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Journal of Clinical EEG & Neuroscience, April, 2009Evidence-Based Neurobehavioral ElectrophysiologyEditorial: John R. Geddes, Guest EditorEvidence-based medicine (EBM) has become an increasingly influential approach to taking stock of clinical knowledge, helping clinicians to keep up-to-date. When the evidence for a treatment is overwhelming and there are many randomized trials – for example, prevention of depressive relapse with long-term antidepressants,1 most people can see the sense and utility of following the rules of EBM. Concern has been raised about the outcomes of applying the procedures of EBM when the evidence is less secure on the basis that this might lead to a dogmatic and unhelpful distinction between “evidence-based” and “non-evidence-based” clinical interventions.2 As with any other powerful methodology, EBM can be misused, and many critiques seem to refer more to these abuses than to the procedures of EBM themselves.3 An overly simplistic application of EBM would clearly be inappropriate in many investigational areas because to do so would be to miss the crucial link between clinical innovation and exploratory science in the development of better diagnostic, prognostic and therapeutic maneuvers. The objective of the articles in this issue of Clinical EEG and Neuroscience is to provide an objective and comprehensive overview of the state of the clinical application of electrophysiology in specific neuropsychiatric disorders. I think it is fair to say that, while there was considerable enthusiasm for this project (reflected in the high quality of the papers), there was also some concern expressed about using an evidence-based approach to evaluate progress within this field. There was debate about the extent to which the EBM approach was valid in an area with so much diagnostic uncertainty and where the focus of effort is still mainly into etiology and pathophysiology. These and other issues are eloquently discussed by Professor Buchsbaum. We hope that these articles nonetheless provide a useful, systematic review of the area and help demonstrate the promise of electrophysiology as an investigational tool and, potentially, as a reliable measure of clinical phenotype.
John R. Geddes, MD, FRCPsych REFERENCES |
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