GTSG

Medication proposer

Practical example: EEG/ERP-based medication decision-making in ADHD

The beforehand by HBImed report generator and Copilot developed EEG report serves as the basis. This includes an accurate medical history, comprehensive questionnaire, a neuropsychological examination and a semi-automatically analyzed EEG/ERP data. The report is automated to systematically according to analyzed the documents for the EEG/ERP-based medication decision-making. Behind the decision-making algorithms, extensive data from Pubmed and experienced specialists stand. The medication proposer service as a recommendation. The responsibility remains, of course, the doctor.

Example: Patient Data

Personal Data

Age: 15 years old (born 03.04.2010)

Gender: female

Diagnostics

Main diagnosis: ADHD, with mixed symptoms of inattention and hyperactivity-impulsivity

Co-morbidities: atopic dermatitis, emotional sensitivity

Special Circumstances

Twin pregnancy, twin sister with ADHD diagnosis, multilingual budget

Current Medication: None

EEG parameters: Arousal and vigilance

Arousal classification (PRIORITY 1)

Arousal-Index: Mainly used in the optimal Zone (O1: 39.6%/4, O2: 33.4%/4 PO)

Classification: Normal Arousal → Symptom-oriented treatment

Vigilance Parameter (PRIORITY 2)

Vigilance-Slope: the Decreased slope in all test conditions (Stanine 1)

Instability index: Increased variability (Stanine 7-8) in Go-terms and conditions

Importance: Significant decrease in the vigilance over the test of time → Activating logs

Sensory Integration (PRIORITY 3)

Somatosensory Index of: standard range (left Hemis.: 15.3%/3, right Hemis.: 32.1%/4 PO)

Drug consequence: Normal Index → Standard ADHD treatment

Spectral Abnormalities

Theta/Beta Ratio: Increased frontal (Fz: Stanine 7), and particularly the parietal (Pz: Stanine 9 in the case of EC, Stanine 8 in VCPT)

Alpha-abnormalities: Increased low Alpha activity O1 (7.81 Hz, Z=2.81), and C3 (9.52 Hz, Z=3.22)

Frontal Midline Theta: Not specifically mentioned, but parietal Theta-increase (Pz: 7.81 Hz, Z=2.95)

Evoked Potentials

Evoked potentials are CRUCIAL for the medication of choice:

Evoked Potentials

Early sensory components

P1N1 visually: Early-latency (fast detection), but late reactivation (control uncertainty)

Rating: Normal to fast visual processing

Attention and Executive potential

P300: Decreased P3 Amplitude in the Central cortex (C4) in the NoGo-condition

P300 findings: Suggests difficulty in inhibiting automatic responses

Inhibition and conflict monitoring

Conflict monitoring (P4): High early, but flat major potentials (indifference/perplexity)

CNV (readiness potential): Flat amplitudes (low activation/preparation processes)

ADHD Subtyping based on EEG

Functional Network Analysis

Network 1: prefrontal cortex

65% – dysfunctional attention/Executive network

Network 2: cinguläres System

56% – Adaptability/Flexibility

EEG characteristics speak for mixed-type, with a focus on inattention:

  • Increased Theta/Beta Ratio (frontal and parietal)
  • Normal Arousal but vigilance problems
  • Decreased inhibition performance in evoked potentials

Medication recommendation based on EEG profile

Primary Medication Recommendation

Methylphenidate as first-line therapy:

  • Justification:
  • Increased Theta/Beta Ratio (characteristic of methylphenidate Response)
  • Normal somatosensory Index
  • Algorithmic Responder Probability: 85%
  • Swiss guidelines: methylphenidate mandatory first-line in ADHD

Dosage and Alternatives

Dosage:

  • Start: 5-10mg/day
  • Slow increase under EEG control
  • Objective: reduction of the Theta/Beta Ratio

Additional Considerations:

In case of insufficient Response or side effects:

  • Amphetamine preparations for the activation of the Central sensory Kortexes

Non-pharmacological measures

Dietary Supplement

  • Omega-3 fatty acids (1000-2000mg/day EPA)
  • Magnesium (200-400mg/day)

Physical Activity

  • Structured physical activity
  • Regular Movement Breaks

Light therapy

In the case of vigilance problems is highly recommended

Behavioral interventions

  • Self-monitoring techniques for attention control
  • Structured learning environment with visual AIDS
  • Regular breaks during longer work periods

Monitoring Protocol

Baseline

In front of medication to the start (already exists)

History

Every 6 months during long-term therapy

Clinical Parameters:

  • Weight/Size: on a Monthly basis in the case of stimulants
  • Cardiovascular Parameters
  • Liver and kidney values control
  • School performance and attention

Safety aspects and summary

Safety Aspects (Age Group 15 Years)

Relative contraindications note:

  • Caution with SSRI/SNRI (risk of suicide in <18 years)
  • Monitoring on emotional changes

Summary

EEG-based classification: ADHD by the mixed type, with a focus on inattention, normal Arousal-Regulation but significant vigilance problems.

Primary recommendation: methylphenidate therapy (5-10mg/day initial) based on the characteristic of the Theta/Beta Ratio patterns and algorithmic Responder probability.

Combination therapy: Non-pharmacological-based measures (Omega-3, Magnesium, structure) parallel to the drug treatment.

Prognosis: Good Response probability with adequate dosing and Monitoring. Vigilance problems to speak of the need to activate the treatment.

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