Brainwaves measured by an EEG are clinically and scientifically meaningful
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Extensive peer-reviewed literature establishes that brainwaves measured via EEG are widely used and clinically meaningful for conditions such as epilepsy, monitoring, and neurofeedback, as well as scientifically meaningful in neuroscience and cognitive research.
A. Digital EEG is an established substitute for recording, reviewing, and storing a paper EEG record. It is a clear technical advance over previous paper methods. It is highly recommended. (Class III evidence, Type C recommendation). B. EEG brain mapping and other advanced QEEG techniques should be used only by physicians highly skilled in clinical EEG, and only as an adjunct to and in conjunction with traditional EEG interpretation. These tests may be clinically useful only for patients who have been well selected on the basis of their clinical presentation. C. Certain quantitative EEG techniques are considered established as an addition to digital EEG in: C.1. Epilepsy: For screening for possible epileptic spikes or seizures in long-term EEG monitoring or ambulatory recording to facilitate subsequent expert visual EEG interpretation. (Class I and II evidence, Type A recommendation as a practice guideline). C.2. OR and ICU monitoring: For continuous EEG monitoring by frequency-trending to detect early, acute intracranial complications in the OR or ICU, and for screening for possible epileptic seizures in high-risk ICU patients. (Class II evidence, Type B recommendation as a practice option). D. Certain quantitative EEG techniques are considered possibly useful practice options as an addition to digital EEG in: D.1. Epilepsy: For topographic voltage and dipole analysis in presurgical evaluations. (Class II evidence, Type B recommendation). D.2. Cerebrovascular Disease: Based on Class II and III evidence, QEEG in expert hands may possibly be useful in evaluating certain patients with symptoms of cerebrovascular disease whose neuroimaging and routine EEG studies are not conclusive. (Type B recommendation). D.3. Dementia: Routine EEG has long been an established test used in evaluations of dementia and encephalopathy when the diagnosis remains unresolved after initial clinical evaluation. In occasional clinical evaluations, QEEG frequency analysis may be a useful adjunct to interpretation of the routine EEG when used in expert hands. (Class II and III evidence as a possibly useful test, Type B recommendation). E. On the basis of current clinical literature, opinions of most experts, and proposed rationales for their use, QEEG remains investigational for clinical use in postconcussion syndrome, mild or moderate head injury, learning disability, attention disorders, schizophrenia, depression, alcoholism, and drug abuse. (Class II and III evidence, Type D recommendation). F. On the basis of clinical and scientific evidence, opinions of most experts, and the technical and methodologic shortcomings, QEEG is not recommended for use in civil or criminal judicial proceedings. (Strong Class III evidence, Type E recommendation). G. Because of the very substantial risk of erroneous interpretations, it is unacceptable for any EEG brain mapping or other QEEG techniques to be used clinically by those who are not physicians highly skilled in clinical EEG interpretation. (Strong Class III evidence, Type E recommendation).
Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.
<h4>Background</h4>Event-related potentials (ERPs), which are electrophysiological neural responses time-locked to a stimulus, have become an increasingly common tool in language and communication disorders research. They can provide complementary evidence to behavioural measures as well as unique perspectives on communication disorders. ERPs have the distinct advantage of providing precise information about the timing of neural processes and can be used in cases where it is difficult to obtain responses from participants, such as infants or individuals who are minimally verbal. However, clinicians and clinician-scientists rarely receive training in how to interpret ERP research.<h4>Aims</h4>To provide information that allows readers to better understand, interpret and evaluate research using ERPs. We focus on research related to communication sciences and disorders and the information that is most relevant to interpreting research articles.<h4>Method</h4>We explain what ERPs are and how ERP data are collected, referencing key texts and primary research articles. Potential threats to validity, guidelines for interpreting data, and the pros and cons using of ERPs are discussed. Research in the area of paediatric language disorders is used as a model; common paradigms such as the semantic incongruity N400 and auditory mismatch negativity are used as tangible examples. With this foundation of understanding ERPs, the state of the field in terms of how ERPs are used and the ways they may inform the field are discussed.<h4>Main contribution</h4>To date, no review has focused on ERPs as they relate to clinical or communication research. The main contribution of this review is that it provides practical information geared toward understanding ERP research.<h4>Conclusions</h4>ERPs offer insights into neural processes supporting communication and can both complement behaviour and provide information that behavioural measures cannot. We encourage readers to evaluate articles using ERPs critically, effectively pushing the field forward through increased understanding and rigor. What this paper adds ERPs have become more prevalent in research relevant to communication sciences and disorders. In order for clinicians to review and evaluate this research, an understanding of ERPs is needed. This review adds to the field by providing an accessible description of what ERPs are, a description of what ERP components are, and the most relevant commonly used components, as well as how ERP data are recorded and processed. With this foundational understanding of how ERPs work, guidelines for the interpretation of ERP data are given. Though few ERP studies currently have direct implications for clinical practice, we discuss several ways through which ERPs can impact clinical practice in future, by providing information that cannot be obtained by behaviour alone about the aetiology of disorders, and as potential biomarkers of disorder or treatment response.
