Brain Assessment: How to Easily Add ERP, qEEG, and...
Transcript of Brain Assessment: How to Easily Add ERP, qEEG, and...
Brain Assessment: How
to Easily Add ERP, qEEG,
and Autonomic Testing to
Your Practice to Improve
Clinical and Practice
Outcomes
David H. Haase, MD
Disclosures
• Founder & Medical Director for MaxWell Clinic for Proactive Medicine
• Medical Director and Board member of Evoke Neuroscience
• Member, Medical Board of Advisors, Shareholder & Speaker for Xymogen
• CMO of LifeStrive
2013 MaxWell Brain David H. Haase, MD
What is the MOST
FUNDAMENTAL Function of the Brain?
2013 MaxWell Brain David H. Haase, MD
What are YOUR Brain’s
Functions? Attention
Concentration
Curiosity
Flexibility
Learning
Memory
Relationship
Reasoning
Consciousness
Sleep
Protection
Creativity
Sensory Awareness
Coordination
Movement
Praxis
Understanding
Emotion
Self-Justification
2013 MaxWell Brain David H. Haase, MD
“I think,
therefore I am…” Rene Descartes (1596-1650)
2013 MaxWell Brain David H. Haase, MD
Brain Function is QUALITY OF LIFE
2013 MaxWell Brain David H. Haase, MD
How DOES the Brain Function?
DOES the Brain Function on SOUP?
Brain Soup:
Pharmacologists, Nutritionists,
Functional Docs
2013 MaxWell Brain David H. Haase, MD
MaxWell Brain David H. Haase, MD 2013
Brain Spark:
Neuro-electro
physiotherapists
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
Hebb’s Law…
“Neurons that Fire Together... Wire Together”
“When an axon of cell A is near enough
to excite cell B and repeatedly or
persistently takes part in firing it, some
growth process or metabolic change
takes place in one or both cells such
that A's efficiency, as one of the cells
firing B, is increased”
2013 MaxWell Brain David H. Haase, MD
Donald O. Hebb (1904-1985)
Neuronal
Connectomes
(complete
connectional map
of a neural circuit)
2013 MaxWell Brain David H. Haase, MD http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.1000032
MaxWell Brain David H. Haase, MD 2013
2013 MaxWell Brain David H. Haase, MD
The Connectome of Delta Airlines at
Atlanta
The Functions of the Cortex
MaxWell Brain David H. Haase, MD 2013
MaxWell Brain David H. Haase, MD 2013
2013 David H. Haase, MD
Parietal Brodmann Networks Frontal Brodmann Networks
Tempral Brodmann Networks Hippocampal-Limbic Brodmann
Networks
2013 David H. Haase, MD
The Brain Sparks as a WHOLE –
Yet, in PARTS
What is usual in-office
Brain Assessment?
2013 MaxWell Brain David H. Haase, MD
DSM-4R (soon V) ICD’s
“MY MEMORY IS NOT AS SHARP AS IT ONCE
WAS…”
“YEA, I MIGHT HAVE AN ATTENTION
PROBLEM- BUT I AM USED TO IT…”
2013 MaxWell Brain David H. Haase, MD
HOW MUCH BRAIN DYSFUNCTION IS
TOLERABLE?
Dyspnea work-up
History - 55 y.o. new onset dyspnea on mild exertion, no wheezing but +allergies
PMFS, Med Hx, etc.
Physical – Auscultation heart, take pulses, skin color, etc.
Would you stop there?
2013 MaxWell Brain David H. Haase, MD
Dyspnea work-up
No. Not for a problem that likely concerns a vital organ. Laboratory testing, Oxygen saturation
ECG, CXR, ECHO, PFT’s, Chest CT, Stress Test etc.
Only then have you likely characterized function in a way
that allows you to make an informed diagnosis and apply the most beneficial therapy.
