Do we value ERP's and EEG in Belgium ?

Probably not, as the KCE (federal centra of execellence and knowledge) has judged those techniques to be of not enough EBM value to grant them further reimbursement. Exit EP and ERP. Hans Berger may turn in his Jena grave but it's not sure that this will change their harsh ruling. Although they claim to have found no evidence for any diagnostic value, all scientific developments go against such statements. So we have a clash of opinion here that will need further democratic (no censorship please) as well as scientific debate. As starters a copy from the ECNS proceedings 2008 (Frankfurt) 11. Evidence Based Electrophysiology of Neurobehavioral Disorders Chair: Moore N, Johnston City, TN Evidence Based Medicine Evaluation of Electrophysiological Studies of the Anxiety Disorders Clark CR, Moores KA, Penrose R, Flinders University, Adelaide, Australia Galletly CA, Ash DJ, McFarlane AC, University of Adelaide, Australia We provide an evidenced based medicine review of the use of electrophysiology in the anxiety disorders. It highlights functional similarities across the disorders and identifies patterns that differentiate disorder classifications. Electrophysiological measures offer reliable and objective clinical indicators of brain dysfunction within individuals, providing biomarkers for the improvement of diagnostic specificity and for informing on treatment decisions and prognostic assessments. Common to most anxiety disorders is a basal instability in cortical arousal, as reflected in measures of quantitative electroencephalography (qEEG). Resting EEG measures tend to correlate with symptom sub-patterns and be exacerbated by condition-specific stimulation. Also common are condition-specific difficulties with sensory gating and attentional control. These are clearly evident from event-related potential (ERP) measures of information processing in OCD, PTSD, PD, GAD and the phobias. Other ERP measures clearly differentiate the disorders, but with considerable variation across studies in relation to inclusion and exclusion criteria, medication status and control group selection. Historically, study numbers have tended to preclude the derivation of reliable diagnostic biomarker patterns but this is now being overcome with the development of databases of brain and cognition function, and the potential for inclusion of electrophysiological measures in disorder classification as foreshadowed for DSM-V. Evidence-Based Medicine and Electrophysiology in Schizophrenia Galderisi S, Mucci A, Volpe U, University of Naples SUN, Naples, Italy Boutros N, Wayne State University, School of Medicine, Detroit, MI, USA The present contribution focuses on qualitative and quantitative EEG and P300 abnormalities as diagnostic tests for schizophrenia. The PubMed clinical query was used; key-words were schizophrenia and EEG/P3/P300. Inclusion criteria were: a diagnosis of schizophrenia confirmed by DSM-III/ICD-9 criteria or later editions; the inclusion of both a schizophrenia and a healthy control group; qualitative or spectral EEG findings or amplitude measures for P3. The included studies were reviewed to verify results homogeneity and the presence of information needed for systematic review and meta-analysis. Studies meeting all requirements were classified according to the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. No standard/clinical EEG study was OCEBM level 3b or better. For spectral EEG most studies qualified as level 4, and 25% as level 3b or better. An increase of delta and theta activity in patients was reported by most studies, while negative or discrepant findings were reported in less than 5% of them. For P3 amplitude reduction, 63% of the studies qualified as level 3b or better. Only 6.8% reported negative findings and none reported opposite results. Moderate effect sizes were found for spectral EEG delta and theta increase, and a large effect size for P300 amplitude reduction. Evidence-Based Evaluation of Diagnostic Accuracy of EEG in Dementia and Mild Cognitive Impairment Jelic V, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden Consistent reports on the validity of the EEG method in dementia work-up and an evidence based consensus on appropriateness of this method in the initial evaluation of patients with suspected cognitive disorder and dementia is missing. Using an evidence-based technique we searched for articles on diagnostic accuracy of spontaneous EEG in dementia disorders published from 1980 until June 2008. Forty-six articles were retrieved that strictly satisfied inclusion criteria. Figures on sensitivity and specificity across the studies varied widely, positive likelihood ratio in studies reporting classification accuracies between patients with Alzheimer’s disease and normal aging ranged between 2.3 and 38.5, and diagnostic odds ratios consequently showed large variations between 7 and 219. Although reported indexes of accuracy are in general high they are obtained and optimised on different clinical populations with variable sample size and disease severity, have large confidence intervals and results, therefore, cannot be extrapolated to other clinical populations. Joint effort of preferably multicentre studies using uniform standards should develop optimised methods, investigate added diagnostic value of EEG in clinically established dementia diagnosis and, more importantly, predictive utility of EEG in mild cognitive impairment and questionable dementia.