In my experience, we cannot fix a diagnosis using EEG only. As far as I have understood, an EEG scan only shows the mechanism of cerebral excitement, and these observations of changes may not necessarily be specific and similar in many different forms of illness (i.e. depression, headache, epilepsy, etc.)

Yes, you are totally right in this regard. It´s impossible to make any clinical diagnosis based merely on the EEG aspects of an individual patient. Indeed, I think that EEG is an auxiliary test, and as with other exams, it is absolutely necessary to include its features in a patient´s clinical setting to extract the its best performance.

On the other hand, it is practically impossible to manage some medical conditions without the use of an EEG. As a neurophysiological method, it has the peculiar property to identify normal and pathologic findings on brain electrical activity.

In this regard, EEG is undoubtedly the best assay to study and manage patients presenting with paroxysmal events, and it is central for the diagnosis of an epileptic disorder and its classification, and for the differential diagnosis of epilepsy with its imitators. It also provides valuable information for the clinical management of patients with epilepsy.

In another relevant set, individuals with acute decrease in level of consciousness, EEG is considered the gold standard test for the diagnosis of a potentially fatal disorder called nonconvulsive status epilepticus. It also assists diagnosing the severity and providing elements to establish a prognosis for comatose patients.

For neurological conditons like headache, dementia, movement disorders, autism, ADHD, and cognitive-behavioral disorders of children, the role of EEG remains rather limited. But still, it is the only one which can identify epileptiform discharges, often useful in neurological settings.

We cannot deny that Hans Berger´s original goal of distinguishing the different psychopathologies by their electrical expression was not achieved. However, 90 years after its invention, EEG still has a role in the management of patients with neuropsychiatric conditions, despite being just a drop in the Medicine´s ocean.

Best regards

Thanks very much for your comments, Jose.

I appreciate that you have taken the time to contribute to my discussion.

I would like to suggest a non-traditional approach to understanding and the utility of EEG.

If we disregard attempts at nosological and topographical uses of EEG, we then have the possibility of interpreting EEG as a result of an enormous quantity of synaptic interactions (specifically how particular quantities and types of neurotransmittors influence de- and hyperpolarizational processes).

My clinic has, over the last twenty years, conducted dynamic EEG tests on 15,000 patients, each for a number of years, in the course of treatment with basic groups of neurotropic drugs (anti-depressants, anti-convulsants and anti-psychotic). And we were able to identify and analyse a regular pattern of excitatory processes in the brain, which enabled us to understand pathogenic mechanisms of excitatory disorders (depression, headache, epilepsy etc.)

I would like to draw your attention to the article I posted in this forum, which presents the results of our research. I'd be very interested in hearing your comments, so as to continue this discussion.

Your opinion would be very useful to me and possibly to other participants in this forum.

Please let me answer in a simple way, adding an attachment: epileptic discharges. EEG in my opinion is the only method to diagnose generalized epilepsy with 3/s spike and wave pattern (5. line).

I agree in this regard with Jose Bragatti.

See my answer above, please.

EEG is useful in detection of pain situations:

1) the magnitude of pain relief by spinal cord stimulation is reflected in P 200 amplitude of the pain evoked potential. Thesis C.C. de Vos University Twente.

2) pain study results are dependent of methods used; J Clin Neurophysiol 2009: 26:54-60

3) Prediction succes of vagus nerve stimulation: Eur J Epilepsy 20: 541-545, 2011

To simple to deny effect of EEG

Dear colleagues,

I have read your contributions with interest and would like to suggest the following approach to this discussion;

I propose to consider psychosomatic disorders, such as pain, as an excitatory dysfunction of the nervous system, in the first instance, the brain.

If we take into consideration, that we only have three major groups of drugs which can be used to treat many different disorders (epilepsy, headache and pain, depression etc.), it is possible to imagine that there is a general pathogenic mechanism at work.

If we then conclude that the general pathogenic mechanism is actually the excitation of the nervous system, then EEG is an extremely important diagnostic method in studying psychosomatic disorders, pain disorders, epilepsy etc.

The question is, what exactly does EEG show us?

We understand that it is a comprehensive representation of the activity of all the synapses in the brain.

In this regard, I would like to ask how EEG testing helps us to understand the workings and function of cerebral synapses.

As I have already noted, the medicines we have at our disposal all act by modifying in some way synaptic neurotransmission. Can we observe this effect on an EEG?