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Quantitative Electroencephalographic Assessment of Brain Function (qEEG)
Quantitative EEG is a scientifically established method for evaluating brain function based on brain electrical activity mapping. In this form of functional brain imaging, your brain's electrical activity, as measured in 19 or 25 sites on your head, is analyzed using complex mathematical and statistical tools in comparison to norms or averages. These norms are based on the electrical activity of thousands of individuals with no known neurological, developmental, or psychiatric disorder. This method of assessing brain function provides information about patterns of brain activation and communication that can then be related to difficulties in daily life functioning such as problems with attention, anxiety, mood, learning, or behavior.
For more information about qEEG, please see the sections below:
Introduction to qEEG
People tend to think of brain function primarily in terms of a class of chemicals, called neurotransmitters, which make possible the transmission of a nerve impulse from one nerve to the next. The dominance of this “chemical soup” model of brain function, probably due to the advances and marketing of the pharmaceutical industry, obscures the fact that the brain is essentially a bioelectric organ.
The EEG or electroencephalogram has long been used to record and study the electrical activity of the outermost layer of the brain – the cerebral cortex. It is usually thought of exclusively as a way to diagnose epilepsy (seizure disorders). In this routine EEG, a neurologist or electroencephalographer (EEG specialist) visually examines the traces of the oscilloscope which show the brain’s electrical activity in the form of a line with repetitive wave-like activity. Hence the name “brainwaves” .
It is well established that the speed of this EEG waveform, measured as the number of times per second that the wave goes from one peak to the next (cycles per second or cps), reflects the degree of activation of the area of the brain beneath the electrode. Slower waveform activity (fewer cycles per second), as in the delta, theta or alpha traces in Figure 1, indicate lowered blood flow and fuel (glucose) use in that part of the brain. Faster activity as in the beta trace, shows increased brain activity. These types of brain electrical activity also reflect the level of arousal of the person: delta activity (2-4 cps) accompanies deep sleep, theta (4-7cps) states of drowsiness, alpha (8-11 cps) relaxed states. Beta range activity reflects an engaged or active brain, and, with very fast beta activity, an excited or urgent/emergency state of mind.
In the last decade or so, a more advanced form of EEG has been developed, called quantitative EEG or qEEG, in which the signal is converted to digital form and compared to a database of individuals without any known neurologically based disorder. In this way, we are able to analyze the background activity with sophisticated statistical techniques to reveal patterns invisible to the naked eye. The results of these analyses can then be presented in graphical form, resulting in topographical displays of brain electrical activity - sometimes called “brain maps".
Research in several university centers has demonstrated the ability of the qEEG to reveal aspects of brain function important to the understanding of a variety of neurodevelopmental disorders, including ADHD, learning disabilities, anxiety, depression, obsessive compulsive disorder, eating disorders, and addictive disorders. A recent study conducted at NYU has shown that a QEEG study can predict the occurrence of dementia in the elderly up to 10 years before symptoms appear with a very high degree of accuracy. QEEG measures of the relative degree of activation in the left versus the right frontal cortex are a good indicator of the current mood state of the person monitored, and of mood traits such as a tendency toward negative emotion or mood (depression, anxiety) or positive emotion or mood. The same measures distinguish children who were identified as having an anxious temperament in the second year of life from those without such a temperament.
Interestingly, researchers at the University of Wisconsin have used these same measures of the relative degree of activation in the left and right frontal cortex to show that when individuals with Autistic Spectrum Disorder are shown photographs of people making strong emotional facial expressions, negative emotional centers are activated in the brain. In addition, qEEG measures have allowed for reliable prediction of response to psychiatric medications independent of symptom pattern and for the determination of whether or not a depressed individual will respond positively to antidepressant medication within only 48 hours of administration, well before the typical 4-6 week period required for symptom reduction to begin. So, clearly, the qEEG is revealing information about brain function that is useful for understanding neurodevelopmental problems.
In addition, research and clinical experience has shown that quantitative EEG assessment of brain function can be used to predict what psychiatric medications an individual is likely to respond favorably to. This allows for the informed prescription of medication based on the underlying brain physiology. Use of this medication-referenced EEG can eliminate the often complicated and trying process of selecting medication through trial and error, and can be helpful with individuals who have not responded well to multiple medications.
To view a Good Morning America segment on the use of qEEG to assist in the diagnosis of attention and learning problems, CLICK HERE.
