Early studies testing neurofeedback for epilepsy showed promise in reducing seizure activity. A double blind cross-over study showed that seizure activity increased during noncontingent reinforcement and decreased by about 50% when persons with epilepsy were reinforced for increasing sensorimotor rhythm or other frequencies that normally inhibit seizures (Lubar, Shabsin, Natelson, et al, 1981). The reduction in seizure activity was accompanied by decreases in nocturnal 4-7Hz activity and increase in 8-11 Hz activity (Whitsett, Lubar, Holder, et al, 1982). More recent studies build on these findings and demonstrate that self-regulation of slow cortical potentials using EEG feedback decreases seizure activity in drug resistant epilepsy when compared to pre-training (Kotchoubey, Schneider, et al., 1996; Kotchoubey, Strehl, et al., 1999; Sterman, 1986; Swingle, 1998). This effect was sustained for at least 6 months after therapy (Kotchoubey, Blankenhorn, Froscher, Strehl, & Birbaumer, 1997). A five consecutive day neurobehavioral treatment protocol resulted in 79% of patients being able to achieve seizure control (Joy Andrews, Reiter, Schonfeld, Kastl, & Denning, 2000). Kotchoubey and colleagues studied patients with refractory epilepsy in a controlled clinical trial comparing an anticonvulsive drug plus psychosocial counseling (drug), a group which learned to control breathing (control), and a group learning self regulation of slow cortical potentials (experimental). The experimental and drug groups showed a significant decrease of seizure frequency, but the control group did not (Kotchoubey, Strehl, Uhlmann, et al., 2001).
A review of 18 studies reporting clinical findings in the treatment of seizure disorders with EEG feedback was completed by Sterman (2000). Of a total of 174 patients treated, 82% demonstrated significant (greater than 30%) seizure reduction, with an average reduction exceeding 50%. Many of the studies also reported reductions in seizure severity and 5% of patients experienced complete control for periods of tabulation up to one year. Although every study reported significant clinical benefits exceeding expected placebo effects, none were designed to be randomized clinical trials. This led a Cochrane Database Systematic Review to conclude that there is no reliable evidence to support the use of EEG biofeedback in the treatment of epilepsy because of methodological deficiencies and limited number of patients studied (Ramaratnam, Baker, & Goldstein, 2001). More randomized controlled clinical studies are needed in this area.
Technical Papers & Abstracts
B. Kotchoubey, D. Schneider, H., Schleichert, U., Strehl, C., Uhlmann, V., Blankenhorn, W., & Fröscher, N. (Nov. 1996). . Epilepsy Research, 25(3), 269-276. Retrieved from Science Direct Database.
Carmen A. Tozzo, Lloyd F. Elfner, Jack G., & May Jr. (Aug. 1988 ) . International Journal of Psychophysiology, 6(3), 185-194. Retrieved from Science Direct Database.
Holzapfel, S., Strehl, U., Kotchoubey, B., & Birbaumer, N. (Sept. 1998).
Applied Psychophysiology And Biofeedback, 23(3), 189-202. Retrieved from Medline Database.
Joy Andrews, D., Reiter, J.M., Schonfeld, W., Kastl, A., & Denning, P. (2000). Seizure, 9(3) 189-197.
Kotchoubey, B., Blankenhorn, V., Froscher, W., Strehl, U., & Birbaumer, N. (1997). Neuroreport, 27;8(8), 1867-1870.
Kotchoubey, B., Busch, S., Strehl, U., & Birbaumer, N. (Dec. 1999). Applied Psychophysiology and Biofeedback, 24 (4), 213-33. Retrieved from Medline Database.
Kotchoubey, B, Schneider, D., Schleichert, H., Strehl, U., Uhlmann, C., Blankenhorn, V., et al. (1996). . Epilepsy Research, 25(3), 269-276.
Kotchoubey, B., Strehl, U., Holzapfel, S., Blankenhorn, V., Froscher, W., & Birbaumer, N. (1999). Clinical Neurophysiology, 110(4), 683-686.
Lubar, J. F., Shouse, M. N. (1976). Use of biofeedback in the treatment of seizure disorders and hyperactivity. Advances in Clinical Child Psychology, 1, 203-265.
Nagai, Y., Goldstein, L., Fenwick, P., & Trimble, M. (2004). Epilepsy & Behavior, 5(2), 216-223. Retrieved from Science Direct Database.
Monderer, R. S., Harrison, D. M., & Haut, S. R. (Jun. 2002). Epilepsy & Behavior, 3(3), 214-218. Retrieved from Science Direct Database.
Ramaratnam, S., Baker, G.A., & Goldstein, L. (2001). Psychological treatments for epilepsy. Cochrane Database of Systematic Reviews Online Update Software, 4, CD002029.
Sheth, R. D., Stafstrom, C. E., & Hsu D. (Jun. 2005). Neurology, 12(2), 106-113. Retrieved from Science Direct Database.
Seifert, R., Lubar, J. F. (Nov. 1975). Biological Psychology, 3(3), 157-184A. Retrieved from Science Direct Database.
Sterman, M. B. (2000). . Clinical Electroencephalography, 31(1), 45-55.
Sterman, M. B. (1986). Epilepsy and its treatment with EEG feedback therapy. Annals of Behavioral Medicine, 8(1), 21-25.
Sterman, M. B., & Friar, L. (1972). Electroencephalography and Clinical Neurophysiology, 33, 89-95.
Sterman, M. B., Macdonald, L. R. (1978). . Epilepsia, 19, 207-222.
Sterman, M. B., Macdonald, L. R., Stone, R. K. (1974). Epilepsia, 15, 395-416.
Sterman, M. B., & Shouse, M. N.(1980). Electroencephalography and Clinical Neurophysiology, 49, 558-576.
Sterman, M. B., Wyrwicka, W., & Roth, S. R. (1969). Annals of New York Academy of Science, 157, 723-739.
Swingle, P. G . (1998). . Biological Psychiatry, 44(11), 1196-1199.
Uhlmann, C., & Fröscher, W. (2001). Seizure, 10(1),34-38. Retrieved from Science Direct Database.
Whitsett, S. F., Lubar, J. F., Holder, G. S., Pamplin, W. E., & Shabsin, H. S. (1982). A double -blind investigation of the relationship between seizure activity and the sleep EEG following EEG biofeedback training. Biofeedback and Self -Regulation, 7(2), 193-209.
The research on SMR & SCP biofeedback is impressive. Significant reductions in seizures were reported by patients who were refractory to "bona fide" pharmacological treatment. Individuals who are not successfully treated with medication have been clinically demonstrated to be responsive to biofeedback. Follow-up monitoring of symptom reduction makes it difficult to dismiss the results as merely placebo.
Schwartz & Andrasik, Biofeedback: A Practitioner's Guide, 2003