Brain Fog

Discussion in 'Fibromyalgia Main Forum' started by rge, Mar 17, 2003.

  1. rge

    rge New Member


    TELEPHONE: (704) 543-0427
    FORENSIC EVALUATION FAX: (704) 543-0423

    July 10, 2002

    Quantitative Electroencephalogram
    U.S. Patent# 5, 267, 570



    REASON FOR EVALUATING: (1): To provide objective data as to whether
    or not this patient experiences these dysfunctions and disabilities
    due to an illness which may be documented in the central nervous
    system, and to provide evaluation regarding present level of
    cognitive functions and physical function. (2): To provide
    information and a baseline for help in designing a treatment approach
    for this patient as requested by physician for evaluation of memory
    loss, confusion and inability to concentrate. (3): To aid the patient
    in issues concentrating ability to work if applicable.

    PROCEDURE: EEG data was acquired in the raw mode using the
    standard International 10-20 System. Data was then transformed into
    a Topograph display, which summarizes EEG data in an easily
    understood color-coded map. The topogragh display is organized into
    vertical columns and horizontal rows. Each vertical column of oval
    topographs shows the activity in a selected band of EEG frequencies.
    The top of each column is numbered to designate the band defined by
    the user. The b@ds (from left to right columns) are delta, theta and

    Each oval topogragh depicts a view of the head from above. The
    forehead is at the top, and the left and right sides, respectively.
    The color scale representing low to high power is displayed as a
    vertical bar to the left of the ovals.

    The bottom row is labeled "REL" (relative). This row maps the full
    color-scale spectrum across the entire amplitude range of the three
    bands. Each topogragh is color coded toindicate how much power it
    contains relative to the other two topographs.

    The top row of oval topographs is labeled "ABS" (absolute). When one
    band has little activity relative to another band, it is difficult to
    clearly see the distribution of power in that band because of the few
    mapped into it. The absolute frequency measurement solves this
    problem by mapping the full color-scale spectrum into each band.

    Topographic brain mapping is performed in some or all of the
    following conditions: (1) Resting with eyes open. (2) Resting with
    eyes closed. (3) Eyes fixed. (4) Subject reading. (5) Subject
    listening. (6) Digits forward and backwards memory testing. (7)
    Bender/Gestalt testing.

    The normal resting record consists of just alpha rhythm in the
    posterior leads and beta in the anterior leads.

    Typical findings for metabolic encephalopathy patients: A brainwave
    signature has evolved among metabolic encephalopathy patients. This
    signature consists of slow activity. Slow activity may be divided
    into generalized slow and lateralized slow activity. The lateralized
    pathology, while generalized slowing suggests a more diffused
    condition. Generalized slowing may indicate toxic, metabolic,
    bacterial or degenerative disorders. Mild to moderate theta slowing
    or markedly slow with delta activity shifting from right to left
    without persistent lateralization is a common pattern in these
    patients. Another record frequently seen in these patients is on
    showing very high voltage that is frontal, positive slow and sharp
    waves the look like eye-blink artifacts. At times they have
    triphasic nature.

    Diffuse, rhythmic, frontal delta patterns are more commonly seen in
    toxic and metabolic disorders than in intracranial diseases.
    Metabolic encephalopathy records vary from a drowsy record with alpha
    activity in the mild cases to very slow activity in all channels,
    which may appear to be about the same bilaterally. There is
    sometimes waxing and waning of the degree of amplitude of slowing,
    depending on the amplitude of slowing, depending on the level of
    awareness, oxygenation, and variation in cerebral perfusion. This is
    the record consistent with metabolic encephalopathy. In the most
    severe cases, the whole record consists of rolling; very slow (½ - 2
    Hz) waves on all head regions. All records described above would
    result in mental status changes for these patients.

    Anterior versus posterior effects: As a general rule, postcentral
    abnormalities are associated with specific sensory or perceptual
    deficits or both. Dysfunctions that do ' not involve the postcentral
    cortex are unlikely to produce specific sensory or perceptual
    disturbances. Motor dysfunctions and control problems are more apt
    to show up when dysfunctions are precentral.

    Focal versus diffuse effects: Focal (concentrated in one place)
    abnormalities of brain function typically produce relatively
    circumscribed and only partial intellectual losses. The simplest and
    most telling evidence of focal abnormality is lateralazation: if the
    impairment pattern implicates functions associated with only one
    hemisphere, then in all probability, the condition is due to a
    discrete localized abnormality. It may be more difficult to identify
    a focal abnormality correctly if it involves both hemispheres,
    particularly if it is relatively large, extends into subcortical
    areas, or accompanies intracranial pressure. @The intellectual
    effects of diffuse conditions tend to appear as nonspecific slowing:
    diminished ability for complex mental activities, such as reasoning,
    planning and abstract conceptualization; general impairment of
    memory, concentration and attention; and generalized mental

    SPECIAL PROCEDURES: Mr. Eheman was evaluated in two sessions:
    the first QEEG was acquired without being exposed to or ingesting
    water indigenous to his home region. The second evaluation was
    performed following ingestion of water potentially contaminated with
    fluoride, the offending agent under investigation.

    Due to the on-going decline in health and Mr. Eheman's strong desire
    to receive help and a proper diagnosis, QEEG evaluation was performed.


