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The forsaking of the clinical EEG by psychiatry: how justified?

Published online by Cambridge University Press:  02 August 2017

Nash N. Boutros
Nash N. Boutros*
Affiliation:
University of Missouri in Kansas City, Kansas City, Missouri, USA
*
*Address correspondence to: Nash N. Boutros, Department of Psychiatry, University of Missouri–Kansas City, 1000 East 24th Street, Kansas City, Missouri 68108. (Email: boutrosn@umkc.edu)
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Abstract

Despite decades of publications attesting to the role of the clinical EEG in diagnosing and managing psychiatric disorders, the procedure remains highly underutilized in the practice of psychiatry. The visually inspected EEG (vEEG) can detect various forms of abnormalities, each with its own clinical significance. Abnormalities can be paroxysmal (i.e., suggestive of an epileptic-like process) or stationary. The most important unanswered question remains the value of detecting epileptiform activity in a nonepileptic psychiatric patient in predicting favorable responses to anticonvulsant treatment. Despite the many shortcomings of vEEG, the available evidence suggests that in the presence of paroxysmal activity in a nonepileptic psychiatric patient a trial of a psychotropic anticonvulsant may be warranted if standard treatment has failed. More research on the contribution of paroxysmal EEG abnormalities to the problem of episodic psychiatric symptoms (e.g., panic attacks, dissociative episodes, repeated violence) is sorely needed. It is postulated that at least some of these conditions may represent an epilepsy spectrum disorder. Similarly, the significance of the presence of a slow-wave activity (whether focal or generalized) also deserves further well-designed research to ascertain the exact clinical significance. Nonetheless, the available data suggest that further medical workup is necessary to ascertain the nature and degree of the pathology when present.

Keywords

Psychiatryelectroencephalogram (EEG)isolated epileptiform discharges (IEDs)magnetoencephalography (MEG)epilepsy spectrum disorders
Type
Review Articles
Information
CNS Spectrums , Volume 23 , Special Issue 3: Theme: Neuropsychiatry , June 2018 , pp. 196 - 204
Copyright
© Cambridge University Press 2017 

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