<b>Background:</b> Posttraumatic stress disorder (PTSD) is a debilitating condition affecting millions of people worldwide. Existing treatments often fail to address the complexity of its symptoms and functional impairments resulting from severe and prolonged trauma. Electroencephalographic Neurofeedback (NFB) has emerged as a promising treatment that aims to reduce the symptoms of PTSD by modulating brain activity.<b>Objective:</b> We conducted a systematic review and meta-analysis of ten clinical trials to answer the question: how effective is NFB in addressing PTSD and other associated symptoms across different trauma populations, and are these improvements related to neurophysiological changes?<b>Method:</b> The review followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. We considered all published and unpublished randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) involving adults with PTSD as a primary diagnosis without exclusion by type of trauma, co-morbid diagnosis, locality, or sex. Ten controlled studies were included; seven RCTs and three NRSIs with a total number of participants <i>n</i> = 293 (128 male). Only RCTs were included in the meta-analysis (215 participants; 88 male).<b>Results:</b> All included studies showed an advantage of NFB over control conditions in reducing symptoms of PTSD, with indications of improvement in symptoms of anxiety and depression and related neurophysiological changes. Meta-analysis of the pooled data shows a significant reduction in PTSD symptoms post-treatment SMD of -1.76 (95% CI -2.69, -0.83), and the mean remission rate was higher in the NFB group (79.3%) compared to the control group (24.4%). However, the studies reviewed were mostly small, with heterogeneous populations and varied quality.<b>Conclusions:</b> The effect of NFB on the symptoms of PTSD was moderate and mechanistic evidence suggested that NFB leads to therapeutic changes in brain functioning. Future research should focus on more rigorous methodological designs, expanded sample size and longer follow-up.
Extended reality (XR) technologies—encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR)—are transforming cognitive assessment and training by offering immersive, interactive environments that simulate real-world tasks. XR enhances ecological validity while enabling real-time, multimodal data collection through tools such as galvanic skin response (GSR), electroencephalography (EEG), eye tracking (ET), hand tracking, and body tracking. This allows for a more comprehensive understanding of cognitive and emotional processes, as well as adaptive, personalized interventions for users. Despite these advancements, current XR applications often underutilize the full potential of multimodal integration, relying primarily on visual and auditory inputs. Challenges such as cybersickness, usability concerns, and accessibility barriers further limit the widespread adoption of XR tools in cognitive science and clinical practice. This review examines XR-based cognitive assessment and training, focusing on its advantages over traditional methods, including ecological validity, engagement, and adaptability. It also explores unresolved challenges such as system usability, cost, and the need for multimodal feedback integration. The review concludes by identifying opportunities for optimizing XR tools to improve cognitive evaluation and rehabilitation outcomes, particularly for diverse populations, including older adults and individuals with cognitive impairments.
Postoperative delirium (POD) has significant implications on morbidity, mortality, and health care expenditures. Monitoring electroencephalography (EEG) to adjust anesthetic management has gained interest as a strategy to mitigate POD. In this Pro-Con commentary article, the pro side supports the use of EEG to reduce POD, citing an empiric reduction in POD with processed EEG (pEEG)-guided general anesthesia found in several studies and recent meta-analysis. The Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) trial is the exception to this, and issues with methods and achieved depths are discussed. Meanwhile, the Con side advocates that the use of EEG to reduce POD is not yet certain, citing that there is a lack of evidence that associations between anesthetic depth and POD represent causal relationships. The Con side also contends that the ideal EEG signatures to guide anesthetic titration are currently unknown, and the potential benefits of reduced anesthesia levels may be outweighed by the risks of potentially insufficient anesthetic administration. As the public health burden of POD increases, anesthesia clinicians will be tasked to consider interventions to mitigate risk such as EEG. This Pro-Con debate will provide 2 perspectives on the evidence and rationales for using EEG to mitigate POD.
