1. Aetna considers the use of quantitative EEG (brain mapping), also known by the acronym BEAM (Brain Electrical Activity Mapping), medically necessary only as an adjunct to traditional EEG for any of the following:

   1. For screening for possible epileptic spikes or seizures in long-term EEG monitoring; or
   2. For ambulatory recording of EEG to facilitate subsequent expert visual EEG interpretation; or
   3. For continuous EEG monitoring by frequency-trending to detect early, acute intracranial complications in the operating room or intensive care unit (ICU); or
   4. For screening for possible epileptic seizures in high-risk ICU members; or
   5. For topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy; or
   6. For evaluation of certain members with symptoms of cerebrovascular disease whose neuroimaging and routine EEG studies are not conclusive; or

   7. For evaluation of dementia and encephalopathy when the diagnosis remains unresolved after initial clinical evaluation.

2. In accordance with the American Academy of Neurology / American Clinical Neurophysiology Society's assessment and available evidence, Aetna considers the use of quantitative EEG experimental and investigational for all other indications, including any of the following diagnoses because there is inadequate scientific evidence to prove its clinical usefulness for these indications:

   • Post-concussion syndrome
   • Mild or moderate head injury
   • Learning disability
   • Attention disorders
   • Schizophrenia
   • Depression
   • Alcoholism
   • Drug abuse
   • Tinnitus

   • Predicting response to psychotropic medication.

See also CPB 480 - Tourette Syndrome.

Quantitative EEG, a technique for topographic display and analysis of brain electrophysiological data, has been proposed for use in the diagnosis of various psychiatric disorders.  Clinical studies have demonstrated distinctive forms of brain electrical activity in psychiatric conditions including attention deficit disorder, schizophrenia, major depression, and obsessive-compulsive disorder.  However, the clinical significance of these distinctive patterns of brain wave activity is unknown. Thus the role of quantitative EEG in diagnosis, evaluation of disease progression, and treatment of these conditions has yet to be elucidated.  A report from the American Academy of Neurology and the American Clinical Neurophysiology Society concluded that quantitative EEG remains investigational for clinical use in post-concussion syndrome, mild-to-moderate head injury, learning disability, attention disorders, schizophrenia, depression, alcoholism, and drug abuse.

While there is some evidence that electroencephalograph activity differs between normal control subjects and subjects suffering from tinnitus, additional evidence is needed to evaluate the value of including quantitative EEG in a battery of electrophysiological tests for the clinical identification of a predominantly central type of tinnitus.  In addition, there is little evidence to support the use of quantitative EEG to determine the need for change of medications in the treatment of tinnitus.

Crumbley and associates (2005) examined the use of quantitative EEG in predicting response to psychotropic medication.  The clinical outcomes of two groups of patients were compared: (i) those with prescribed medication regimens that were concordant with the quantitative EEG predictors, and (ii) those whose medication regimens were discordant with the quantitative EEG predictors.  Participants included 70 adolescent inpatients who were administered quantitative EEG upon admission.  The results indicated no significant difference in clinical outcome between the two groups.  The failure of this study to find significant differences in patient outcomes questions this particular use of the quantitative EEG (Crumbley, et al., 2005).

John and Prichep (2006) noted that as quantitative EEG and pharmaco-EEG have evolved, a vast body of facts has been accumulated, describing changes in the EEG or event-related potentials observed in a variety of brain disorders or after administration of a variety of medications.  With some notable exceptions, these studies have tended to be phenomenological rather than analytical.  There has not been a systematic attempt to integrate these phenomena to provide better understanding of how the abnormal behaviors of a particular psychiatric patient might be related to the specific pattern of the deviant electrical activity, nor just how pharmacological reduction of that deviant activity may have resulted in more normal behavior.

Snyder and Hall (2006) performed a meta-analysis on the use of quantitative EEG in evaluating patients with attention-deficit hyperactivity disorder (ADHD).  The 9 eligible studies (n = 1498) observed quantitative EEG traits of a theta power increase and a beta power decrease, summarized in the theta/beta ratio with a pooled effect size of 3.08 (95 % confidence interval, 2.90, 3.26) for ADHD versus controls (normal children, adolescents, and adults).   These investigators concluded that this meta-analysis supports that a theta/beta ratio increase is a commonly observed trait in patients with ADHD relative to normal controls.  Moreover, they noted that since it is known that the theta/beta ratio trait may arise with other conditions, a prospective study covering differential diagnosis would be needed to determine generalizability to clinical applications.  Furthermore, standardization of the quantitative EEG technique is also needed, specifically with control of mental state, drowsiness, and medication.