# I?m off for an EEG Scan (Neurophysiology)



## Guest (Feb 2, 2007)

So I got a letter through my door today asking to phone my hospital up to make an appoint to scan my head and see if I have a brain, I phoned them and made an appointment for next Wednesday at 3:15pm, so now I will find out whether I have ?Temporal Lobe Epilepsy? or not ? I?ll keep you up to date =)

The "Chill out wave":


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## Pablo (Sep 1, 2005)

Good luck. Im not sure if this is a strange question but what do you want the results to be? because if they find a problem then you have something to get to grips with and target to treat you so it might be good, but if they find nothing then that means you are healthy in terms of brain activity so that is also good, so which is best do you think?


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## Guest (Feb 2, 2007)

Pablo said:


> Good luck. Im not sure if this is a strange question but what do you want the results to be? because if they find a problem then you have something to get to grips with and target to treat you so it might be good, but if they find nothing then that means you are healthy in terms of brain activity so that is also good, so which is best do you think?


Thanks mate. No that?s a good question because I?ve already thought about it.

What I was thinking myself was:

If it turns out I have TLE, I will then be labeled and know ?why? all this shite has happened to me, but then it will mean it?s a ?physical? problem which means it would be hard to treat and sort out.

If it turns out I haven?t got it? I?ll be disappointed because I will still not been in the ?know? about what is wrong with me ect?

So as you can see I?m taking the ?positive? thinking approach with it :? .

I want to live a life which seems worth while, and now is a good time while I?m still young.


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## Guest (Feb 3, 2007)

SAME here, it was terrible not knowing what this was, when i got the call saying i was fine i was relieved but soo dissapointed, i hate the unknown


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## Guest (Feb 3, 2007)

Cloverstone said:


> When I went for my EEG I had high hopes that they would find something that could explain this but then again I would have to be medicated for the rest of my life so I was torn. Truthfully though when it came back without explanation I was very, very disappointed.
> 
> I too am going for a bunch of tests this Wednesday in the hopes of being diagnosed with a very possible disease...my psych and I have determined that I have approximately 90% of the symptoms. Even though it would be life altering and minimally, possibly life threatening (in the long term) I am actually excited at the prospect of living with something other than DP.
> 
> This kind of thinking would sound insane to most people but they haven't experienced what we have obviously. So I hope it turns out in the best way possible for you Darren, whichever way you want it to. :wink:


Hello future wife, how are you? =)

Yes, it?s like a double edge sword isn?t it? Either way I think I?ll be crying =*( *Puts arms out to receive a hug* =P.

You?re ?doing? some tests on Wednesday too? Well ?snap? then =P. which disease would that be if you don?t mind me asking *puppy eyes*. Yeah I know what you mean, when you?ve assumed you?ve had something for so long, it weakens you? so to hear it?s something else mite interest you for a start? I hope it isn?t anything bad though.

Awww you so sweet *cuddles nice lady friend* Good luck to you as well ?puts your real name here(I don't want to upset you if you don't want others knowing your real name)?.


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## Guest (Feb 3, 2007)

Jgard10 said:


> SAME here, it was terrible not knowing what this was, when i got the call saying i was fine i was relieved but soo dissapointed, i hate the unknown


Every one hates the "UN"known, that?s why we?ve made up loads of shite to make it seem like there?s some point to live. =)


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## Guest (Feb 3, 2007)

My results:


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## Guest (Feb 4, 2007)

I believe I?m also a hypochondriac? it?s kinda hard to admit that. No it?s not fair enough, I?m gonna PM you to find out because I want everything my own way =P

I think I may know which ?exotic disease? you?re on about, I?ll PM ya about it chief.



