Precision Tools for Precision Medicine

Advances in biomedical sciences in the past two decades have led to new approaches to medical interventions. Precision Medicine (PM) is a medical model that proposes the customisation of healthcare, in which medical decisions, practices, and therapeutic remedies are tailored for the individual patient. The term “Personalized Medicine” is also used to convey this meaning (although this term is sometimes misinterpreted as implying that unique treatments can be designed for each individual). In January 2015, President Obama announced the Precision Medicine Initiative (PMI) that will enable a new era of medicine in which researchers, providers and patients work together to develop individualised care.

 In Precision Medicine (PM) individuals are classified into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment. Consequently, preventative or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not.

 PM involves the application of panomic analysis (genomic, proteomic, metabolic, etc.) and systems biology to analyse the cause of an individual’s disease at the molecular level and then to utilize targeted treatments to address that individual’s disease process. The theoretical basis of PM refers to the "unique disease principle", which embraces the heterogeneity of disease aetiology and pathogenesis.

 One of the most important aspects of PM is the identification the biological markers, i.e. biomarkers (or neuromarkers in neuroscience) for specific conditions. A biomarker refers to a measurable indicator of some biological state or condition. Biomarkers are often measured and evaluated in order to examine normal biological processes, pathological processes, or pharmacologic responses to therapeutic interventions.

In the last two decades, research on functional neuromarkers in different psychiatric conditions such as ADHDschizophrenia and OCD, has provided a vast amount of empirical knowledge with clear indication that at least some of those neuromarkers are reliable and powerful tools in discriminating patients from healthy controls. 
Currently we are facing a decade of translation that focuses on application of functional neuromarkers for providing an early detection of brain dysfunction, as well as a personalised care for patients with disease. 
The early detection of neuromarkers of mental illness in its turn requires development of preventive interventions.

In identifying functional neuromarkers, event-related potentials (ERPs) and quantitative electroencephalography (QEEG) have been particularly useful. ERPs are considered to be a gold-standard in clinical neuropsychology and neurophysiology, and can detect subtle deviations from the average measures in the healthy population. This method is used for assessing how the brain is processing information under various task conditions and allows seeing markers for specific brain disorders; such as ADHD and schizophrenia. QEEG records, analyses and compares with normative databases, the electrical activity of the brain in order to reveal any diagnostic information and/or cognitive deficit.

 Identification of functional neuromarkers is becoming increasingly important for a variety of medical and non-medical fields such as psychiatrists, clinical psychologists, sport psychologists and insurance companies. Undoubtedly, neuromarkers are and will be immensely important in the field of Precision Medicine.                      

ERP-Based Endophenotypes article from the book: Neuromodulation.pdf
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