Collection of electroencephalographic (EEG) data provides an opportunity to non-invasively study human brain plasticity, learning and the evolution of various neuropsychiatric disorders. Traditionally, due to sophisticated hardware, EEG studies have been largely limited to research centers which restrict both testing contexts and repeated longitudinal measures. The emergence of low-cost "wearable" EEG devices now provides the prospect of frequent and remote monitoring of the human brain for a variety of physiological and pathological brain states. In this manuscript, we survey evidence that EEG wearables provide high-quality data and review various software used for remote data collection. We then discuss the growing body of evidence supporting the feasibility of remote and longitudinal EEG data collection using wearables including a discussion of potential biomedical applications of these protocols. Lastly, we discuss some additional challenges needed for EEG wearable research to gain further widespread adoption.
This critical review synthesizes findings from quantitative electroencephalography (QEEG) to bridge the gap between systems-level neurophysiology and the underlying cellular pathology of Attention-Deficit/Hyperactivity Disorder (ADHD). As a prevalent neurodevelopmental disorder, ADHD diagnosis is challenged by symptomatic heterogeneity, creating an urgent need for objective biological indicators. Analysis of QEEG data reveals consistent neurophysiological patterns in ADHD, primarily an excess of Theta-band activity and a deficit in Beta-band activity. These findings have led to the proposal of specific biomarkers, such as the Theta/Beta Ratio (TBR), and serve as the basis for neurofeedback interventions aimed at modulating brainwave activity. While not a standalone diagnostic tool, this review posits that QEEG-based biomarkers and Neurofeedback responses are systems-level manifestations of putative cellular and synaptic dysfunctions. By outlining these robust macro-scale patterns, this work provides a conceptual framework intended to guide future molecular and cellular research into the fundamental biology of ADHD.
<h4>Background</h4>Physical exercise is recognized as a potential strategy to mitigate the cognitive decline associated with mild cognitive impairment (MCI). This systematic review aims to examine the specific effects of physical exercise on cortical brain activity in patients with MCI, an area that has not been thoroughly explored.<h4>Methods</h4>We conducted a search across 9 electronic databases for randomized controlled trials assessing the impact of physical exercise on the cortical activity of patients with MCI. The search covered the period from database inception to September 2023. Literature screening, data extraction, and quality assessments were carried out by 2 independent researchers. Meta-analyses were conducted using RevMan 5.3, and publication bias was evaluated using STATA 17.0. This study primarily assessed P300 latency and amplitude, alongside cognitive evaluations using the mini-mental state examination and Montreal Cognitive Assessment.<h4>Results</h4>Six high-quality randomized controlled trials, involving a total of 360 participants, were included. Compared to the control group, significant enhancements were observed in the amplitude of central midline electrode (mean difference [MD] = 1.64 [95% confidence interval [CI], 0.92-2.36]; P < .00001), frontal midline electrode (MD = 2.70 [95% CI, 2.02-3.38]; P < .00001), and parietal midline electrode (MD = 2.42 [95% CI, 0.44-4.41]; P = .02). Latency periods of the central midline electrode (MD = -32.40 [95% CI, -40.27 to -24.54]; P < .00001), frontal midline electrode (MD = -12.57 [95% CI, -30.83 to 5.69]; P = .18), and parietal midline electrode (MD = -12.57 [95% CI, -30.83 to 5.69]; P = .81) were also notably influenced. Moreover, overarching cognitive functions as measured by mini-mental state examination (MD = 1.02 [95% CI, 0.61-1.43]; P < .00001) and Montreal Cognitive Assessment (MD = 1.39 [95% CI, 0.67-2.12]; P = .0002) exhibited marked improvement.<h4>Conclusion</h4>This meta-analysis suggests that physical exercise can augment the P300 amplitude, reduce the P300 latency period, and, overall, enhance cognitive functionality in individuals with MCI.
Lucid dreaming refers to the phenomenon of becoming aware of the fact that one is dreaming during ongoing sleep. Despite having been physiologically validated for decades, the neurobiology of lucid dreaming is still incompletely characterized. Here we review the neuroscientific literature on lucid dreaming, including electroencephalographic, neuroimaging, brain lesion, pharmacological and brain stimulation studies. Electroencephalographic studies of lucid dreaming are mostly underpowered and show mixed results. Neuroimaging data is scant but preliminary results suggest that prefrontal and parietal regions are involved in lucid dreaming. A focus of research is also to develop methods to induce lucid dreams. Combining training in mental set with cholinergic stimulation has shown promising results, while it remains unclear whether electrical brain stimulation could be used to induce lucid dreams. Finally, we discuss strategies to measure lucid dreaming, including best-practice procedures for the sleep laboratory. Lucid dreaming has clinical and scientific applications, and shows emerging potential as a methodology in the cognitive neuroscience of consciousness. Further research with larger sample sizes and refined methodology is needed.