Cloverstone said:


> The tests I am going for are only one of many possibilities. (As a hypochondriac myself, I would rather not say because I know the reaction most people would have and don't want to scare anyone. If however it turns out positive I would share the info so that others could look into it and maybe get tested.) Fair enough?
> 
> After more than 5 years with the same psychiatrist, he is starting to believe that there may be a physical cause (of possibly a more exotic disease) that is keeping me stuck in the DP/DR cycle. He has had DP'ed patients before and thought that I would have recovered by now after all of the work that we have done. :?
> 
> It is something kind of bad but almost anything is better than a life sentence with chronic DP.


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## Guest (Feb 8, 2007)

It went well... I chatted the nurse up *rude not too* and she told me quite a lot about what the EEG scan is was all about. I nearly fell a sleep which was funny... heh. The heavy breathing for 2-3 minutes was weird, my whole body felt as if it had pins and needles... but my left arm was worse because it had a type of pulsation with tinges...

Now I just have to wait and see what the deal is.


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## DannyD (Sep 14, 2006)

when will you get the results?

have you ever been on any meds, and are you on any currently? if so which ones, if you dont mind telling?

thanks man,


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## Guest (Feb 11, 2007)

The lady would have read my results last Friday and i've been told it could take anything up to a month, but maybe 2-3 weeks.

Yeah i've tried all the different anti depressants families, No i'm not taking any at the moment.

You're welcome, that be ?5 payable to "[email protected]" via paypal =P


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## medo (Dec 19, 2006)

Emulated Puppet}eer said:


> The lady would have read my results last Friday and i've been told it could take anything up to a month, but maybe 2-3 weeks.
> 
> Yeah i've tried all the different anti depressants families, No i'm not taking any at the moment.
> 
> You're welcome, that be ?5 payable to "[email protected]" via paypal =P


It is quite possible that your cause is physical. I think its same with me unless anxiety caused my everyday dizziness, eye pain, ear sensation etc...


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## Guest (Feb 12, 2007)

medo said:


> It is quite possible that your cause is physical. I think its same with me unless anxiety caused my everyday dizziness, eye pain, ear sensation etc...


Why do you say it's "quite possible" that it is a physical cause? Anxiety alone can cause all of them which you just said.


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## medo (Dec 19, 2006)

Emulated Puppet}eer said:


> medo said:
> 
> 
> > It is quite possible that your cause is physical. I think its same with me unless anxiety caused my everyday dizziness, eye pain, ear sensation etc...
> ...


I know it can but doesnt mean it did. See, when i touch my right ear the dizziness almost knocks me out every time. That doesnt sound like anxiety to me. and dizziness + dp look a lot alike.


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## Guest (Feb 12, 2007)

How does touching your right ear nearly knock you out? Are you cutting off the blood to that ear (Yeah I know, it wouldn?t be possible) I think you?ve addressed a ?trigger? while touching your right ear, you may have assumed that touching it causes you to become dizzy (before the first time it happened) and so you?ve reinforced that belief due to anxiety.

I just don?t see how ?touching? it would nearly knock you out, what part of the right ear does that to you, any part of it?

P.s I've just woke up.


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## Guest (Feb 28, 2007)

Nothing abnormal in the results, I'm really pleasure =)


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## Guest (Feb 28, 2007)

Thats great news Darren :wink:

Greg


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## Guest (Feb 28, 2007)

Cheers pal... time to focus on therapy... or maybe I need to avoid focusing on anything at all.


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## Coming?Back2Life (Oct 20, 2006)

How did u get sent for this brain scan darren i`m very interested to know as i`ve had nothing but simple blood tests and urine tests??


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## Guest (Mar 2, 2007)

I put my fist up to my doc's face... seemed to work *shrugs*

Just kept saying? I wanted my brain scanning, just winded him up till he gave up *Sweet smile*.


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## Guest (Jul 11, 2007)

My councellor printed this off for me:










Thoughts?... :?


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## Guest (Jul 12, 2007)

What are you worried about D?

