SKIL Report Example

CLIENT INFORMATION

Name: Tom Doe DOB: 12-Aug-75 Male Right-handed

Reason for Study: Attention, impulse and conduct disorder. Resistent to psychotherapy.

Medication: No proprietary meds. Self-medicates with coffee and tobacco.

METHODOLOGY

Topographic EEG Methodology: A fitted electrode cap with leads placed according to the International 10/20 System was applied to achieve a standardized 19 channel (Lexicor system) EEG recording. A referential montage was obtained with linked earlobes. Electrode impedance of less then 10 Kohms was required at all sites prior to the initiation of recording. EEG signals were fed directly to a quantitative topographic analysis system where they were digitized at a rate at or above 256 samples per second. The data were band-pass filtered between 1 and 30 Hz and stored on a hard disk for subsequent analysis.

The client was seated in a comfortable reclining chair placed approximately 3.5 meters in front of a video monitor screen. The legs were rested on a small ottoman in front of the seat. A series of standardized tests, each lasting approximately 3 minutes, was administered. These included 1) eyes closed, 2) eyes open, 3) reading for comprehension, and 4) a mathematics test of graded difficulty. Digitized data were subjected to a custom automatic artifact detection program that identified and deleted eye-blink and movement artifact. This was supplemented by a visual review of the record for removal of residual undetected eye and head movement artifact, as well as muscle activity of potential consequence to the analysis. A manual cursor was used to selectively identify and delete only those brief segments affected. Atypical transients in the EEG signal were noted for subsequent analysis during this procedure.

Corrected EEG data were then analyzed for frequency content using the Fast Fourier Transform. Evaluation of these data employed various descriptive and statistical displays with a variety of frequency band formats. These included data tables, spectral maps, individual frequency band topometric analysis (providing both within and between state evaluation), topographic maps, and covariance analysis. Statistical analysis compared subject data with an adult normative database corrected for significant time-of-day variations and state transitions. Data also were evaluated for percentage change across states and compared with a normative database for state modulation. Finally, topographic maps showing covariance between all sites at relevant frequencies were compared with a normative database to evaluate the status of functional cortical interactions.

HISTORY

This 23 year old, right-handed Caucasian male has a long history of conduct disorder, impulsivity, and aggression. While he is intelligent and did well in High School he has had serious difficulties functioning in the adult world. A brief stint in the US Navy was terminated when he was discharged for throwing an officer overboard from a docked vessel. Further, while he was courteous and responsive during the intake interview, his face and arms were scarred as a result of his most recent combat. He has not been able to hold a job and has had bouts of substance abuse and voluntary withdrawal from social interaction. He is currently living in a shed in the local mountains. His parents are divorced but a new stepmother shows great concern and sensitivity towards this troubled young man. She has brought him for evaluation in the hope he will attempt neurofeedback, since he has been resistant to standard psychotherapy. He reports no known medical problems and states that he is currently abstinent and drug free. He further reports improved self-control when he drinks coffee but refuses stimulant medications.

FINDINGS

With eyes closed this subject showed a dominant frequency in the 8-10 Hz range that was greatest in posterior cortex and bilaterally symmetrical Figs 1 and 2). This frequency band was effectively suppressed with attentional demand and was within statistical database range in all states tested (figs. 4, 10 and 13). The primary deviant finding here was in the 6-8 Hz band during Task 2, involving difficult mathematical solutions. Activity in this band was specifically increased in frontal cortex (figs. 3, 8, 9, and 14). Findings in this band were, however, comparable to the database in all other tests (figs. 5, 6, & 7). Further analysis of these dynamics in terms of percent change between states showed typical changes in 4-8 Hz activity from eyes open to Task 1 (fig. 11). However, state comparison between eyes open and Task 2 disclosed a significant increase in 4-8 Hz activity during Task 2 (fig. 12). Covariance analysis disclosed no related disturbance in cortical interactions but suggested an attenuation in communication between the right posterior temporal area and occipital cortex (fig. 15). Statistical tables were used here to emphasize the possible corruption of QEEG findings due to artifact and technical errors (figs 16 and 17).

CONCLUSIONS

This subject showed deviant findings in the EEG that were consistent with a clinical history of conduct disorder and impulse control problems. The specific and very deviant increase in anterior cortex 6-8 Hz activity during significant cognitive challenge is a pattern that has been described in several studies of ADHD populations. A theoretical discussion of this literature, and possible underlying physiological mechanisms is beyond the scope of this demonstration. However, this literature would suggest that neurofeedback strategy be directed to suppressing this deviant fronto-central EEG slowing by the combined application of the standard SMR protocol and a site-specific effort at normalization with shaping.

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