Clinical electrophysiologic assessments and mild traumatic brain injury: State-of-the-science and implications for clinical practice

Conventional and quantitative electroencephalography (EEG and qEEG, respectively) may enhance clinical diagnosis and treatment planning provided to persons with mild traumatic brain injury (mTBI) and postconcussive symptoms. Effective and appropriate use of EEG and qEEG in this context requires expert-level knowledge of these technologies, mTBI, and the differential diagnosis for postconcussive symptoms. A practical and brief review from the perspective of a clinician–scientist engaged principally in the care and study of persons with mTBI therefore may be of use and value to other clinicians and scientists interested in these matters. Toward that end, this article offers an overview of the current applications of conventional EEG and qEEG to the study and clinical evaluation of persons with mTBI. The clinical case definition of TBI, the differential diagnosis of post-injury neuropsychiatric disturbances, and the typical course of recovery following mTBI are reviewed. With this background and context, the strengths and limitations of the literature describing EEG and qEEG studies in this population are considered. The implications of this review on the applications of these electrophysiologic assessments to the clinical evaluation of persons with mTBI and postconcussive symptoms are then considered. Finally, suggestions are offered regarding the design of future studies using these technologies in this population. Although this review may be of interest and value to professionals engaged in clinical or research electrophysiology in their daily work, it is intended to serve more immediately the needs of clinicians less familiar with these types of clinical electrophysiologic assessments.

Research Highlights
► EEG and qEEG are used to assess persons with mild TBI and postconcussive symptoms.
► The differential diagnoses of these problems affect EEG and qEEG interpretation.
► These issues are inadequately considered in the qEEG research literature.
► Studies therein often make post hoc ergo propter hoc or cum ergo propter hoc errors.
► This limits the application of qEEG to the evaluation of persons with these problems.