Greg


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## David Kozin (Jan 11, 2005)

Here is my qEEG results for individuals with Hallucinogen Persiting Perception Disorder...

given for contrast:

---------------------------------------

LETTER TO PATIENT FROM PRIMARY PHYSICAN

I have received the full quantitative EEG report from Dr. *****?s lab at Children?s Hospital. As I suspected, it is not a normal study. Generally, it shows electrical abnormalities, particularily in the posterior region of the nervous sytem, and particularily in the visual evoked potential study, a measure of visual function. The good news is that this is consistent with HPPD, and indicated no other ongoing problem, such as epilepsy. I am enclosing a copy for your records.

MEDICAL RECORD FROM NEUROPHYSIOLOGY LABORATORY: Children?s Hospital, Boston, Massachusettes

BRAIN ELECTRICAL ACTIVITY MAPPING (BEAM)
QUANTITATIVE ELECTROENCEPHALOGRAM (qEEG)

This report consists of 5 parts:

* ELECTROENCEPHALOGRAM ANALYSIS and ELECTROENCEPHALOGRAM IMPRESSION
* SPIKE TOPPOGRAPHY IMPRESSION
* SPECTRAL ANALYSIS and SPECTRICAL IMPRESSION
* EVOKED POTENTIALS ANALYSIS and EVOKED POTENTIALS IMPRESSION
* SUMMARY OF FINDINGS

ELECTROENCEPHALOGRAM IMPRESSIONIn the waking, eyes closed state this is 1 hour and 6 minutes record reveals 11 Hz well developed symmetrical and reactive occipital alpha atop otherwise low amplitude background. There is a well developed anterior-posterior gradient. Anteriorly, the experienced amounts of beta and theta are seen for age. In mild drowsiness on two occasions, a low amplitude spike is seen in the left parietal region. No other discharges are seen. Well developed stage 2 sleep is seen with symmetrical spindle and vertex waves. Throughout the photic stimulation fails to activate discharges but shows a normal driving response. Stimuli used to form evoked potentials do not activate discharges. Hyperventilation shows age appropriate buildup but without activation of seizure discharges. Ctenoids or 14 & 6 bursts are noted in the right temporal region (T6)

Electroencephalogram Impression

A borderline record due to the appearance of two low amplitude spikes in the left parietal (P3) electrode in drowsiness and light sleep. Otherwise waking and sleep background are normal. Alpha is well developed. The normal variant rhythm of ctenoids (14 and 6) is noted.

SPIKE TOPOGRAPHYSpike Topography Impression

Ctenoids (14 and 6) are noted in the right posterior temporal electrode (T6). Occasional left parietal (P3) low amplitude spikes are documented.

SPECTRAL ANALYSISThe walking, eyes closed record reveals delta and theta to be the maximal in the central vertex region. Alpha is seen in the parietal and central regions as well as in the occipital region left more then right. Betas 2 and 3 are seen to be maximal in the occipital region right more that left. Beta 3 is seen to be artifact dominated. In comparison to an age appropriate normal database theta is increased by 3.49 SD broadly in the frontal and central regions without asymmetry. Spectral analysis of the EEG background in the eyes close state reveals delta to be maximal in the occipital region. Theta is seen to be maximal in the central vertex region. Alpha and the beta spectral bands are seen to be maximal in the occipital region. In comparison to an age appropriate normal database, Thete is increased by 2.56 SD bilaterally in the fronto-central region with no asymmetry. Alpha is seen to peak at 22 Hz (mean alpha peak for age is 10 Hz). The relative (%) spectral data are within normal limits. The symmetry function is within normal limits.

Spectral Analysis Impression:

An abnormal EEG spectral background due to excessive bifrontal and central theta with no evident asymmetry. Also is seen to peak at 11 Hz, 1 Hz above mean for age.

