Eeg En Patologia Psiquiatrica

SPECIAL ARTICLES

Electroencephalographic
Cerebral Dysrhythmic
Abnormalities in the
Trinity of Nonepileptic
General Population,
Neuropsychiatric, and
Neurobehavioral
Disorders
Bhaskara P. Shelley, M.B., B.S., M.D., D.M.
Michael R. Trimble, M.D., F.R.C.P.,
FRCPsych
Nash N. Boutros, M.D.
Subclinical electroencephalographic epileptiform
discharges in neurobehavioral disorders are notuncommon. The clinical significance and behavioral, diagnostic, and therapeutic implications of
this EEG cerebral dysrhythmia have not been
fully examined. Currently the only connotation
for distinctive epileptiform electroencephalographic patterns is epileptic seizures. Given the
prevailing dogma of not treating EEGs, these potential aberrations are either disregarded as irrelevant or aremisattributed to indicate epilepsy.
This article reappraises the literature on paroxysmal EEG dysrhythmia in normative studies of the
“healthy” nonepileptic general populations, neuropsychiatry, and in neurobehavioral disorders.
These EEG aberrations may be reflective of underlying morpho-functional brain abnormalities that
underpin various neurobehavioral disturbances.
(The Journal ofNeuropsychiatry and Clinical
Neurosciences 2008; 20:7–22)

J Neuropsychiatry Clin Neurosci 20:1, Winter 2008

E

ver since the introduction of the EEG by the psychiatrist Hans Berger,1 an important target of clinical neurophysiology research has been to identify the
electroencephalographic correlates of human behavioral
disorders and psychopathologies. Much of the pioneering work of Hans Bergerinvolved schizophrenia and
other serious psychiatric disorders. The interested
reader may be referred to the earliest treatise of EEG
abnormalities in schizophrenia by Hill.2 Over the course
of the last six decades, a voluminous literature has
emerged that substantiated a high prevalence of conventional EEG findings in the psychiatric population.
Numerous epidemiological studies of large“healthy”
nonepileptic populations were conducted to define and
establish the limits of the normative EEG. Such studies
have documented a wide range of prevalence rates of

Received December 30, 2006; revised April 21, 2007; accepted May 25,
2007. Dr. Shelley is affiliated with the Raymond Way Neuropsychiatry
Research Group at the Institute of Neurology at Queen Sq., London;
Dr. Trimble is affiliatedwith the Institute of Neurology at Queen
Square, London; Dr. Boutros is affiliated with Wayne State University
School of Medicine in Detroit, Michigan. Address correspondence to
Dr. Bhaskara P. Shelley, MBBS, M.D., D.M., Head, Department of Neurology, Father Muller Medical College, Karnataka, Mangalore-575 002,
India; bpshelley@yahoo.com (e-mail).
Copyright 2008 American PsychiatricPublishing, Inc.

http://neuro.psychiatryonline.org

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ELECTROENCEPHALOGRAPHIC CEREBRAL DYSRYTHMIC ABNORMALITIES
EEG dysrhythmia in the nonepileptic general population.
Although the existing EEG literature is replete with
reports of abnormalities in association with different
neuropsychiatric disorders, only a few generalizations
can be made between particular EEG patterns and disorders. Thestrong (and relatively straightforward) correlation that has been established between EEG abnormalities and epilepsy has overshadowed the more
complex relationship between EEG abnormalities and
psychiatric disorders. Moreover, the prevailing concept
of “not treating the EEG” led to further de-emphasizing
such EEG deviations. These issues prompted us to critically and systematically reappraisethe extensive available literature, which spanned almost six decades, on
EEG dysrhythmia to dissect the EEG-behavior equation,
address the merits and demerits of various studies, and
examine the validity of such EEG findings in the current
environment of evidence-based medicine. The interested reader is referred to the reviews of Hill & Parr3 on
EEG correlates of psychopathic behavior and...