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Epilepsy and Seizure Disorders
Cott, A., Pavloski, R. P., & Black, A. H. (1979). Reducing epileptic seizures through operant conditioning of central nervous system activity: Procedural variables. Science , 203, 73-75.
Operant conditioning of the sensorimotor rhythm of the human electroencephalogram with time-outs contingent on epileptiform activity reduces epileptic seizure rates in patients whose seizures are not well controlled by medication. A comparison of this procedure with time-out training alone demonstrates that operant conditioning of the sensorimotor rhythm is neither necessary nor sufficient for seizure reduction.
Egner T., Sterman MB. (2006). Neurofeedback treatment of epilepsy: from basic rationale to practical application. Expert Rev Neurother .;6(2):247-57. The treatment of epilepsy through operant conditioning of the sensorimotor rhythm electroencephalogram has a 35-year history. Neurophysiological studies have shown that this phasic oscillation reflects an inhibitory state of the sensorimotor system. Operant learning of sensory motor rhythm production results in an upregulation of excitation thresholds within the thalamocortical sensory and motor circuitry, which in turn is associated with reduced susceptibility to seizures. The clinical benefits derived from this neurofeedback training protocol, particularly in patients that are nonresponsive to pharmacotherapy, have been documented in many independent laboratories. Recent advances in computer technology have resulted in the availability of relatively inexpensive high-quality equipment for the application of neurofeedback therapy, thus presenting a viable and promising treatment alternative to the interested clinician.
Finley, W. W. (1976). Effects of sham-feedback following successful SMR training in an epileptic: A follow-up study. Biofeedback & Self-Regulation , 1, 227-235.
After 1 year of SMR biofeedback training of a severe epileptic teenage male, incidence of atonic seizures decreased from 8/hr to less than 1/3 hr. SMR increased from 10% to 70%. Epileptiform discharges decreased from 45% to 15%. Unknown to the patient, his family, or certain members of our research staff, noncontingent feedback was introduced on 7/22/74, ending 9/11/74. A significant decrease occurred for SMR (down 8%), and a significant increase for epileptiform discharges (up 4%). Rate of seizures increased, but was not statistically significant over preceding months of contingent feedback. Incidence of seizures associated with urine loss increased from approximately 6/month to 23/month during noncontingent feedback, a significant increase. Urine-loss results suggest that although seizures did not become more frequent, those the patient did experience were "harder," i.e., more severe. Contingent feedback was reinstituted following the 7-wk sham, and recovery of all variables to their former levels (prior to sham) occurred.
Finley, W. W. (1977). Operant conditioning of the EEG in two patients with epilepsy: Methodologic and clinical considerations. Pavlovian Journal of Biological Science , 12(2), 93-111.
Methodologic and clinical considerations are discussed in sensorimotor rhythm (SMR) biofeedback research on two dissimilar but severe epileptic males. The first case, an akinetic epileptic who prior to feedback training experienced 80-100 clinical seizures every 10 hours, showed considerable seizure reduction after 6 months of SMR and epileptiform training. A number of methodologic and instrumentation advances were pioneered with the akinetic patient: (1) development of and ultra-sharp band-pass filter; (2) use of epileptiform inhibit and feedback circuitry; (3) use of monetary rewards as additional incentive; (4) use of correlational analysis for evaluation of acquisition in the major dependent variables and; (5) use of noncontingent feedback and reinforcement as control techniques. The second case, a psychomotor epileptic, also showed therapeutic benefit from SMR training. Clinical information regarding the effect of anticonvulsant medications on the course and therapeutic outcome of SMR training are described. In conjunction with operant conditioning of 12 Hz activity, corresponding changes for other EEG parameters are examined.
Hanson, L. M., Trudeau, D. L., & Grace, D. L. (1996). Neurotherapy and drug therapy in combination for adult ADHD, personality disorder, and seizure disorder: A case report. Journal of Neurotherapy , 2(1) 6-14. This is a case report of an adult female patient with ADHD, temporal seizure disorder, and Borderline Personality Disorder treated with 30 weekly sessions of SMR neurofeedback and carbamazepine. Posttreatment measures showed improvements in T.O.V.A., self report, and QEEG. Both neurofeedback and carbamazepine showed the most effect in early treatment. Progress continued after discontinuance of the drug.
Hurt, E., Arnold, AE. & Lofthouse, N. (2014). Quantitative EEG neurofeedback for the treatment of pediatric attention-deficit hyperactivity disorder, autism spectrum disorders, learning disorders and epilepsy. Child and Adolescent Psychiatric Clinics of North America:23(3). 465-86. Neurofeedback (NF) using surface electroencephalographic signals has been used to treat various child psychiatric disorders by providing patients with video/audio information about their brain's electrical activity in real -time. Research data are reviewed and clinical recommendations are made regarding NF treatment of youth with attention deficit/hyperactivity disorder, autism, learning disorders, and epilepsy. Most NF studies are limited by methodological issues, such as failure to use or test the validity of a full-blind or sham NF. The safety of NF treatment has not been thoroughly investigated in youth or adults, although clinical experience suggests reasonable safety.