EVOKED POTENTIALSThe VER to flash stimuli shows very high amplitude response with very prominent late time locked alpha. In comparison to an age appropriate normal database from 68-104 msec there is broadly but symmetrically increased posterior negativity by 6.08 SD. From 288-324 msec there is excessive posterior positively by 2.87 SD. From 340-376 msec there is increased biposterior positively by 5.09 SD also related to time locked alpha. The AER to click stimulate shows very normal morphology although the P2 component is slightly delayed. Amplitudes are overall normal. In comparison to an age appropriate normal database from 216-252 msec the delayed P2 shows excessive central positively by 2.64 SD

Evoked Potential Impression

A very abnormal flash VER with extremely high amplitude posterior activity but without asymmetry. In contrast the click AER is quite normal in morphology although the P2 is slightly delayed. Thus the AER is borderline.

SUMMARY OF FINDINGSThe brain EEG is borderline due to two left parietal (P3) low amplitude spikes. Otherwise waking and sleep background are within normal limits. Spike topography confirms the P3 spike foci.Sprectral data are surprisingly abnormal with consistently excessive fronto-central theta. Alpha is seen to peak at 1 Hz fast for age 11 Hz. the VER to flash stimuli is extremely high amplitude, whereas, the click AER is of normal amplitude. No EP asymmetries are noted, however.

*Overall this is an abnormal study. The astoundingly high amplitude VER apmplitude, the fast alpha, and the left parietal spikes may somehow be related to the patient?s hallucinations. Spikes always raise the possibility of a seizure disorder; however, such occipital over-reactivity may be associated with post-substance abuse hallucinations short of frank seizures. The front theta raises the possibility of a mild encephalopathic process as well.*

*********, MD

This qEEG was reprinted with the permission of the patient.


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## David Kozin (Jan 11, 2005)

WHAT IS EEG? (reprinted with permission from Dr. Duffy)

To understand qeeg one must first understand EEG. EEG is the abbreviation for electroencephalography. Small, non-invasive electrodes (usually 16 to 32 in number) are placed upon a patient?s scalp, after careful measurement by a trained technologist, with paste or a glue like substance to hold them in place. Low voltage signals (5-500 microvolts) are amplified by the EEG machine and results are typically written by ink-fed pens on a moving paper strip chart. The resulting polygraphic strip chart, looking much like a multiple channel seismograph, is typically read by unaided visual inspection. The physician interpreting such a tracing is usually a neurologist with special training in EEG. Such an individual is often referred to as a neurophysiologist or electroencephalographer. Psychiatrists, neurosurgeons, and psychologists may also interpret EEGs but to do so, like neurologists, they require special EEG training. Board certification is available in EEG and other aspects of neurophysiology from several organizations. Similarly EEG technologists should have special training in EEG and may become ?registered?.

Techniques for interpretation of EEG by visual inspection have changed little since EEG?s discovery in the 1920s by Berger and its extension to clinical issues in the 30s and 40s by Gibbs, Lennox, Lombroso. Typically the EEG is screened for features that stand out ( transient responses) like the spike or spike and wave associated with epilepsy. Next the frequency or spectral content of the remaining EEG background is visually evaluated. There are four broad spectral band of clinical interest: delta (0-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), and beta (above 12 Hz). Not everyone agrees on the exact boundaries of these rhythms and many subdivide these bands, especially beta. Pathology typically increases slow activity (delta, theta) and diminishes fast activity (alpha, beta). Thus overlying a localized brain tumor one would expect increased slowing and decreased fast activity. Similarly following a global brain insult resulting in a global encephalopathy one might expect globally increased slowing and decreased fact activity. However, there are many exceptions to this oversimplified explanation. EEG interpretation requires considerable skill and often years of clinical experience. The mere determination of whether an EEG spectral band is normal, increased, or decreased may require years of experience. Some have likened EEG reading to the grading of equine or canine conformation by judges who have spent their careers learning what to look for. EEG interpretation is as much an art as a science.

