Bipolar disorder traits: An electroencephalogram systematic review

Bipolar disorder (BD) is a serious mental disorder that globally affected 40 million people in 2019. According to the National Alliance on Mental Illness (NAMI), the present state of scientific knowledge only permits psychiatrists to diagnose BD using subjective and imprecise questionnaires. Therefore, developing a diagnostic tool with objective and precise biomarkers should be a major focus of research in this field. Among the potential biomarkers for BD, electroencephalogram (EEG)-based signatures of BD are considered to be the most optimal marker due to their strong links with behavioural symptoms and also their non-invasiveness. The goal of this review is to give a detailed summary of current techniques for investigating the traces of BD through EEG abnormalities. In this review, 13 studies from databases such as ScienceDirect and PubMed seeking to utilize EEG characteristics to diagnose BD were selected. The search keywords were “EEG in BD diagnosis”, “EEG microstates in BD”, and “EEG features for BD patients”. The publication date was set from 2007 to 2021. From these studies, we synthesize the effects of BD on each EEG feature, as well as detail the pros and cons when using each feature as a biomarker for BD. Results showed that EEG microstates demonstrate their potential among the seven EEG properties discussed in this article, as shown by several studies. By definition, EEG microstates are a dynamic representation of the spatial distribution of the scalp's electric potential as it varies over time. Specifically, four microstate classes recorded in different brain regions are classified into A (right-frontal left-posterior), B (left-frontal right-posterior), C (midline frontal-occipital), and D (midline frontal topographies). Greater presence of microstate class B in BD patients during task-free resting states are a distinctive characteristic of BD patients from which BD can be differentiated from other psychiatric illnesses. Besides microstates, EEG resting states are also considered to have a bright future in BD diagnosis. Specifically, by investigating brain frequency bands, researchers have discovered that BD patients exhibit abnormal delta and alpha signals as compared to healthy controls (HCs). The abnormalities of microstate B in EEG microstate characteristics would be the most promising biomarker for detecting BD. In addition, anomalies in delta and alpha signals during resting EEG states are possible BD diagnostic indicators.