGESTIONS
• Learning Disabilities

• Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder

(ADHD)

• Post Concussive Syndrome / Head Injury

• Neurofeedback - EEG Biofeedback - a Drug-Free Strategy for ADHD, Learning

Disorders and Other Conditions

• QEEG and Neurofeedback - diagnostic and training modalities for the

enhancement of CNS functioning in ADHD and other disorders

LINKS

PLEASE NOTE :
Learning Discoveries offers the links below as a convenience to our clients and
the users of this website. However, we do not control third party websites and
we are not responsible for the websites content.

• Deymed Diagnostic
www.deymed.com/
Offers state of the art acquisition hardware; EEG acquisition / analysis and
neurofeedback software

• The International Society for Neurofeedback and Research

www.isnr.org/
An international society for promotion and professionalism in QEEG and
Neurofeedback

• MindSet
by Wayne Nolan
www.altered-states.net
Wayne Nolan's 16 and 24 channel MindSet EEG Acquisition Hardware and
MindMeld EEG / QEEG acquisition and analysis software

• Applied Neuroscience, Inc

Neuroguide EEG and QEEG Software
by Dr. Robert Thatcher
www.appliedneuroscience.com
Many informative articles and links on QEEG

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• Nova Tech EEG
by Leslie Sherlin
www.novatecheeg.com/
Offers QEEG analysis freeware software as well as professional "add-ons"

• SkilTM Topometric EEG Analysis and Training

by Dr. David Kaiser and Prof. Barry Sterman
www.skiltopo.com/
Many informative articles and links on QEEG

REFERENCES
1. Abarbanel, A (1995): Gates, states, rhythms and resonances: The scientific
basis of neurofeedback training. Journal of Neurotherapy, 1, 15-38.

2. Andreassi, J.L (1985): Psychophysiology: Human behaviour and physiological

response. 3rd edition. LaurenceErlbaum Associates. Hillsdale New Jersey.

3. Cantor, D.S (1999): An overview of quantitative EEG and its applications to

neurofeedback.

4. Chabot, R J et al (1999): behavioral and electrophysiologic predictors of

treatment response to stimulants in children with attention deficit disorders.
Journal of child Neurology Vol 14 (6) 343-351.

5. Chabot, R.J, et al (1996): Sensitivity and specificity of QEEG in children with

attention deficit or specific developmental learning disorders. Clinical
Electroencephalography. Jan Vol 27 (1) 26-34.

6. Chabot, RJ & Serfontain (1996): Quantitative electroencephalographic

profiles of children with attention deficit disorder. Biological Psychiatry Nov 15
(10): 951-963.

7. Clarke, A.R., et al. (1998). EEG Analysis in Attention-Deficit/Hyperactivity

Disorder: a comparative study of two subtypes. Psychiatry Research. Oct
19(1): p. 19-29.

8. Crawford, H.J. & Barabasz, M (1996): Quantitative EEG magnitudes in

children with and without attention deficit disorder during neurological
screening and cognitive tasks. Child Study Journal. Vol 26 (1) 71-86.

9. Diro, F.M, MD (1989): The EEG Handbook ,. Little, Brown & Co. Boston,
Massachusetts.

10.Duffy, F (2000) Neurotherapy: Editorial Comments. Clinical

Electroencephalography. January Vol 31 (1) v-viii

11.Evans, J.R & Abarbanel, A (1999): Introduction to Quantitative EEG and

Neurofeedback. Academic Press, Harcourt Place, London.

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12.Gunkelman J & Hammond C (2001): The Art of Artifacting. Society for
Neuronal Regulation, California, USA Heinemann. Newton, Massachusetts.

13.Hughes, J (1994): EEG in Clinical Practice (2nd edition). Butterworth

14.Hughes, J.R & John, E.R (1999): Conventional and Quantitative

Electroencephalography in Psychiatry. Journal of Neuropsychiatry and Clinical
Neurosciences Vol 11(2): 190-208. May. American Psychiatric Press Inc.

15.Kuperman, S, et al (1996) Quantitative EEG differences in a nonclinical

sample of children with ADHD and undifferentiated ADD. Journal of the
American Academy of Child and Adolescent Psychiatry, p- Adolescent
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16.Loo, S & Camp, B (1997): QEEG differences amongst ADHD children with and
without Oppositional Behaviours in Annual meeting of the Association for
Applied Psychophysiology and Biofeedback.

17.Lubar, J F (1991): Discourse on the development of EEG diagnostics and

biofeedback for attention deficit/hyperactivity disorders. Biofeedback and Self
Regulation. Vol 16 (3) 201-225.

18.Lubar, J.F., J.N. Swartwood, and D.L. Timmerman,(1995): Quantitative EEG

and auditory event-related potentials in the evaluation of Attention
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Special, 1995: p. 143-160.

19.Lubar, J.O. & Lubar , J.F. (1984): Electroencephalographic biofeedback of

SMR and beta for treatment of attention deficit disorders in a clinical setting.
Biofeedback and Self Regulation. Vol 9 (1) 1-23.

20.McEvoy, L.K., Smith, M.E. and Gevins, A. (2000): Test-retest reliability of

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21.Monastra, V.J .et al. (1999) Assessing attention deficit hyperactivity disorder
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22.Silberstein, R.B. (1995). Neuromodulation of neocortical dynamics. In P.L.

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25.Watson, C.G., Jacobs, L., & Herder, J (1979). Correlates of alpha, beta and
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