Modern advances in EEG have included what is referred to as digital EEG or dEEG. Here brain signals are similarly collected from the scalp and amplified but are fed into a computer (i.e., digitized) and then interpreted by viewing them not on paper but on the computer screen. Important advantages include storage of efficient digital media rather than on bulky paper. Another advantage is the ability to view the same EEG signals from different perspectives - paper affords only one view of a time period. A draw-back is that the computer screen may not afford the same clarity of image that is available on paper. Another advance is the more speedy placement of electrodes by using an elastic cap with electrodes already imbedded. Careless use of this technology may result in improperly positioned electrode or poor electrode contact.

EEG has survived the advent of all the modern neuroimaging techniques including pneumoencephalography, arteriography, CT scanning, MRI, fMRI, SPECT and PET and remains the number one diagnostic test for epilepsy. Its advantages, among other measures of brain function, is that demonstrates a nearly diagnostic finding in epilepsy and it is the most sensitive functional test to changes in brain function over short time periods. It lacks primarily in ability to localize exactly where in the brain abnormalities arise. Clinically, therefore, EEG is often combined with other neuroimaging tests. Training in EEG is also very demanding with the value of a given EEG to a patient often determined by who interprets it. This is very true in pediatric EEG and especially true for newborn EEGs. The child and neonatal EEGs are not simply smaller versions of adult EEG. Pediatric EEG is a most demanding specialty.

Good solid texts in EEG are provided by Hughes and also by Neidermeyer.

WHAT IS qeeg?

Introduction

To understand qeeg one must first understand EEG. qeeg, or quantitative EEG, began in the 1970s and early 80s as an attempt to extract from brain electrical activity more than what could be readily appreciated by simple, unaided visual inspection of EEG. In that sense qEEG should be viewed as an extension of and not a replacement for traditional EEG. Clinically, as now used, qEEG should always follow the preparation and analysis of the classic EEG (or dEEG). The human eye is still superior to the computer in many aspects of brain signal analysis. Pioneers in qEEG include names such as Bickford, Duffy, Harner, John, Lehmann, Ueno, and many others.

Spectral Analysis and Mapping

To assist in the estimation of EEG spectral content (one of the most difficult tasks by visual inspection), EEG data are entered into a computer, as for qEEG, and spectral content is rigorously determined by the use of techniques of mathematical signal analysis (typically by the FFT or Fast Fourier Transform algorithm). One of the first problems was how to visualize results since qEEG typically uses more channels than EEG. The solution was to map the results using colored grey scaling on schematic maps of the head. To some, such brain electrical activity mapping or simply ?mapping? is taken as synonymous with qEEG. However mapping is only a display technique and only the first step. The heart of qEEG lies with the underlying computerized analytic and statistical techniques.

Spectral Coherence

A special results of spectral analysis is the measure of coherence between two electrodes. It assesses the similarity of spectral content of two electrodes over time and is usually taken to reflect a measure of ?coupling? between brain regions. It is virtually impossible to estimate coherence by visual EEG inspection. Some illnesses may begin with abnormalities of cortical coupling. Leuchter has reported such abnormalities in Alzheimer's disease and Thatcher found abnormality of coherence as the best discriminator of mild closed head injury.

The SPM (statistical probability maps)

Such spectral maps provide excellent displays of the spatial distribution of EEG spectral content and are clinically useful as such. However, it soon became evident that in some way it would be necessary to estimate when such data were outside of normal bounds for a patients age. This lead, first, to the need for and the development of normative data bases of brain electrical activity at all ages. Second, it lead to the development of the technique of mapping not just a patient?s brain activity but also the degree of statistical deviancy of the patient from the normal data base (in units of standard deviation of Z-scores). Such images of deviancy are referred to as SPM (statistical or significance probability maps). Thus a neurophysiologist may look at a SPM and locate regions of possible clinical abnormality by deviant regions on the SPM. The term ?encephalopathic? often refers to brains with excessive EEG slowing. A typical application would be to determine whether behavioral disturbance in an adult is due to early dementia (increased slowing) or otherwise uncomplicated depression (no increase of slowing). qeeg techniques add significant power to the search for subtle encephalopathic change. Although developed first for qEEG analyses, the SPM technique has been widely adapted for use with other neuroimaging techniques.