If your child has an autism spectrum disorder (Autism, Asperger's Disorder, PDD-NOS) you may want to help him or her to prepare for the QEEG recording. Social stories are often useful to help kids with ASD understand a difficult or confusing situation. The kids usually feel much more comfortable with a new experience if they can make a visual map of the experience in advance. It helps them to know what to expect so that they do not get surprised. We have written a social story to help you prepare your child for their QEEG recording. You may want to read it to them several times before they come to our center for the recording. You can download the story by clicking here.
Scientific Research on qEEG
Research using quantitative QEEG has provided substantial evidence of a significant relationship between EEG abnormalities and a variety of disorders of behavior, emotion, thinking, learning, and development. Simply put, this body of reasearch demonstrates that the EEG signal is a good indicator of patterns of cortical activation that play a role in many forms of psychological disorder, including ADHD, anxiety, depression, learning disabilities, and autism and other neurodevelopmental disorders. Much of this research has been amply cross-validated using other neuroimaging techniques.
One intriguing finding is the presence of different patterns of EEG abnormality within diagnostic groups. These patterns have been reliably measured in different laboratories, and may reflect distinct subtypes of brain dysfunction within groups that are identical symptomatically. It is now widely assumed that many if not most forms of psychological disorder, as designated by symptom based diagnostic categories, are heterogenous with regard to their origins or causes. There seems little question that this heterogeneity has hindered both research and treatment in psychiatry. Both are likely to be more effective when based on participant/patient selection that shows greater homogeneity. 
Electrophysiological subtyping based on the QEEG may provide such a means in the future, as QEEG research is providing evidence of physiologically specifiable subtypes within these heterogeneous groups. This has been seen in a variety of disorders, including schizophrenia, substance abuse, mood disorder, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), and learning disabilities. Some promising research suggests that these electrophysiological subtypes have practical significance for the prescription of psychiatric medication and for other forms of treatment. For example, one QEEG subtype observed among cocaine abusers accurately predicted rapid relapse after treatment. Another QEEG measure accurately predicts positive response to anti-depressant medication among those hospitalized for major depression within 48 hours of treatment initiation, whereas symptom improvements are usually not apparent until 4 - 6 weeks after administration.
Several areas of QEEG research into the development of psychological disorders are of interest. Replicated QEEG studies have revealed what may be a neurophysiological substrate of reactive/anxious temperament among infants. This pattern, of frontal activation asymmetry such that there is greater activation in the right compared to the left frontal cortex, is similar to that observed with some adults with depression. In addition, the infants of depressed mothers display this same frontal EEG activation asymmetry, even as young as at 3-6 months of age.
The bulk of QEEG research into child and adolescent psychiatric disorders has been done with ADHD. Multiple QEEG studies have demonstrated a pattern of electrophysiological abnormality among individuals with this disorder. Discriminant function analysis using QEEG variables has shown very high levels of sensitivity and specificity in identifying ADHD participants in several studies. In fact, in two studies, a single ratio of theta/beta power recorded from a single site resulted in sensitivity levels of 86% and 90% and specificity levels of 94% and 98%. A recently completed blinded multi-center study of 159 subjects showed that qEEG was far more accurate in identifying those subjects who had ADHD than the much more commonly used parent and teacher rating scales. qEEG identified ADHD with a sensitivity of 87% (87% of those who had ADDHD were correctly found to have it by the qEEG) and a specificty of 94% (94% of those who did not have ADHD were correctly found not to have it by the qEEG). For a description of this study and its significance, CLICK HERE.
Some experts have recommended that neuroimaging studies be included in the routine assessment of ADHD. This research would suggest that QEEG should be the preferred means, since validity and reliability are high and cost is relatively low.
There are very good reasons to include such a qEEG assessment to verify the presence of the neurophysiological substrate of the disorder in ADHD. In clinical practice, many parents lack confidence in diagnoses that are made soley based on rating scales, as is often the case in everyday practice. And common sense would suggest that these parents are less likely to follow through on treatment recommendations when they are not even sure that the diagnosis is correct.
In fact, compliance with medical treatment in ADHD is very poor. Studies have shown that from 50% to 66% of children diagnsoed with ADHD are not receiving medical treatment just one year after diagnosis.
