A Neurologist's Advice for Mental Health Professionals on the Use of QEEG and Neurofeedback

I am a practicing neurologist. I graduated from medical school in 1960 and finished my residency in 1965. I had the usual electroencephalography (EEG) training during my residency which involved three months of reading EEGs side by side with an electroencephalographer (Ralph Druckman). I learned EEG by the apprentice method. At first, he would point out what was real and what was artifact. Then he began to point out various transients and to ask what they represented (artifact, normal physiology, or some type of pathology). At first, he would dictate the reports, always emphasizing the clinical relevance of the findings and suggesting possible treatment. Recognition of epileptiform activity was strongly emphasized, as well as recognition of focal or generalized slow wave activity. The importance of digital analyses and databases was not yet recognized (paper EEG only). When I finished my residency, I entered academic medicine and the EEGs were read by more thoroughly trained (board certified) electroenephalographers. Later I became associated with an epilepsy monitoring unit, took additional training in EEG, and became board certified in EEG. Then, I began to read EEGs on a daily basis, eventually interpreting several thousand. When the first QEEG machines came out, I got one and learned about the additional difficulties of using and interpreting QEEGs. The QEEG databases and discriminants developed by E. Roy John (John, Prichep, Fridman, & Easton, 1988) proved more helpful than raw EEG in differential diagnosis of nonepileptic problems (dementia versus depression, unipolar versus bipolar depression, multi-infarct dementia versus Alzheimer’s, performance anxiety versus ADD, etc.). Later work by Suffin and Emory (1995) showed that QEEG