    Specific findings: Background activity is disorganized and consists
    primarily of moderate amplitude delta and theta activity. Delta
    activity appears in all cortical regions at moderate voltage during
    brain activation, appearing at highest voltage in the right temporal
    region and the left parietal region. As brain activation continues,
    theta becomes higher in voltage in the anterior regions, especially
    in the left hemisphere and into the sensory motor region, which
    correlates with the limbic regions of the brain. The left hemisphere
    is primarily responsible for analytical and numerical calculations.
    Beta activity is recorded as suppressed in all regions with the
    exceptions of some focal beta activity in the visual cortex which
    suggests a compensatory brain response to the dysfunctional frontal
    and temporal regions, in this patient the right occipital region is
    more activated than the left. The most functional cortical regions
    are represented in the left and right temporal regions.

    The record began with Mr.. Eheman awake with eyes open and minimizing
    blinking. During this state, generalized 3-per-second spike-wave
    complexes were seen with highest amplitude in the frontal regions,
    extending into the sensory motor region. Duration of the discharges
    was 2-7 seconds. Cognitive challenge augmented the spike-wave
    complexes. As cognitive challenge continued and became more
    difficult, a single spike was observed with maximal negativity at
    CZ. The spike did recur during the record. Alpha activity
    isrecorded at abnormally high levels and amplitudes in a diffuse
    fashion from all cortical regions during brain activation. Relative
    beta. activity is recorded as suppressed by the higher amplitude slow

    Focal attenuation of EEG activity, especially loss of beta activity,
    is always a sign of cerebral dysfunction. Occipital abnormalities
    can cause unilateral loss of the posterior alpha. Unilateral slow
    abnormalities may also disrupt sleep patterns so that sleep spindles,
    vertex waves, or both are seen from the affected hemisphere. A
    review of the raw data confirms these abnormalities for this patient.


    Specific findings: Background activity is extremely disorganized and
    consists primarily of high amplitude delta activity recorded from all
    cortical regions, highest in the anterior brain regions. This delta
    activity lateralizes to the left fronto-polar region. Theta activity
    is recorded in high amplitude, primarily in the central, parietal and
    occipital regions. Beta activity becomes suppressed. The most
    functional beta activity is recorded in the left temporal region.

    STATISTICAL ANALYSIS In a blinded study, evidence to back-up findings
    in interpreting the raw EEG data was performed. The P value of each
    variable selection was less than .02; and utilizing a student's T-
    test allowed for 90% specificity and 90% sensitivity. -

    A ratio analysis was performed which was band specific. Total
    microvolts were then reviewed by comparing data in a cognitively
    challenged state to the eyes closed, relaxed condition. By
    mathematical derivation the following were ratios specific to
    patients found positive for the illness of CFIDS:


    Delta <2.556 0.563
    Theta <1.565 0.815
    Beta <1.311 0.496

    Total uV ratios
    <1.413 0.726

    This patient tested positive for all four variables to be classified
    as a CFIDS patient. The four variables are representation of brain
    function as measured through the production of brain waves. CFIDS is
    most likely an illness resulting from a post-viral, post-bacterial or
    metabolic disease. The extreme and debilitating fatigue experienced
    could be classified
    as a "central fatigue" designating an origin in the central nervous


    Delta: 0.649

    Theta: 0.465

    Beta: 0.513

    Total uV ratios: 1.024

    IMPRESSION: Mr. Eheman's QEEG prior to drinking the water was
    abnormal. The
    abnormalities are primarily in the ratios to total brain activation.
    The prominence of slow wave activity is recorded in the delta and
    theta frequencies. The lack of beta activity also represents an
    abnormal finding.

    Following the exposure to water, Mr. Eheman's delta activity
    increased, theta activity decreased due to the higher amplitude
    pathological delta activity. Beta activity increased very slightly.
    This may represent a cortical irritability combined with the
    patient's attempt to perform well on the neuropsychometric tests.
    Performance on these tests declined sharply from the pre-to post
    water drinking. This is evidenced further in the overall microvolts
    of brain activation: total brain function declined in the post-water
    drinking QEEG.

    CONCLUSIONS: Extremely abnormal QEEG due to the diffuse delta and
    theta activity and the lack of brain activation in the beta range in
    the frontal and temporal regions. This pattern correlates with the
    patient's report of severe cognitive loss. Abnormalities such as
    these correlate with the limbic system and immune dysfunction, the
    fatigue, the cognitive problems. It is important to note that the
    pre-water evaluation was quite abnormal, confirming the chronicity of
    the patient's illness. The post-water drinking decline correlates
    with the patient's history of fluoride poisoning. Exposure to this
    toxin exacerbated the neurophysiological disruption.

    Focal attenuation of EEG activity, especially loss of beta activity,
    is always a sign of cerebral dysfunction. Occipital abnormalities
    cause unilateral loss of the posterior alpha. Unilateral slow
    abnormalities may also disrupt sleep patterns so that sleep spindles,
    vertex waves, or both are seen from the affected hemisphere. A
    review of the raw data confirms these abnormalities for this patient.

    Mr. Eheman clearly exhibits diffuse brain dysfunction, which
    typically results from a widespread condition such as a metabolic
    disease including heavy metal poisoning. This indicates a neurotoxic
    poisoning. Fluoride is a neurotoxin that acts on postsynaptic
    receptors. This neurotoxic condition correlates with the disrupted
    brain physiology and the secondary development of Chronic Fatigue
    Immune Dysfunction and Fibromyalgia Syndrome. Unfortunately, there
    is no known effective treatment for these conditions.

    In my professional opinion and to the best of my knowledge, Mr.
    Eheman is completely disabled from any gainful employment at the
    present time and the foreseeable future.

    Myra Preston, Ph.D.
    Clinical Neurophysiology/Psychophysiology