Brain Assessment: How to Easily Add ERP, qEEG, and ...assets.a4m.com/.../webcast_pdfs/...David-Haase.pdf · •Eyes Open Quantitative EEG – awake •Eyes Closed Quantitative EEG

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

• Mitcha@renuamedical.com

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

• Mitcha@renuamedical.com

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 Mitcha@renuamedical.com