One very important study looked at the reasons for these low levels of compliance. The results suggested that much of this lack of follow through on treatment recommendations is related to lack of confidence in the diagnosis. In fact, when qEEG was addeed to the diagnostic process, compliance rose to greater than 90%.
In a recent report by the Committe on Research of the American Neuropsychiatric Association, published in the Journal of Neuropsychiatry and Clinical Neuroscience, the Committe carefully reviewed the existing research on the use of qEEG in clinical practice in psychiatry. The authors recommended that qEEG be used as a part of the diagnostic processs along with standard diagnostic methods for the assessment of ADHD and learning disabilities in children and adolescents, and mood disorders and dementia in adults.
qEEG to Guide Psychiatric Medication Selection
Quantitative EEG can help guide your physician in determining which medication or combination of medications will be most helpful with difficulties with attention, mood, anxiety, and behavior, including a range of psychological or psychiatric disorders. Instead of a lengthy trial and error process, which often takes many months, and just as often ends with less than satisfactory results, an easy to administer, scientifically-derived test of your brain's functioning can allow your doctor to select the medication which has been shown to best restore normal brain function.
Initial studies showed that medication prescription based on indicators from the QEEG resulted in a significantly higher rate of success than prescription based soley on symptom patterns (as it is usually done). Additional research has substantially improved the effectiveness of this method, through the development of a medication-referenced EEG, also known as rEEG
In most areas of medicine, your doctor's decisions are guided by data from scientific laboratory tests. Blood tests, lab cultures, urine and stool samples - these tests reveal details of your body's functioning which cannot simpy be observed. For most types of disorders, these test are critical to making diagnostic and treatment decisions. Except for psychological disorders. Brain physiology is not usually tested to guide the prescription of medications that act on the brain.
With the development of the drug referenced quantitative EEG database (rEEG), it is now possible to guide treatment decisions for brain-based disorders on a complex and scientifically derived measure of each individual's brain functioning. Initial research and clinical experience with this important tool have demonstrated that its use can significantly increase treatment success with a wide range of disorders. This is especially true for those individuals who have not responded to medications prescribed in the conventional way.
Referenced-EEG is a patented technology that utilizes 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 by the reference laboratory.
Multiple studies have shown that treatment guided by rEEG has led to positive outcomes in approximately 80% of the 2000+ patients who have previously failed to respond to traditional treatment efforts.
The NeuroDevelopment Center is now making this service available in our region. We will record your EEG in our center using state of the art QEEG equipment. We then forward the data to the team of psychiatrists who are responsible for developing this cutting edge neurophysiogical lab test.
This enormously data-rich picture of your brain's functioning is then compared to an FDA aproved database of individuals with no known neurological problems. Over one thousand measures of your brain's function are used by the team to pinpoint the specific pattern of dysfunction that is giving rise to your difficulties. This pattern is then analyzed against an additional database that links specific underlying neurological profiles to known constellations of response to a wide range of psychiatric medications.
Armed with this degree of information on brain function and medication response, your chances of rapid recovery are greatly improved.
This drug referenced qEEG assessment requires that you cease use of all psychiatric medications until they are no longer active in your system. This allows the acquisition of a "clean" picture of how your brain functions, without the impact of medications. The consulting psychiatrists at the rEEG lab will work closely with your prescribing physician on the technical guidelines for this process. This can only be done under close medical supervision, with the collaboration of your doctor and the rEEG medical staff.
The cost for this test is $750.
For more information about this assessment procedure, visit www.cnsresponse.com, or call 401 351-7779.
For articles on rEEG from medical publications, go to rEEG helps prescribing or EEG database can help guide psychotropic Rx
Some of the research using rEEG is listed below:
rEEG Research
Suffin SC, Emory WH, Neurometric Subgroups in Attentional and Affective Disorders and Their Association with Pharmacotherapeutic Outcome. Journal of Clinical Electroencephalography 1995; 26: 76-83. (.pdf document ) (for further inquiry, contact ClinicalEEG@aol.com)
Stephen C. Suffin, M.D., W. Hamlin Emory, M.D., Nicholas Gutierrez, M.D., Sarla Karan, M.D., Gurdev S. Arora, M.D., Mark J. Schiller, M.D., Jack Johnston, Ph.D., Arthur Kling, M.D. A QEEG Database Method for Predicting Pharmacotherapeutic Outcome in Refractory Major Depressive Disorder, in submission. (.pdf document )
Suffin SC, Emory WH, Neurometric EEG Classifiers and Response to Medicine. Syllabus and Proceedings Summary, American Psychiatric Association 1996 Annual Meeting. Washington, DC, 1996; 87-88.
