| Wednesday, May 17, 2017
On a daily basis, primary care physicians are responsible for managing a wide variety of patients. Facing patient symptoms that range from headaches to memory problems, fatigue, and anxiety, physicians are charged with determining the root cause of patients’ complaints. And, for an aging patient population fearing neurodegenerative conditions, detecting potential diseases early is critical to providing the most optimal treatment choices. The problem is that objective and sensitive cognitive assessment tools and treatment options are limited when it comes to early detection and differential diagnosis.
Although the brain is seemingly involved in every disease state, few clinical tools allow us to evaluate neurological function itself. Effort-based tests and questionnaires (such as MoCA or MMSE) often fall short in detecting mild or early-on disease presentations. Moreover, they don’t lend much support for differential diagnosis, especially in terms of discriminating dementia from other potentially reversible conditions, such as depression, thyroid disorder, and infection – all of which can mimic neurodegenerative dementia. Perhaps most poignant, these memory questionnaires and effort-based screening measures do not rely on objective biomarkers that allow doctors to target specific brain regions and functional neural networks. This can feed forward into “guess and check” treatment plans that provide symptomatic relief but make a targeted approach that treats the underlying etiology difficult to ascertain.
In a medical system that typically does not afford ample time or resources for exhaustive interviews, testing, or expensive laboratory-based neuroimaging, physicians need a very fast, low-cost, objective, and sensitive test.Rather than relying on paper and pencil tests that do not measure the brain itself, the eVox® System by Evoke Neuroscience allows primary care physicians and specialists to offer a fast, non-invasive, and office-based approach to directly measure nervous system function.
Honing the advances made in electroencephalography (EEG) over the past decade, Evoke has created a clinical tool that analyzes brain and autonomic nervous system function and offers biofeedback treatment solutions. The easy-to-run electrophysiology assessment objectively maps patients’ brains and allows physicians to narrowly identify activity within specific areas, such as hypofunction in the dorsolateral prefrontal cortex that is associated with dementia. The eVox System is designed for in-office use for unmatched accessibility and has been embraced by insurance companies.
The large amounts of electrophysiology data collected are analyzed and turned into a meaningful report of brain function that reflect disease biomarkers and can be utilized for differential diagnosis. Patients can witness objective evidence of their conditions, and track their progress throughout the course of different treatments.
For many patients, the key to designing a successful treatment plan hinges on looking at the brain itself. Such was the case two years ago for a middle-age active duty military patient referred to me for a second opinion. The patient had been recently diagnosed with late-onset Bipolar Disorder. I performed a quantitative electroencephalography (EEG) scan as part of a comprehensive functional brain evaluation with the eVox System. Digital and visual analysis of the EEG showed telltale diffuse neuroinflammation with greater severity over the left and right dorsolateral prefrontal cortex -- regions responsible for mood regulation. These observations did not support a diagnosis of Bipolar Disorder, but instead suggested an inflammatory reaction might be responsible for the patient’s behavioral symptoms. A deeper look into the patient’s history reveled that his symptoms began shortly after a water operations training in a remote part of Asia. The patient was treated for a water-borne infection and prescribed high dose pre- and probiotics. Within 4 weeks, his “manic” and “depressed” symptoms reversed, and his potentially career-ending diagnosis was removed.
While this case might be unique, I have seen this scenario time and time again. Namely, that the appropriate diagnosis and treatment would likely have been missed if not for adding an electrophysiology assessment of brain function to systemic diagnostic tests.
By putting easy-to-use this brain function assessment and neurofeedback technology in the hands of general practitioners, a current gap in brain assessments and training solutions can be closed. An office-based tool yielding sensitive and objective biomarker information to support differential diagnosis and detect early disease states is invaluable for patients with cognitive concerns. It is important to note that not all functional neuroimaging devices being sold are medical grade and designed for physician prescriptive use; and, just as important as tools that are easy-to-use, are those that are easy-to-access, affordable, and are embraced by insurance companies.