2013 MaxWell Brain David H. Haase, MD
“MY MEMORY IS NOT AS SHARP AS IT ONCE
WAS…”
“YEA, I MIGHT HAVE AN ATTENTION
PROBLEM- BUT I AM USED TO IT…”
2013 MaxWell Brain David H. Haase, MD
HOW MUCH BRAIN DYSFUNCTION IS
TOLERABLE?
Neuro-Functional Assessment
• Story:
• Symptoms, Beliefs, Behaviors, History, Exposures, etc.
• Skill:
• Performance of Normed Tasks – Attention, Memory, etc.
• Soup:
• Mitochondrial function, Oxidative Stress, Dysglycemia, Toxins, Leaky Gut, Hormone imbalance, Immune activation, Nutrient Deficiencies, Genomics
• Spark:
• Resting pattern of electrical “ruts” - qEEG
• Processing Speed assessment – Multi-Channel ERPs
• Neuro-cardiac and Autonomic System - HRV
2013 MaxWell Brain David H. Haase, MD
Why Measure NeuroFunction?
• To optimally BASELINE, DIAGNOSE and/or plan TREATMENT for:
• Memory complaints, Attention Complaints, Cognition Complaints and Dementia, MCI, HIV, Substance abuse, Depression, ADHD, ADD, Seizure Disorders, Medication use, Delirium, Vascular Disease, Learning disorders, Bipolar, Schizo, Head Injury, DM, Anxiety, Movement d/o
• Before endeavoring to Optimize:
• Athletic Performance, Musical Performance, Surgical Skills, Cognitive enhancement, or Spiritual experience.
2013 MaxWell Brain David H. Haase, MD
Neuro-Functional Assessment
Neuro-Perceptual
(Story)
Neuro-Cognitive
(Skill)
Neuro-Biochemical
(Soup)
Neuro-Electrical
(Spark)
Neuro-Functional Assessment
MaxWell Brain David H. Haase, MD 2013
HOW DO WE ASSESS BRAIN
FUNCTION?
MaxWell Brain David H. Haase, MD 2013
Structural MRI reveals brain anatomy.
Functional MRI (fMRI) reveals brain function.
2013 David H. Haase, MD (Disease-centered labs). (Function-centered labs).
Korn, Focal Cortical Dysfunction and Blood–Brain Barrier Disruption in Patients With Postconcussion Syndrome Journal of Clinical Neurophysiology • Volume 22, Number 1, February 2005
MaxWell Brain David H. Haase, MD 2013
• System is available through:
• Renua Medical:
• Mitch Abrahams
• Sales Director
• 310 430 6957
2013 MaxWell Brain David H. Haase, MD
In my office
• Neuro-Cardiac multi-Functional assessment hardware.
• Wireless amplifier connects with laptop.
2013 MaxWell Brain David H. Haase, MD
Useful Clinical Systems
• System needs to …
• Be Scientifically Valid and Clinically Relevant
• Be Very easy to operate
• Require minimal staff training
• Require minimal clinic space
• Guide better patient care
• Decrease total cost of care for the patient
• Be Revenue generating for hospital/clinic/provider
2013 MaxWell Brain David H. Haase, MD
In my office
• Full study =
• Neuropsych symptom screening
• Eyes Open Quantitative EEG – awake
• Eyes Closed Quantitative EEG – drowsy
• Visual Event Related Potentials
• Auditory Event Related Potentials
• Continuous Performance Testing
• Motor Speed Testing
• Cardiac & Autonomic Testing
• Peak Frequency Analysis
2013 MaxWell Brain David H. Haase, MD
The process
• Cap is placed on patient
• Electro-gel is inserted into cap electrode sites (10-20 distribution of sites) using a blunt needle.
2013 MaxWell Brain David H. Haase, MD
The Process
• After Cap has been placed …
• Enter Basic patient information – presenting symptoms and meds.
• Patient completes symptom checklist
• Patient is lead through EEG/ERP/HRV/performance testing via screen instructions.