specific clinical settings. Visual interpretation of EEG is subject to inter-rater and intra-rater variability. Voltage fluctuations measured by the EEG bio
Electroencephalography (EEG)
is a method to record an electrogram of the spontaneous electrical activity of the brain. The bio signals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex and allocortex. It is typically non-invasive, with the EEG electrodes placed along the scalp (commonly called "scalp EEG") using the International 10–20 s
EEG and the related study of ERPs are used extensively in neuroscience, cognitive science, cognitive psychology, neurolinguistics, and psychophysiological research, as well as to study human functions such as swallowing. Any EEG techniques used in research are not sufficiently standardised for clinical use, and many ERP studies fail to report all of the necessary processing steps for data collection and reduction, limiting the reproducibility…
EEG can detect covert processing (i.e., processing that does not require a response)
EEG can be used in subjects who are incapable of making a motor response
Some ERP components can be detected even when the subject is not attending to the stimuli
Unlike other means of studying reaction time, ERPs can elucidate stages of processing (rather than just the result)
the simplicity of EEG readily provides for tracking of brain changes during different phases of life. EEG sleep analysis can indicate significant aspects of the timing of brain development, including evaluating adolescent brain maturation.
In EEG there is a better understanding of what signal is measured as compared to other research techniques, e.g. the BOLD response in MRI.
EEG is an extremely useful technique for studying brain activity, but the signal measured is always contaminated by artifacts which can impact the analysis of the data. An artifact is any measured signal that does not originate within the brain. Although multiple algorithms exist for the removal of artifacts, the problem of how to deal with them remains an open question. The source of artifacts can be from issues relating to the instrument, such as faulty electrodes, line noise or high electrode impedance, or they may be from the physiology of the subject being recorded. This can include, eye blinks and movement, cardiac activity and muscle activity and these types of artifacts are more complicated to remove. Artifacts may bias the visual interpretation of EEG data as some may mimic cognitive activity that could affect diagnoses of problems such as Alzheimer's disease or sleep disorders. As such the removal of such artifacts in EEG data used for practical applications is of the utmost importance.
Early detection of cognitive decline remains one of the major challenges in contemporary neurology. Although event-related potentials associated with cognitive processes, particularly the P300 component, as well as resting-state EEG analysis, have long been investigated as potential functional biomarkers of dementia, their clinical application is often limited by methodological heterogeneity and insufficient transparency of signal processing procedures. In this article, we present a reproducible EEG-ERP methodology based on proprietary software for stimulus generation, synchronization, and deterministic averaging of visual event-related potentials, combined with quantitative analysis of resting-state EEG frequency. The approach integrates precise stimulus timing, transparent offline synchronization using an audio marker recorded on the ECG channel, and a fully deterministic averaging procedure. Pilot clinical data obtained from patients with mild cognitive impairment and dementia are included to illustrate the feasibility of the proposed workflow. • Software-controlled visual stimulation with fixed inter-stimulus intervals and explicit offline synchronization using an audio marker. • Deterministic ERP averaging enabling reliable estimation of P300 latency in routine clinical EEG recordings. • Integration of resting-state EEG frequency and P300 latency as interpretable electrophysiological markers of cognitive decline.
Audiovisual Entrainment (AVE) is a non-invasive, non-pharmacological neuromodulation approach that aims to align brain activity with externally delivered auditory and visual rhythms. This review surveys AVE's historical development, technical parameters (e.g., frequency, phase, waveform, color, intensity, presentation mode), components and delivery methods, reported clinical applications, and safety considerations. Given the heterogeneity of AVE protocols and terminology, we conducted a structured narrative review (PubMed, Scopus, Google Scholar; earliest records to July 2025), including human and animal studies that met an operational definition of regulated AVE and consistent administration of specified auditory and visual frequencies, with critical methodological details reported. We highlight AVE's accessibility and versatility, outline a stepwise parameter reporting framework to support standardization, and discuss putative mechanisms via sensory and oscillatory pathways. However, current findings are heterogeneous and include null or limited effects. Mechanistic understanding and parameter optimization remain insufficiently developed, and premature claims of efficacy are not warranted. Rigorous, standardized, and adequately controlled studies are needed before AVE can be considered a reliable therapeutic tool.
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