Kuhlman, W. N., & Allison, T. (1977). EEG feedback training in the treatment of epilepsy: Some questions and some answers. Pavlovian Journal of Biological Science , 12(2), 112-122. A basic question in EEG feedback training of epileptic patients is whether the decrease in seizures is specifically due to the training or to other factors. Questions may also be raised as to what EEG changes are involved. Preliminary results in five patients suggest that seizure reductions can occur with training which are not due to placebo or nonspecific effects or to changes in medication compliance. These changes occurred rapidly during EEG-contingent feedback training but not whenfeedback was random in relation to the EEG. Reliable changes in the EEG were also observed, but the question of which mechanism accounts for these results has yet to be answered.
Lantz, D., & Sterman, M. B. (1988). Neuropsychological assessment of subjects with uncontrolled epilepsy: Effects of EEG biofeedback training. Epilepsia , 29(2), 163-171. A battery of neuropsychological tests was administered at baseline, post-control period, and post-training period to 24 drug-refractory subjects with epilepsy participating in a study of sensorimotor electroencephalographic (EEG) normalization feedback trai ning. Results revealed the following. First, subjects exhibited significant baseline deficits in psychosocial, cognitive and motor functioning. Second, certain tests discriminated subjects before training who were subsequently above and below the median in seizure reduction following EEG training. Subjects who showed the greatest seizure reduction performed better on a test of general problem-solving ability but not on other cognitive tests and worse on tests involving strong motor components and were more intact psychosocially. These subjects also took significantly fewer medications in combination than did less successful subjects. Third, improvement on several measures occurred following participation in the study. Cognitive and motor functioning improved only in subjects with the greatest seizure reduction and only after actual training as opposed to control conditions. Psychological functioning, as measured by the Minnesota Multiphasic Personality Inventory (MMPI) improved in both outcome groups. MMPI improvement, unlike cognitive improvement, was as likely to occur after control conditions, when seizure reduction had not yet occurred, as after EEG training. Thus, MMPI changes apparently reflected the nonspecific benefits of participation in this study.
Lubar, J. F., & Bahler, W. W. (1976). Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm. Biofeedback & Self- Regulation, 7, 77-104. Eight severely epileptic patients, four males and four females, ranging in age from 10 to 29 years, were trained to increase 12-14 Hzeta EEG activity from the regions overlying the Rolandic area. This activity, the sensorimotor rhythm (SMR), has been hypothesized to be related to motor inhibitory processes (Sterman, 1974). The patients represented a cross-section of several different types of epilepsy, including grand mal, myoclonic, akinetic, focal, and psychomotor types. Three of them had varying degrees of mental retardation. SMR was detected by a combination of an analog filtering system and digital processing. Feedback, both auditory and/or visual, was provided whenever one-half second of 12-14-Hz activity was detected in the EEG. Patients were provided with additional feedback keyed by the output of a 4-7-Hz filter which indicated the presence of epileptiform spike activity, slow waves, or movement. Feedback for SMR was inhibited whenever slow-wave activity spikes or movement was also present. During the treatment period most of the patients showed varying degrees of improvement. Two of the patients who had been severely epileptic, having multiple seizures per week, have been seizure free for periods of up to 1 month. Other patients have developed the ability to block many of their seizures. Seizure intensity and duration have also decreased. Furthermore, the successful patients demonstrated an increase in the amount of SMR and an increase in amplitude of SMR during the training period. Spectral analyses for the EEGs were performed periodically. The effectiveness of SMR conditioning for the control of epileptic seizures is evaluated in terms of patient characteristics and type of seizures.
Monderer, R. S., Harrison, D. M., & Haut, S. R. (2002). Review: Neurofeedback and epilepsy. Epilepsy & Behavior , 3, 214-218. Over the past three decades, researchers have examined various behavioral approaches to the treatment of epilepsy. One prominent line of inquiry concerns the effectiveness of neurofeedback, which entails the entrainment of specific electroencephalographic frequencies for the purpose of decreasing seizure frequencies in patients with epilepsy. This article reviews the current literature on the efficacy of neurofeedback in reducing seizure frequency. While it is clear that neurofeedback had a positive effect in most of the studies reviewed, these findings are limited due to multiple confounding factors. In the absence of any rigorously controlled studies, the relationship between neurofeedback and seizure frequency cannot be firmly established. Despite these limitations, the promising role of neurofeedback as a treatment for epilepsy is illustrated.