Suffin SC, Gutierrez NM, Karan S, Aurora G, Emory WH, Kling A, Neurometric EEG Predicts Pharmacotherapeutic Outcome in Depressed Outpatients: A Prospective Trial. Program and Abstracts on New Research, American Psychiatric Association 1997 Annual Meeting. Washington, DC, 1997; 170.
Suffin SC, Emory WH, Proler ML, Neurometric EEG Predictors of Response to Medication in Psychiatric Patients. American Clinical Neurophysiology Society Program and Proceedings Booklet. Bloomfield, CT,1997; 62.
Emory WH, Schiller M ,Suffin SC, Referenced -EEG in the Treatment of Eating Disorders, presented at 44th Annual Meeting, NIMH, National Clinical Drug Evaluation Unit, Phoenix, AZ June, 2004. (http://www.nimh.nih.gov/ncdeu/ncdeu2004abstracts.pdf, Poster No. 221)
qEEG and the Autism Spectrum
This paper was published as a Research Update in the March-April 2003 issue of Autism/Asperger's Digest.
by Laurence M. Hirshberg, Ph.D.
In the 15 years that I have been working with individuals with autistic spectrum disorders (ASD), there have been innumerable times I have wished I could somehow “see into” their brains. Recently I have been lucky enough to have had this wish granted, as I have begun incorporating a form of neuro-imaging into my clinical practice - quantitative electroencephalography (qEEG).
People tend to think of brain function primarily in terms of a class of chemicals, called neurotransmitters, which make possible the transmission of a nerve impulse from one nerve to the next. The dominance of this “chemical soup” model of brain function, probably due to the advances and marketing of the pharmaceutical industry, obscures the fact that the brain is essentially a bioelectric organ.
The EEG or electroencephalogram has long been used to record and study the electrical activity of the outermost layer of the brain – the cerebral cortex. It is usually thought of exclusively as a way to diagnose epilepsy (seizure disorders). In this routine EEG, a neurologist or electroencephalographer (EEG specialist) visually examines the traces of the oscilloscope which show the brain’s electrical activity in the form of a line with repetitive wave-like activity. Hence the name “brainwaves” .
It has long been known that the speed of this EEG waveform, measured as the number of times per second that the wave goes from one peak to the next (cycles per second or cps), reflects the degree of activation of the area of the brain beneath the electrode. Slower waveform activity (fewer cycles per second), as in the theta or delta traces in Figure 1, indicate lowered blood flow and fuel (glucose) use in that part of the brain. Faster activity as in the beta trace, shows increased brain activity. These types of brain electrical activity also reflect the level of arousal of the person: delta activity (2-4 cps) accompanies deep sleep, theta (4-7cps) states of drowsiness, alpha (8-11 cps) relaxed states. Beta range activity reflects an engaged or active brain, and, with very fast beta activity, an excited or urgent/emergency state of mind.
In the last decade or so, a more advanced form of EEG has been developed, called quantitative EEG or qEEG, in which the signal is converted to digital form and compared to a database of individuals without any known neurologically based disorder. In this way, we are able to analyze the background activity with sophisticated statistical techniques to reveal patterns invisible to the naked eye. The results of these analyses can then be presented in graphical form, resulting in topographical displays of brain electrical activity - sometimes called “brain maps.”
Research in several university centers has demonstrated the ability of the qEEG to reveal aspects of brain function important to the understanding of a variety of neurodevelopmental disorders, including ADHD, learning disabilities, anxiety, depression, obsessive compulsive disorder, eating disorders, and addictive disorders. QEEG measures of the relative degree of activation in the left versus the right frontal cortex are a good indicator of the current mood state of the person monitored, and of mood traits such as a tendency toward negative emotion or mood (depression, anxiety) or positive emotion or mood. The same measures distinguish children who were identified as having an anxious temperament in the second year of life from those without such a temperament. Interestingly, researchers at the University of Wisconsin have used these same measures of the relative degree of activation in the left and right frontal cortex to show that when individuals with ASD are shown photographs of people making strong emotional facial expressions, negative emotional centers are activated in the brain. In addition, qEEG measures have allowed for reliable prediction of response to psychiatric medications independent of symptom pattern and for the determination of whether or not a depressed individual will respond positively to antidepressant medication within only 48 hours of administration, well before the typical 4-6 week period required for symptom reduction to begin. So, clearly, the qEEG is revealing information about brain function that is useful for understanding neurodevelopmental problems. What is even more intriguing is that qEEG results can be directly applicable in formulating treatment approaches.to train the brain toward improved functioning.
