Epilepsy

Case Studies Technical Papers General Information
Introduction to Neurofeedback and Epilepsy

E.: Nocturnal seizures, 44yF

Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning.
Sterman MB.
Clin Electroencephalogr. 2000 Jan;31(1):45-55. Review.
The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor’s opinion.
Duffy FH.
Clin Electroencephalogr. 2000 Jan;31(1):V-VII.
Neurotherapy and Drug Therapy in Combination for Adult ADHD, Personality Disorder, and Seizure
Lisa M. Hansen, B.S., David L. Trudeau, M.D., and Dixie L. Grace, Ph.D
Journal of Neurotherapy, 2(1), 1996
EEG biofeedback and relaxation training in the control of epileptic seizures.
Tozzo CA, Elfner LF, May JG Jr
Int J Psychophysiol 6 (3): 185-194 (Aug 1988)

Neuropsychological assessment of subjects with uncontrolled epilepsy: effects of EEG feedback training.

Lantz DL, Sterman MB
Epilepsia 29 (2): 163-171 (Mar 1988)
The Response of a case of petit mal epilepsy to EEG sensorimotor rhythm biofeedback training.
Tansey MA
Int J Psychophysiol 3 (2): 81-84 (Nov 1985)
A double-blind investigation of the relationship between seizure activity and the sleep EEG following EEG biofeedback training.
Whitsett SF, Lubar JF, Holder GS, Pamplin WE, Shabsin HS
Biofeedback & Self-Regulation 7 (2): 193-209 (Jun 1982)
EEG operant conditioning in intractable epileptics.
Lubar JF, Shabsin HS, Natelson SE, Holder GS, Whitsett SF, Pamplin WE, Krulikowski DI
Arch Neurol 38 (11): 700-704 (Nov 1981)
Quantitative analysis of training, sleep EEG and clinical response to EEG operant conditioning in epileptics.
Sterman MB, Shouse MN
Electroencephalogr Clin Neurophysiol 49 (5-6): 558-576 (Sep 1980)
Sensorimotor rhythm feedback training and epilepsy: some methodological and conceptual issues.
Quy RJ, Hutt SJ, Forrest S
Biol Psychol 9 (2): 129-149 (Sep 1979)
EEG feedback training of epileptic patients: clinical and electroencephalographic analysis.
Kuhlman WN
Electroencephalogr Clin Neurophysiol 45 (6): 699-710 (Dec 1978)
Effects of central cortical EEG feedback training on incidence of poorly controlled seizures.
Sterman MB, Macdonald LR
Epilepsia 19 (3): 207-222 (Jun 1978)
Operant conditioning of the EEG in two patients with epilepsy: methodologic and clinical considerations.
Finley WW
Pavlov J Biol Sci 12 (2): 93-111 (Apr 1977)
Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm.
Lubar JF, Bahler WW
Biofeedback & Self-Regulation 1 (1): 77-104 (Mar 1976)
Effects of sham feedback following successful SMR training in an epileptic: follow-up study.
Finley WW
Biofeedback & Self-Regulation 1 (2): 227-235 (Jun 1976)
Reduction of epileptic seizures through EEG biofeedback training.
Seifert AR, Lubar JF
Biol Psychol 3 (3): 157-184 (Nov 1975)
Reduction of seizures and normalization of the EEG in a severe epileptic following sensorimotor biofeedback training: preliminary study.
Finley WW, Smith HA, Etherton MD
Biol Psychol 2 (3): 189-203 (1975)
Andrews, D.J., & Schonfeld, W.H. (1992).
Predictive factors for controlling seizures using a behavioural approach. Seizure, 1, 111-116.
Ellertson, B., & Klove, H. (1976).
Clinical application of biofeedback training in epilepsy.
Scandinavian Journal of Behavior Therapy, 5, 133-144.
Wyler, A.R., Lockard, J.S., & Ward, A.A. (1976).
Conditioned EEG desynchronization and seizure occurrence in patients.
Electroencephalography and Clinical Neurophysiology, 41, 501-512.

EEG Biofeedback Training for Epilepsy

The technique of EEG biofeedback training was first used therapeutically for epilepsy, and the scientific literature is most extensive for this condition, dating back to the early 1970’s. EEG biofeedback has been shown to be helpful for all kinds of epilepsy, including petit mal, grand mal, and complex partial seizures. A variety of training protocols has been used successfully. However, the technique did not become widely accepted. This is ascribed to the fact that initially the training took a very long time, was not widely available, and was very expensive. Also, there was no agreement on a model of efficacy.

Recent progress in instrumentation and in methodology has made the training much more economical. However, there remains a large variety of outcomes. In some cases, the client may respond dramatically in just a few sessions. In other cases, the training remains long-term, requiring on the order of 80-100 training sessions. EEG biofeedback may also need to be complemented with other approaches, such as lifestyle changes which avoid those conditions which effect a lowering of seizure threshold. Also, active interventions may be learned which can serve to abort incipient seizures. Finally, determination of dietary susceptibilities may be important, insofar as there are a number of substances which may alter the seizure threshold adversely.

EEG biofeedback should therefore be considered as an element of a comprehensive program of management of epilepsy which includes pharmacological intervention, dietary sensitivity analysis, and consideration of lifestyle issues which are found to impinge on seizure susceptibility in a particular case. It is found that epilepsy is highly susceptible to many behavioral variables over which the client may exercise a large measure of control.

In many cases of epilepsy, pharmacological intervention is sufficient to achieve seizure control. However, other behavioral correlates are still observed. In other cases, the anticonvulsant medication may be accompanied by significant side effects on the client’s mood, sleep, mental alertness, and cognitive ability. The behavioral consequences appear to be associated with what is most likely “sub-clinical seizure activity”, namely cortical disturbances which are qualitatively similar to seizure phenomena, but not quantitatively sufficient to result in a well-defined seizure. These phenomena are what the neurologist looks for in a clinical EEG, or electroencephalogram.

EEG biofeedback is likely to achieve regulation of such behavioral disturbances even before an improvement in seizure incidence is observed. EEG biofeedback training may also be used to reduce the medication dose required to achieve seizure control, and hence reduce the side effects attributable to such medication. Persons under medication must remain under the active supervision of their prescribing physician as they undergo the training. Following the advice of the prescribing physician is particularly important because of the potential need to adjust the medication as the training proceeds.

In many cases of epilepsy in young children, the cause may be a difficult birth, even though the seizures don’t manifest until later stages of cortical maturity. In these cases, there may be other deficits in the child’s functioning which are also attributable to the traumatic birth (mood disorders, sleep disorders, learning disabilities, attention deficits), which may also respond to the EEG training.

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