Neurofeedback for Epilepsy and Seizure Disorders
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In this particular case study, sensorimotor rhythm (SMR) biofeedback training was conducted on a 13 year-old male with frequent epileptic seizures, averaging almost 8 clinical seizures an hour. The SMR filter was tuned to 12 ±1 Hz and training was conducted for approximately 6 months. During that time, the participant’s SMR increased from 10 to 65% after the 34th training session. This was associated with a decrease in clinical seizures by a factor of 10 and a significant decrease in percentage of epileptiform discharges.

In this study, 6 young adults with a diagnosis of epilepsy for at least 2 years underwent sensorimotor rhythm (SMR) biofeedback training. These participants were unable to control their seizures with different regimens of anticonvulsant medications. Participants ranged from severely mentally impaired to above average functioning. The experiment utilized a single subject multiple baseline design which consisted of 6 phases: baseline one, relaxation training; baseline two, biofeedback training one; baseline three, biofeedback treatment two and follow-up. It was found that participants were able to significantly increase percent time in SMR. Further, five out of the six participants demonstrated decreases in seizure frequency during the treatment phase. Two of the six participants also benefited from relaxation training. Lastly, for four participants, an increase in percent SMR was associated with decreased seizure rates.

This article reports on a randomized double blinded sham-controlled trial that investigated the impact of two different modalities of neurofeedback (NFB) on cognitive functioning and quality of life measurements in children and adolescents with controlled focal epilepsy. 44 participants were randomized to either receiving 25 sessions of sensorimotor rhythm (SMR) NFB, slow cortical potentials (SCO) NFB, or sham NFB. The authors found that SMR NFB improved cognitive functioning while all interventions resulted in improvements in quality of life.

This meta-analysis examines existing literature on neurofeedback and epilepsy indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 that provided seizure frequency change in response to either sensorimotor rhythm (SMR) or slow cortical potentials (SCP) feedback training. The authors found sixty-three published studies and 10 of which provided enough information to be included in the meta-analysis. All studies worked with patients diagnosed with epilepsy and seizures that were not controlled by medical therapies. The papers reported an overall decreased average seizure incidence following treatment and 74% of patients reported few weekly seizures in response to EEG biofeedback. In all, the authors conclude that EEG operant conditioning, otherwise known as neurofeedback, was found to produce a significant reduction in seizure frequency.

The objective of this study was to determine the clinical and neurophysiological effectiveness of neurofeedback in children with epilepsy with primary generalized seizures. This study included 63 children with primary generalized seizures, aged 6-16, including 39 girls and 24 boys. These children had been referred for neurofeedback training since the efficacy of pharmacotherapy was not satisfactory. Individual neurofeedback therapy protocols were elaborated and training was conducted over 0.5 - 4 years. It was found that neurofeedback training caused a subsidence of seizures in most of the participating children. In 23/63 children, antiepileptic treatment was withdrawn and in 15 reduction of treatment was achieved. Further, paroxysmal EEG pattern, which is associated with symptomatic generalized epilepsy, had subsided in the majority of the children. It had decreased from 63 to only 16 kids.

It has been found that medically intractable seizures are highly corrected with focal slow wave activity (delta or theta), and decreases in the coherence of theta. It has been hypothesized that normalizing focal slowing and decreased theta coherence using neurofeedback will help to decrease or eliminate seizures. In this study, all of the intractable epileptic patients had one or more slow foci (excessive theta or delta compared with the normal database). When most of the power and coherence abnormalities were normalized with neurofeedback training, all the patients became seizure-free, with 76% of participants no longer requiring an anticonvulsant for seizure control.

The objective of this study was to determine the effects of neurofeedback on cognitive flexibility in children with ADHD and temporal lobe epilepsy (TLE). The study included 26 ADHD children without TLE, 18 with ADHD and neurofeedback, and 25 age-matched ADHD children with TLE and neurofeedback training. The last group was divided into two subgroups: mesial temporal lobe epilepsy (16 patients, 9 with hippocampal sclerosis and 7 with hippocampal atrophy), and lateral temporal lobe epilepsy (9 patients, 5 with temporal lobe dysplasia, 3 with temporal lobe cysts, and 1 with a temporal lobe cavernoma). ADHD was treated through 30 sessions of EEG neurofeedback. Significant differences in reaction time and error rates on the Trail Making Test Part B were found when comparing before and treatment scores for all groups of patients except for those who had mesial temporal lobe epilepsy with hippocampal atrophy. Therefore, neurofeedback can be an alternative treatment option for children with ADHD and TLE.

