Dr. Price and Colleagues Reply

To the Editor: We appreciate Dr. Fink’s letter and would like to respond. Without suggesting a better alternative, he states that the term “abnormality” used to describe changes in EEGs is a term used in clinical neurology that is not applicable to describing the effects of psychoactive drugs. We respectfully disagree.

Since the EEG was invented in 1929, the term “abnormality” has been used by convention as applying to any EEG that is not considered normal. It is well recognized that abnormal EEGs may have no deleterious functional consequences. Likewise, in our article, we did not imply that the EEG abnormalities suggested a deleterious clinical effect. In fact, we stated that “The present study was unable to specify the clinical significance of EEG abnormalities encountered….Prospective studies are required to define the clinical significance of specific types and levels of EEG abnormalities” (p. 114). We commented that our study “encourage[s] prospective EEG analyses before and during treatment with specific drugs and objective ratings of clinical changes” (p. 114).

We also acknowledged Stevens’s 1995 article, among others (see references 34–37), regarding the as-yet-unsettled controversy surrounding abnormal EEG changes possibly heralding the efficacy of clozapine.

The main points in our article were that

1. Various psychoactive drugs may alter the EEG architecture in predictable ways.

2. These EEG abnormalities can be seen by routine EEG inspection without requiring computer processing.

3. The interpretation of EEGs must be careful to avoid misattribution of these psychoactive drug changes to underlying disease.

4. The use of EEGs in psychiatric populations should be reinvigorated given their possible implications regarding diagnosis, function, and prognosis.

It is for these reasons that we defend the use of the term “EEG abnormalities” and disagree that it “degrades the science.”