2013 MaxWell Brain David H. Haase, MD
Output is a Report
• Contents…
1. Demographics and ***Summary of Findings***
2. Neuropsych Screening & Attention Data
3. HRV & Neuro-Cardiac Data
4. Raw EEG
5. qEEG Brain Maps eyes open and closed
6. Resting State with standard deviations
7. ERP & Peak frequency gradients
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
27 Hz Frontal activity consistent with Bipolar
Disease
2013 MaxWell Brain David H. Haase, MD
27 Hz Frontal activity consistent with Bipolar
Disease
11Hz activity centrally- Supression of
Cingulate Activity
2013 MaxWell Brain David H. Haase, MD
These data indicate high
sensitivity and specificity for
baseline QEEG as a differential
predictor of future cognitive state in
normal, subjectively
impaired elderly.
2013 MaxWell Brain David H. Haase, MD
Effect of HRT on Brain - Right Vigilance
2013 David H. Haase, MD
2013 David H. Haase, MD
High Purity
2013 David H. Haase, MD
Generalizations->
SNEAK PEAK !!!!
qEEG brain maps utility example
• 40 yo female nurse with marked anxiety, panic, inability to perform her job, persistent ruminations, catastrophic thinking, depression, severe insomnia, joint pain, memory loss, abdominal cramping.
• + TPO antibodies 164, TSH 8.4
• Multiple food sensitivities on IgG, hs-CRP of 5.2
• Dx: presumed leaky gut with inflammation induced depression and HPA dysfunction contributing to panic disorder.
• Tx: Elimination diet, Anti-Inflammatory Functional Food, Probiotics, NRF-2 Activating Herbals, Omega 3 Fatty Acids, 5-HTP-controlled release.
2013 MaxWell Brain David H. Haase, MD
2013 MaxWell Brain David H. Haase, MD
Functional food: Dose: 2 scoops in water QD
2013 MaxWell Brain David H. Haase, MD
2 caps Omega 3 oils QD
1 cap PO BID
1 CR tablet PO BID
1 cap PO QD
3 month follow-up
• No workplace anxiety or panic attacks, marked improved sleep. No joint pain, ruminations diminished, memory is sharper. Now she notes that episodes such as this have been a lifelong pattern for her.
• TSH now 2.2, TPO antibodies 136, hs-CRP 0.9
• Still on strict program of wheat, corn, dairy, soy avoidance.
• What about her qEEG?
2013 MaxWell Brain David H. Haase, MD
Post-GI restoration
10-30-2012 2-26-2013
2013 MaxWell Brain David H. Haase, MD
Pre-GI restoration
But Poor Brain Speed
did not Improve
2-26-13 10-30-2012
2013 MaxWell Brain David H. Haase, MD
How does this change what we do?
• Pt. has a far more accurate and realistic understanding of the challenge ahead and the achievements to date.
• Markedly improves adherence with recommended therapies.
• We will step up what has worked and consider more “spark” centric interventions such as neurofeedback, as well as emphasize HRV biofeedback.
2013 MaxWell Brain David H. Haase, MD
EEG-Neurofeedback
Feedback of the brain - for the brain.
Making the pre-conscious available to the conscious mind.
When you inform the brain of what your brain waves are doing, your brain can use that information to change how it works.
• Thatcher, R.W. EEG database guided
neurotherapy. In: J. Evans and A. Arbanel,
editors Introduction to Quantitative EEG and
Neurofeedback, Academic Press, San Diego, 1999
Post-GI restoration
10-30-2012 2-26-2013
2013 MaxWell Brain David H. Haase, MD
Pre-GI restoration Post-NFB
5-21-2013
Marked Improvement in Brain Speed!
2-26-13 5-21-13
2013 MaxWell Brain David H. Haase, MD
• System is available through:
• Renua Medical:
• Mitch Abrahams
• Sales Director
• 310 430 6957
2013 MaxWell Brain David H. Haase, MD
Do you want to continue the conversation?
Then please join the..
MaxWell Brain David H. Haase, MD 2013
“MaxWell Brain” Facebook Group
EEG/ERP/HRV (Evoke) System is available through: Renua Medical:
Mitch Abrahams Sales Director 310 430 6957 [email protected]