QEEG and traumatic brain injury: rebuttal of the American Academy of Neurology 1997 report by the EEG and Clinical Neuroscience Society.

Abstract

INTRODUCTION In the American Academy of Neurology and American Clinical Neurophysiology Society (AANIACNS) paper, "Assessment of digital EEG, quantitative EEG, and EEG brain mapping,"' it was concluded that "...evidence of clinical usefulness or consistency of results are not considered sufficient for us to support its [QEEG] use in diagnosis of patients with postconcussion syndrome, or minor or moderate head injury." The present EEG and Clinical Neuroscience Society (ECNS) report and rebuttal will show that factual misrepresentation and bias formed the basis of the AANIACNS position on QEEG in postconcussion syndrome, and minor and moderate head injury. The background and basis of this EEG and Clinical Neuroscience (ECNS) report and rebuttal is the fact that there are approximately 1 to 2 million people who experience a traumatic brain injury (TBI) in the U.S. each year,z5 and all TBI patients, their families and employers deserve the best that medicine can provide Importantly, TBI patients and their families are often devastated by this injury even when it is neurologically classified as "mild." Another important fact is that as of this date, the standard or "routine EEG" and "conventional MRI" are essentially useless because of their Iow sensitivity and low reliability to detect mild to moderate TBI (e.g., < 20% positive in routine visual EEG and visual MRI) D 9 If GEEG is to be excluded from the arsenal of diagnostic tests for the detection and evaluation of mild to moderate TBI, then there must be an excellent and compelling reason to do so and not one based on misrepresentation and biased logic. In the paragraphs below, factual misrepresentations and omissions of facts will be shown to have occurred repeatedly in Earlier reviews of QEEG and traumatic brain injury, and these same misrepresentations eventually reemerged in the 1997 AAN/ACNS article.' Contrary to the opinim of AAN/ACNS, it will be shown ihat QEEG has been demonstrated to objectively meet the standards espoused in the 1997 AANlACNS article. Factual Misrepresentations The historical and primary focus of AAN/ACNS arguments against the use of QEEG in mild traumatic brain injury' lo l1 is exclusively based upon criticisms by Dr. Marc Nuwer of the Thatcher el al, 198912 QEEG study of 608 mild headinjured patients involving multiple independent cross-validations, and the Thatcher el al, 199113 QEEG study predicting outcome at 1 year post-injury. For example, in the AANIACNS paper there was only one literature citation concerning QEEG and mild head injury other than the studies by Thatcher. If a fair and proper review had been conducted, additional QEEG studies would have been presented such as Mas el al,I4 von Bierbrauer et all5 and Ruijs et allq6 Given the absence of a more complete literature review, the criticisms in previous publications by NuwerIo l ' and the AAN/ACNS paper are even more remarkable for the extent to which they are based on misrepresentations of the procedures and results reported in the Thatcher studies. For example, in 1997 the AANIACNS paper' stated (pp. 205-206): "Users have criticized this technique [i.e , Thatcher et al's QEEG technique] as being overly sensitive to nonpathological states such as drowsiness or medication effects (Nuwer, 1992'"))." Nuwer in the AANiACNS articlel and in 1996" cites his own 1992 paper'O as the source for this alleged criticism. however. after careful reading of the 1992 paperlo one fails to find even a single mention or reference of this allege0 criticism. In other words, Nuwer cites himself as the 1992 source of this "rumor" without any scientific evidence, and then proceeds as sole author of the AANIACNS report to influence readers into thinking that there is an actual scientific citation to establish this as fact. The simple truth IS that drowsiness, which is an artifact that can and must be eliminated, has never been established to be a problem with the Thatcher et all2 GEEG technique. Another example of factual misrepresentation, is when AAN/ACNS states: "In one small group of patients with