Although qEEG research studies have been completed documenting the electrophysiological characteristics of other disorders, as of yet no qEEG studies have been published concerning ASD as a group. However, many qEEG studies of individuals with ASD have been done in clinical centers all over the US and abroad, including ours.
The type of “brain map” presented in Figure 2 shows degrees of difference from the database average in the four standard bands or speeds of activity – delta, theta, alpha, and beta. Due to printing limitations, a grey scale version of the map is presented here. (For the full color version, go to www.neurodevelopmentcenter.com/resources/autismdigest.) The gradations of grey shown in the scale on the left (gradations of color in the original) represent degrees between the database average or mean (shown as black on the scale) and the extremes of three standard deviations (SD) above (99th percentile) and below (1st percentile) the average (both shown as the lightest grey). Gradations of shading (and of color in the original) represent degrees of deviation from the mean toward these extremes.
This qEEG study is of an adult with Asperger’s disorder. It is quite typical of the qEEG studies we have seen at our center of individuals with autistic spectrum disorder (ASD) , in that it shows excesses of theta band activity in the frontal and prefrontal area, along the midline, and in the parietal area, and strongest in the right posterior temporal area. It also shows excessive fast (beta) activity along the midline, which we have seen in some of our ASD studies.
It is widely understood in the autism field that ASD is a heterogenous group. Individuals with ASD differ widely from each other in many dimensions, although they share some common characteristics – strengths and vulnerabilities. So it should not be surprising that the qEEG studies of this group are not by any means all the same. In our sample, under-activation of the midline and frontal- prefrontal areas, usually most evident in the ratio of theta to beta (slow to fast activity), is the most common finding, present in 89% and 85% of our cases respectively. Seventy-nine percent showed under-activation of the central motor strip and of the parietal area. Under-activation has also frequently (74%) been evident at the posterior part of the right temporal lobe, and in the occipital area (58%). Finally, abnormalities in coherence, which is, very generally, a measure of the degree of communication (or co-activation) of two areas of the brain, have also been common. Patterns of excessive coherence were seen in 58% of the studies, with abnormalities most often in the prefrontal area, and in the right hemisphere between areas of the front and back of the brain.
The ASD group whose qEEG studies are summarized above includes individuals diagnosed variously with Autistic Disorder, Asperger’s Disorder, and PDD-NOS. It includes individuals with varying degrees of severity and notable differences in personality or style of functioning. I have not been able to identify any differences in patterns of symptom or behavior within this group that appear to be reliably associated with the differences we have observed in the qEEG studies; certainly it is not the case that there are clear differences in qEEG profile among the three diagnostic groups. In addition, there does not appear to be a correlation between the degree of abnormality evident in the qEEG and severity of functional disturbance.
However, the pattern of deficit in brain function revealed by qEEG for the group as a whole is entirely consistent with the overall symptoms pattern in ASD. Prefrontal and frontal lobe functions include flexible control of attention, organization and planning, initiation of behavior, abstract thinking, emotional regulation and control, and problem solving – all frequently weak for individuals with ASD. The anterior midline findings, seen also with obsessive compulsive disorder and generalized anxiety disorder, arise from an area of the brain called the cingulate gyrus, which is involved in attentional networks, in motivation, in the function of shifting of mental sets and therefore in cognitive and behavioral flexibility, and error detection and therefore in problem solving. Other neuroscientists have argued that the anterior cingulate gyrus and the prefrontal cortex are the critical brain areas for theory of mind functions, known to be disturbed in individuals with ASD. Parietal areas are known to be involved in sensory processing, again frequently an area of difficulty in ASD. Interestingly, clinic based qEEG studies have shown that math learning disabilities are often associated with parietal lobe findings; in my clinical experience, many individuals with ASD have particular weaknesses in math. Finally, the right posterior temporal lobe findings are associated with a part of the brain specialized for face and facial expression recognition and, more generally, in recognizing or decoding visual perceptual wholes.