The objective of this study was to determine if the reduction of seizures in patients with intractable epilepsy after self-regulation of slow cortical potential (SCPs) was maintained 10 years after the end of treatment. Nineteen out of the original 41 patients who received SCP-neurofeedback training were willing to participate in the follow-up study. These patients also took part in three SCP-training sessions at the follow-up evaluation. It was found that seizure frequency had significantly decreased even 10 years after the end of SCP treatment, with a medium to high clinical significance. Further, all patients were still able to self-regulate their SCPs during the feedback condition.

Augmenting the sensorimotor rhythm (SMR) is a common neurofeedback protocol for epilepsy patients. The objective of this study was to determine the outcomes of an SMR-augmenting neurofeedback protocol in refractory epilepsy patients. Participants underwent 5 sessions of neurofeedback while their EEG was recorded with a 22-electrode system. It was found that SMR before and after training significantly differed in the frontal, and central electrodes and in the channel used for training.

The objective of this study is to explore the effectiveness of LORETA z-score training within the default mode network (DMN) in reducing seizure frequency in patients with medically-refractory seizures. This review focused on 6 patients, none of whom had ever been seizure free for more than 1 year. On average, patients had been trained using LORETA z-score training within the DMN for an average of 20.8 ± 5.2 weeks (1-2 sessions per week for 20-30 minutes per session). DMN training using LORETA z-scores resulted in subjective improvement in seizure frequency from baseline in 5 out of 6 patients.

This multiple case study summarizes the results of implementing LORETA Z-score Neurofeedback (NFB) therapy for 10 seizure patients. Majority of the patients in this study were medically refractory epilepsy cases and were not responsive to pharmacological treatments. They found that LORETA Z-score NFB training (of at least once per week) eliminated or greatly reduced the frequency of seizures, regardless of the type of epilepsy. They also reported other benefits such as long lasting clinical remissions and cognitive improvements with this type of NFB training, especially with more frequent NFB sessions.

This case study evaluated the effect of EEG biofeedback as a treatment for psychogenic non epileptic seizures (PNES) in a 47 year-old female patient with multiple sclerosis. The patient underwent 16 sessions of the EEG biofeedback over two months. Following treatment, the patient reported that the PNES attacks had stopped and there was a significant reduction in her clinical seizure symptoms. The analysis of sensorimotor rhythm (SMR) values revealed reduction of psychogenic non-epileptic seizure. Additionally, decreased anxiety and increased quality of life were also observed. This case study shows that EEG biofeedback was a useful procedure in treating PNES, promoting quality of life and reducing anxiety.

This case study examined the impact of neurofeedback therapy combined with hyperbaric oxygen treatment (HBOT) in a 26 year-old male patient who developed post-traumatic epilepsy after a brain injury from a motor vehicle accident. The patient underwent a left side craniotomy and was comatose for 26 days. He was discharged after eight months with significant speech, ambulation, spasticity, and cognitive issues. The combination of neurofeedback and HBOT improved the patient’s short-term memory, personality, language, and executive function, as well as significantly reducing the incidence of seizures. These results suggest that HBOT combined with neurofeedback may be a viable option in treating severe brain injuries and post-traumatic epileptic seizures.

This literature review examines the available evidence for neurofeedback therapy in pediatric epilepsy. The authors found that although a mix of pediatric cases have been sampled in previous studies, no age effects have been reported. Additionally, as of 2019, no randomized control trial specific to pediatric epilepsy has been published. The existing research suggesting that neurofeedback can effectively treat epilepsy are not specific to the pediatric population. There is also a lack of rigor in the studies in which the effects of neurofeedback in children and adolescents with epilepsy are documented. Based on the literature as of 2019, there is not enough evidence to state that neurofeedback is efficacious for the treatment of pediatric epilepsy.

This article reviewed a number of papers on the current treatments available for epilepsy, neurofeedback protocols, and specific neurofeedback protocols available for epilepsy. Currently, the most common treatments for epilepsy include pharmacology, surgery, and diet therapy. This article identified two successful neurofeedback treatment protocols that reduce the frequency of seizures in epilepsy patients. Sensorimotor rhythm training controls the excessive excitation in cortical and thalamocortical structures as a result of epilepsy. Slow Cortical Potentials training helps the epilepsy patient to consciously control their brain waves by helping them be consciously aware of positive and negative shifts. This article however, does not review the efficacy of these two protocols in epilepsy patients.

