Wes' Quantitative Electroencephalogram

 

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

Date of Test:              03-15-99

Date of Report:          05-15-99

 

PRIMARY SYMPTOMS:

Using the Multiple Symptom Questionnaire the patient reported the following as symptoms experienced "frequently with severe effect":

• poor memory
• noise sensitivity
• physical. fatigue and sluggishness
• balance problems
• pain and aches in joints and muscles
• stiffness and limitation of movement
• heat and cold intolerance
• cold hands and feet
• chemical and odor sensitivities
• numbness and tingling sensations
• insomnia and unrefreshing sleep
• flushing and hot flashes

The most debilitating symptoms are reported as "bilateral shoulder pain and forearm, hand, finger tingling, fatigue that comes on when the above starts, and lack of sleep when the ache and tingling are happening, despite fatigue." The date of onset is reported as 11-18-97 beginning with a neuropathy.  The patient reports the reason for seeking this test is to "diagnostically document the slow brain problem."  A head injury is reported in 1978.

 

REASON FOR EVALUATION:

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 function and physical function.
2. To provide information and a baseline for help in designing a treatment approach for this patient.
3. To aid the patient in issues concerning 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 topograph 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 bottom of each column shows the band width as defined by the user.  The bands (from left to right columns) are delta, theta, and beta.

 

Each oval. topograph depicts a view of the head from above.  The forehead is at the top, and the left and right ears are at 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 Iabeled "REL" (relative).  This row maps the full color scale spectrum across the entire amplitude range of the three bands.  Each topograph is color coded to indicate 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 backward 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.

 

BRAIN DAMAGE:

HIV causes brain damage that complicates all the related emotional disturbance and therapeutic demands.  In fact, some authorities believe that any serious and lasting change in mood or mental status in a person with HIV should be regarded as a result of the infection until there is proof to the contrary.  Neuropsychological deficiencies and neurological symptoms are common at more advanced stages of the illness, and brain tissue studies of AIDS patients usually show inflammation and gliosis (the overgrowth of non-nervous supportive tissue) in the brain.

 

Some of the damage is caused by opportunistic infection and other secondary disorders.  Symptoms of toxoplasmosis may include personality changes as well as tremors, paralysis, and blindness.  The fungal diseases cryptococcoses and candidiasis can attack the brain and cause symptoms that resemble dementia.  These infections can usually be treated, but treatment must continue for a lifetime to prevent recurrence.  Other assaults on the mind and brain are more difficult to cope with - the cancer known as non-Hodgkin's lymphoma and the viral diseases leukoencephalopathy and cytomegalovirus (CMV).  Brain functioning in people with AIDS may also be affected by syphilis, tuberculosis, liver and kidney failure, or cerebrovascular strokes.  In one study of men who tested positive for HIV, 40% developed at least one secondary disorder affecting the brain over an eight-year period.

 

AIDS-RELATED DEMENTIA:

Even before opportunistic infections or cancers appear, the human immunodeficiency virus itself gains entry to the brain through two types of immune cells, monocytes and macrophages.  The resulting disorder, the most common single neurological complication of AIDS has been called AIDS dementia complex (ARC), AIDS-related dementia, HIV encephalopathy, and, most recently, HIV associated dementia (or, in its milder forms, HIV-associated-motor-cognitive disorder).  The symptoms include absentmindedness, apathy and withdrawal, forgetfulness and disorientation, slow and unsteady speech, and sometimes irritability, poor judgment, and socially inappropriate behavior.  Neurological symptoms and loss of motor coordination are also common; tremors and paralysis may occur in the late stages.  Until recently, about 25% of people with AIDS showed at least mild symptoms of dementia, and 30% to 50% were somewhat cognitively impaired at the time of death.  This disorder is especially devastating in children.  Before antiviral drugs were introduced, most HIV-infected children became seriously retarded.

 

Little can be. done to treat the disorder, apart from relieving symptoms with antidepressants, stimulants, and antipsychotic drugs.  One reason is that the cause is unknown.  Often the brain itself contains little of the virus, and it is not clear whether a higher level of virus is correlated with severe symptoms of dementia.  Neurons are not directly infected but may die from poisons secreted by infected monocytes and macrophages.  According to one theory, these toxins are free radicals (negatively charged molecules) that cause the excitatory neurotransmitter glutamate to flood the neurons with calcium.  Researchers are exploring drugs that block receptors for glutamate and associated transmitters.  AZT has been shown to delay the onset of dementia, and the protease inhibitors probably have some effect as well, although they do not pass easily from the bloodstream to the brain.  Dementia may persist even while physical health improves, because some infected cells usually remain in the brain even after treatment with antiviral drugs.

 

SPECIFIC FINDINGS:

Background activity is slow and disorganized.  Abnormal slow wave activity in the delta range is recorded in a diffuse fashion from all cortical regions in the relative scale during brain activation.  Theta activity is recorded in a diffuse fashion in the frontal and central regions, and is also representative of abnormal slow wave activity during brain activation.  Delta activity is suppressed in all anterior cortical regions.  An area of focal beta activity is recorded in the right temporal and central regions.

 

IMPRESSION:

Severely abnormal QEEQ due to the presence of diffuse delta activity, focal theta activity, and the suppression of functional beta activity with the exception of focal beta in the right hemisphere.  This record correlates with the patient's complaints of mental status changes due to the delta activity, the presence of theta activity in the awake state confirms the presence of a sleep disorder.  Physical fatigue and lethargy would be expected with this record.