Long Latency Evoked potentials

Another area where qEEG techniques have been applied is to the long latency sensory evoked potentials. EEG represents the brain?s ambient, spontaneously ongoing electrical activity. Evoked potentials (EPs) are the brain's transient response to externally applied stimuli - such as light flashes, auditory clicks, and mild electrical shocks. These stimuli form, respectively, the visual evoked response or potential (VEP), auditory EP (AEP) and somatosensory EP (SEP). Since the EEG is much higher amplitude than the EP, it is necessary to apply a stimulus repetitively at random times and average the result so as to effectively remove the random background EEG and visualize the EP. This computerized technique is often referred to as signal averaging. Classic neurophysiology employs a few EP channels and evaluates the short latency response (e.g., under 30 msec). When obtained these signals are seen to arise from specific deep brain structures and allow for assessment of structures within the brain stem and thalamus. When longer latencies (longer times from stimulation) are evaluated, signals appear to be coming from the cortical mantle. Unfortunately the complex waveform morphologies from a large set of such long latency EPs can be very difficult to analyze by unaided visual inspection. However with the use of normative data bases and the SPM technique, regions of clinically important abnormality can be delineated within the complex combined spatial-temporal information within long latency EP data sets. Many qEEG laboratories incorporate the long latency EP along with spectral analyzed EEG signals and traditional EEG as part of their routine clinical studies. Such EP data tend to be sensitive to clinical conditions where cortical dysfunction is hypothesized (e.g., dyslexia, schizophrenia, Alzheimer's disease) although they are also often found to be abnormal in epilepsy.

Discriminant Analysis

Discriminant analysis refers to the established "multivariate" statistical technique whereby a multiplicity of gathered data (multiple variables) are combined into a single number (the discriminant function) in such a way that this new variable (the discriminant) maximally separates two patient populations. John, Duffy, and Thatcher have all demonstrated that when discriminant analysis is applied to qEEG data, resulting discriminant functions are accurate in classifying individual subjects into clinically relevant diagnostic groups (e.g., head injured or not, dyslexia or not, bipolar vs. monopolar depression, etc). Such discriminants are more widely used for psychiatric than neurologic issues.

Epileptic Source Analysis

A major goal in the neurophysiologic investigation of patients with epilepsy is to locate the epileptic focus. This involves determining where inside the three dimensional brain, the abnormal signals are generated using only data gathered from the intact scalp. This is a key prelude to removal of the epileptic focus by neurosurgical procedure. Considerable progress has been made in our ability to calculate, from simple scalp recorded segments containing epileptic spikes, where these signals arise. Scherg has been a leader in the development of brain electrical source analysis or besa. It involves calculation of a source assuming a multi-sphere brain model. Other techniques (using boundary or finite element analyses) such as that pioneered by Fuchs use MRI constructed realistic head models. Multisphere calculations permit better separation of multiple epileptic sources, whereas, realistic head models allow for better representation of results with the patient?s own brain structure. This technology is rapidly improving and it is likely to shown increasing use and value in the combined neurological and neurosurgical investigation of epileptic patients.


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## Guest (Jul 12, 2007)

Hiya *Greg*? It?s the part which quotes ?On one occasion there is some irregular theta/sharp activity on the left, more marked frontally?

So with there not being any ?significant/important? abnormalities? does that mean the irregular theta sharp activity is ?normal?? and could there be some other abnormalities which aren?t ?significant/important? which relate to my disorder?

The letter just lacks information.

Thanks mate.


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## Guest (Jul 12, 2007)

Thank you very much for that information NODID. I can't really make much of it out because i'm really tired which has made my brain fog return and this does not help my Dyslexia. I've just come home from my English class a hour early due to being unable to focus well. Does this mean that my EGG scan was good enough to analyse my brain patterns... or do I need one of these qEEGs?

Thanks again.


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