This review presents an overview of the neurophysiological basis, clinic research literature, and methods of practice relating to clinical neurofeedback focusing on the treatment of epilepsy with sensorimotor rhythm (SMR) training. Following analysis and review of current and past literature, the authors present this treatment method as arguably the best established application of EEG operant conditioning. Research also suggested that the skilled practice of clinical neurofeedback requires a strong understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as a grasp of the hardware and software equipmenting required for the practice. Additionally, it is advised that the best application of training would include the systematic mapping of quantitative EEG (QEEG) measures against a normative database before and after treatment to guide the treatment strategy and document progress. In all, the authors conclude that neurofeedback treatment of epilepsy and seizure disorders is a well-supported and viable alternative to anticonvulsant pharmacotherapy.

This article presents insight into the efficacy and integrity of biofeedback and neurofeedback as an intervention option for seizures and epilepsy. The author reviews both neuroscience healthcare clinician experience and a 60-year literature foundation to reach the conclusion that biofeedback/neurofeedback is a non-invasive, low-risk, low-cost, and relief treatment option. The article presents evidence and studies showing that neurofeedback can improve brain dysregulation and abnormal brain network dynamics that are known to be at the root of seizures/epilepsy. Specifically, the exhaustive literature review documented here yielded 150 articles published from the 1960s that demonstrate that biofeedback/neurofeedback training leads to improvements in seizures and EEG/QEEG abnormalities. The author concludes by stating the clinicians, insurers, and the public should supposed BFB/NFB as a first-line intervention for epilepsy and seizures.

This study aims to investigate the effect of sensorimotor rhythm (SMR) neurofeedback training on quality of life for individuals diagnosed with epilepsy. Previous research has shown that SMR neurofeedback changes regulatory systems in the brain as well as cortical excitation thresholds leading to reduction in seizure frequency, and the results of this study further support these findings. Patient records from individuals trained using SMR neurofeedback at the University of Colorado Neurofeedback Clinic were reviewed, abstracted, and analyzed. In particular, the scores from Quality of Life in Epilepsy-31 (QOLIE-31) surveys that were recorded from patients’ clinical intakes and at intervals throughout their treatment program were examined. It was found that 78% of the patients had improvement in their scores following training with the largest improvements in seizure worry and cognitive subscores of the survey. In all, the author concludes that SMR neurofeedback training modestly improves quality of life in patients with epilepsy.

The objective of this study was to determine the effect of sensorimotor electroencephalographic (EEG) normalization feedback training in 24 drug refractory patients with epilepsy. Neuropsychological tests administered at baseline revealed that participants had significant deficits in psychosocial, cognitive and motor functioning. Further, baseline testing could discriminate between subjects who were subsequently above or below the median in seizure reduction following EEG training. Participants with the greatest seizure reduction performed better on a test of general problem-solving ability, were more intact psychosocially, but did worse on tests with strong motor components. Additionally, these subjects took significantly less medications than less successful subjects. Lastly, several improvements were observed following EEG training. 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 improved in both experimental and control groups.

Nagai introduces the literature on the use of biofeedback as a noninvasive behavioral treatment for epilepsy. The author first reviews the body of literature regarding sensory motor rhythm (SMR) and slow cortical potential (SCP) training. In the early stages of research, studies were concentrated on SMR as a neurophysiological training.More recently, the lens has shifted to studying SCP biofeedback that focuses on the regulation of the amplitude of cortical potential changes while SMR biofeedback aims to modulate the frequency components of one’s EEG. In all, Nagai concludes that both SMR and SCP biofeedback is both well understood and effective.

In this article, Sterman reviews the application of electroencephalographic (EEG) operant conditioning, otherwise known as biofeedback or neurofeedback, as an alternative treatment for the major types of seizure disorder. First, the author describes the initial body of animal research that showed that brain mechanisms that mediate learned behavioral inhibition was uniquely correlated with 12 to 15 Hz EEG rhythm localized to the sensorimotor cortex, now more commonly referred to as the sensorimotor rhythm (SMR). Further research discovered that increasing SMR using EEG operant conditioning resulted in an anticonvulsant effect on drug-induced seizures in cats and monkeys. Continuing animal studies fortified this discovery and identified further patterns underlying the effect. More recently, human epileptic studies have documented and reported significant reductions in seizure incidence and severity coinciding with EEG pattern normalization. The author calls for further research in the area to understand the complexity of seizure disorders in light of alternative therapies like EEG biofeedback.