CNS Response: The key to informed mental health treatment

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For years psychiatrists have attempted to use EEG as a physiologic correlate of patient behavior in a range of psychiatric disorders.  Since the 1970’s EEG recordings have been digitized and subjected to quantitative analysis (QEEG), which yields more information than can be appreciated by simple visual inspection.  QEEG extends EEG technology beyond qualitative identification of abnormality and allows for comparison of an individual patient's EEG pattern with large public databases of age matched, asymptomatic (control) group EEG values (Duffy et al. 1979; John et al., 1977).

Medication induced changes in EEG data have been reported for a broad range of antidepressants, benzodiazepines, stimulants, antipsychotics, lithium salts, and anticonvulsants. These drug changes are specific in regard to effects on distinct components of the EEG pattern and are dose dependent, reversible upon medication withdrawal, and measurable across psychiatric syndromes and in asymptomatic volunteers.

Prior attempts to use EEG in the selection of pharmacotherapy for neuropsychiatric patients have not been consistently useful. One reason is that the majority of studies have ignored established technical and methodological guidelines for EEG recording (Nuwer, 1997) resulting in diverse findings and leading to substantial criticism over the use of EEG data in psychiatry.   Another major problem has been the lack of studies comparing medication-free patient EEGs to the database of medication-free, asymptomatic controls.  Medication-free EEG values are necessary to determine whether drug treatments affected the electrical activity and whether there was a correlation between the drug-induced changes in activity and clinical outcome.   

In those few studies obtaining baseline, medication-free EEGs, investigators demonstrated unique QEEG features that could be used to predict treatment outcome.  These studies found that there were significant EEG heterogeneities within neuropsychiatric disorders.  The existence of these subgroups suggests that different patients within the same neuropsychiatric disorder would respond differently to medications and indicates that EEG patterns could predict the most effective pharmacotherapy for a specific patient.

Over the last twenty years a unique and very dedicated group of people (scientists, physicians, therapists, business people and even lawyers) have helped develop technology to dramatically improve treatment of patients suffering with behavioral disorders.  They have given of their time and their capital.  CNSR has succeeded in this goal and is now able to educate patients, families and friends, physicians, therapists and counselors, scientists and technology developers, and payers about Referenced-EEG^® (rEEG^®) which should contribute to the efforts of all in this field.

Studies Synopsis
To date, eight separate studies (including retrospective, blinded prospective and clinical case series) covering a wide range of disorders (anorexia, bulimia, depression, ADD, addiction and others) have reported on improvement of treatment efficacy using rEEG^® Report data.  In each study, the conclusion was that rEEG^® was demonstrably effective in treating primarily treatment-resistant patients. Treatment success ranged from 70-95% in these studies.  A summary scientific poster accepted for presentation at the 2005 American Psychiatric Association annual meeting cumulated these results and the data shown below.

Additional studies are now underway or planned validating its utility in treatment-resistant depression, bipolar illness, dual diagnoses addiction, PTSD and other areas.  CNSR anticipates its continued participation in academic and field studies on applicability of rEEG^® to additional diagnoses, development of therapeutics, economic analytics and other areas for many years to come. 

The Technology 
rEEG^® is a technology that was developed by an Pathologist M.D. / Psychiatrist as well as a clinical Psychiatrist Over 18 years, patients that came into their practice were weaned off their existing medications, a baseline quantitative EEG (QEEG) was taken, various pharmaco-therapy trials were administered and clinical outcomes were recorded.  In this way, a growing Outcomes Database was built, an integral and proprietary part of the rEEG^® methodology.  Their efforts were formalized into a company, NuPharm, Inc. which was first capitalized in 1999.  CNS Response was incorporated in 2000, and acquired all the assets of NuPharm, including patent applications and the Outcomes Database.  The founders included the two researchers along with the current CEO and Chief Engineer.

Focus group interview with physicians directed the next development stage of the rEEG^® technology. It became clear that physicians needed more then physiologic guidance on medication classes. They needed to understand the physiological impact of individual medications. They desired greater ability to distinguish between antidepressant classes such as SSRI’s, TCA’s and MAOI’s and between individual medication in a class such as SSRI’s, Paxil, Prozac and Zoloft.

They also needed a simple communication of results that did not require them to have completed a specialty in neurophysiology. The company started developing this advanced work and today is able to do both of these. Approximately 30 psychotropic medications are now individually identified with the rEEG^® pheno-marker system as well as numerous medication classes. The rEEG^® report is now generated in a highly automated fashion and can be understood with more modest training requirements.

During these intervening years the utility of rEEG^® also has been validated in a variety of clinical settings and trials. Much of this work was done independent of any financial or other incentives from CNS Response by researchers who were simply seeking a better approach to medication management.