These clinic-based qEEG findings are also largely consistent with results from other forms of functional neuro-imaging research, including fMRI, SPECT, and PET, which, like qEEG allow us to see the brain at work. However, unlike these other techniques for functional neuro-imaging, qEEG provides information about brain function that is practically useful for intervention – intervention through biofeedback based on the EEG, called variously EEG biofeedback, neurotherapy, or neurofeedback. Indeed this is the primary reason for the large number of qEEG studies done in clinics – to guide the process of neurofeedback. In this context, the individual differences in electrophysiology among ASD individuals, as revealed by the qEEG, are quite meaningful. They indicate specifically how to conduct the neurofeedback training. Information on the ways neurofeedback can benefit individuals with autism will be presented in a follow up article in the next issue of the Autism Asperger’s Digest.
To view a Good Morning America segment on the use of qEEG to assist in the diagnosis of autism spectrum disorders, CLICK HERE.
If your child has an autism spectrum disorder (Autism, Asperger's Disorder, PDD-NOS) you may want to help him or her to prepare for the QEEG recording. Social stories are often useful to help kids with ASD understand a difficult or confusing situation. The kids usually feel much more comfortable with a new experience if they can make a visual map of the experience in advance. It helps them to know what to expect so that they do not get surprised. We have written a social story to help you prepare your child for their QEEG recording. You may want to read it to them several times before they come to our center for the recording. You can download the story by clicking here.
Practical Matters
Using a Previously Recorded EEG for Neurofeedback
Many clients who wish to begin with neurofeedback have had a prior EEG recording, usually at the request of a neurologist. Unfortunately, it is rare that we are able to use these recordings for our quantitative analysis. Unfortunately there is no widely accepted or uniform technical standard for the file format of digital EEG recordings. Our analysis software accepts many, but by no means all such formats. Other technical issues also make use of previously recorded EEG's difficult.
If you have had an EEG in the past year, and you would like to see if we can use this EEG for quantitative analysis, please request that the EEG technician at the center where the recording was made communicate with Kyle Frederick, our head technician. He can be reached by telephone at 401 351 7779, extension 110 or by email at kfrederick@neurodevelopmentcenter.com.
If we determine that the files can be used, you will need you to complete an authorization for release of information either at our center or the center where the recording was done. Our release can be obtained on our website on the download documents page. It is the fourht page of our new patient registration documents.
If you have any questions please call Kyle Frederick at 401 351-7779, ext 110.
Preparing for your QEEG:
If your child has an autism spectrum disorder (Autism, Asperger's Disorder, PDD-NOS) you may want to help him or her to prepare for the QEEG recording. Social stories are often useful to help kids with ASD understand a difficult or confusing situation. The kids usually feel much more comfortable with a new experience if they can make a visual map of the experience in advance. It helps them to know what to expect so that they do not get surprised. We have written a social story to help you prepare your child for their QEEG recording. You may want to read it to them several times before they come to our center for the recording. You can download the story by clicking here.
It is critically important for obtaining a valid quantitative EEG study of brain function that you follow the steps below prior to your QEEG recording. The brain mapping results are only as good as the recording, so it is imperative that you carefully follow each of the steps below:
Please click here to download a checklist to complete and bring along with you to your qEEG appointment. (This document requires the free Adobe Acrobat reader. If you don't have this installed already, it's a free download from Adobe's Website.)
1. If you are taking stimulant medication, it is preferable to do the qEEG recording after a 48-hour medication washout. Please check with your prescribing physician to determine if it is possible to stop taking the stimulants 48 hours prior to recording the qEEG. Do not make changes in any other medication, but be sure to bring medication type and dosage information to provide to the technician to record before the EEG is done.
2. If you are sick, please call to reschedule. Please reschedule even if you just have a cold.
3. Avoid taking any over the counter medication or supplements for three or four days prior to the qEEG.
4. Do not drink coffee, tea, red bull, caffeinated soft drinks, or any other substance with caffeine less than 15 hours prior to the qEEG.
5. Call to reschedule the EEG if you are ill. We do not want to conduct the recording, even if you only have a cold.
6. Be sure to get a good night’s sleep before the qEEG is done. Let the technician know if there has been any sleep disturbance.
7. Drink plenty of water the day before the qEEG recording to hydrate the skin.
8. The evening before your qEEG, wash your hair 3 times with a ph neutral shampoo, such as Neutrogena non-residue shampoo (available at CVS). Do not use creme rinse or any other hair products on your hair until after your appointment. Do not wash your hair again in the morning of your appointment.
9. Make sure hair is completely dry before coming for the qEEG.
10. Do not put any hair products on your hair such as hair spray or gel of any kind the morning of your mapping.
11. Use the restroom if you need to prior to the start of the qEEG because we will not be able to stop once the recording begins.
12. For younger children: The application of the electrode caps takes approximately 15 to 20 minutes. During this time, kids can choose to play Gameboy or to watch a DVD. They will need to sit patiently without any other activity during the actual EEG recording, so we want to keep them engaged and enjoying themselves during the preparation time to reduce the likelihood of restlessness during the recording. Ask your child which he/she would prefer (gameboy or DVD) ahead of time. If it is DVD, you may want to rent one he/she is especially interested in and bring it along or bring a favorite from home. We also have a selection of kids DVD's here at the Center.
13. FOR THE rEEG ONLY: The medication referenced rEEG assessment requires that you cease use of all psychiatric medications until they are no longer active in your system. This allows the acquisition of a "clean" picture of how your brain functions, without the impact of medications. The NeuroDevelopment Center will inform you, based on specific guidelines from the lab, how long before you take the test you need to cease use of each medication. However, you must consult your doctor to determine if this is medically indicated. The team of psychiatrists from the laboratory will consult with your doctor if requested.
The NeuroDevelopment Center does not serve as a participating provider for most insurance companies. We require that you pay all fees at the time of service. You may be able to obtain reimbursement for your payments from your insurance carrier, although we do not guarantee such reimbursement. We will provide you with a statement to submit to your carrier.
For coverage of the Quantitative EEG assessment, your insurance carrier may require an indication of medical necessity, which would be provided by your primary care physician. QEEG is often used to rule out any medical contribution to your symptom pattern, such as epilepsy or some form of encephalopathy. Dr. Hirshberg can speak to your physician should he/she wish.
The interpretation of the EEG is done by a board certified neurologist, which should satisfy the requirement your insurance company may have that the assessment be done by a qualified medical professional.
Here are our recommendations on how to inquire about insurance coverage for QEEG:
First, get the name and employee number of the representative you are talking to. Explain that you are seeking services from The NeuroDevelopment Center and that it is not a participating provider.
Then, for each of the procedure codes listed below, ask the insurance representative, “Is this a covered service, and if so, how much is reimbursed for it?” If the representative gives you a percentage, ask “percent of what (dollar amount).” If they tell you that that information is only given to providers, tell them that The NeuroDevelopment Center is not a participating provider and is not able to obtain this information for every patient for every insurance carrier and policy. Emphasize that you are responsible for the fees so you need to know how much will be reimbursed to you. Be patient but firm and persistent. If the representative continues to refuse to give you an amount, ask to speak to a supervisor. Do not accept no for an answer. How can you make an informed decision about your health care, if you don’t know what it will cost? We would recommend a call to the state insurance commissioner if your insurer refuses to provide information about your coverage.
Obtain and record the following information:
- Name of representative:
- Employee number:
Quantitative EEG procedure (CPT) codes:
(All four codes are billed for the QEEG.)
- For procedure 95816, is this a covered service?
- If so, how much will be reimbursed for this service?
- For procedure 95816 - 26, is this a covered service?
- If so, how much will be reimbursed for this service?
- For procedure 95957, is this a covered service?
- If so, how much will be reimbursed for this service?
- For procedure 95957 - 26, is this a covered service?
- If so, how much will be reimbursed for this service?
Whenever possible, get a written response from your representative confirming coverage.
PLEASE REMEMBER: We do not submit claims to insurance carriers. We do not accept reimbursement assignment directly from most insurance companies, as we do not serve as participating providers for most plans. We require that our clients pay all fees due at the time of the service. We then provide our clients with statements to submit to their insurance carriers to obtain any reimbursement they are entitled to under the specific terms of their insurance policy. WE DO NOT GUARANTEE REIMBURSEMENT FOR ANY SERVICE.
To assist you in obtaining a record of information concerning your insurance coverage for QEEG, we have designed a worksheet. Please click here to download this worksheet. (This document requires the free Adobe Acrobat reader. If you don't have this installed already, it's a free dowload from Adobe's Website.)