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Level 3 Efficacy (Probably Efficacious)
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.

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Technical Papers & Abstracts

B. Kotchoubey, D. Schneider, H., Schleichert, U., Strehl, C., Uhlmann, V., Blankenhorn, W., & Fröscher, N. (Nov. 1996). Self-regulation of slow cortical potentials in epilepsy: A retrial with analysis of influencing factors. Epilepsy Research, 25(3), 269-276.

Carmen A. Tozzo, Lloyd F. Elfner, Jack G., & May Jr. (Aug. 1988 ) EEG biofeedback and relaxation training in the control of epileptic seizures. International Journal of Psychophysiology, 6(3), 185-194.

Holzapfel, S., Strehl, U., Kotchoubey, B., & Birbaumer, N. (Sept. 1998). Behavioral psychophysiological intervention in a mentally retarded epileptic patient with brain lesion.
Applied Psychophysiology And Biofeedback, 23
(3), 189-202.

Joy Andrews, D., Reiter, J.M., Schonfeld, W., Kastl, A., & Denning, P. (2000). A neurobehavioral treatment for unilateral complex partial seizure disorders: A comparison of right- and left-hemisphere patients. Seizure, 9(3) 189-197.

Kotchoubey, B., Blankenhorn, V., Froscher, W., Strehl, U., & Birbaumer, N. (1997). Stability of cortical self-regulation in epilepsy patients. Neuroreport, 27;8(8), 1867-1870.

Kotchoubey, B., Busch, S., Strehl, U., & Birbaumer, N. (Dec. 1999). Changes in EEG power spectra during biofeedback of slow cortical potentials in epilepsy. Applied Psychophysiology and Biofeedback, 24 (4), 213-33.

Kotchoubey, B, Schneider, D., Schleichert, H., Strehl, U., Uhlmann, C., Blankenhorn, V., et al. (1996). Self-regulation of slow cortical potentials in epilepsy: a retrial with analysis of influencing factors. Epilepsy Research, 25(3), 269-276.

Kotchoubey, B., Strehl, U., Holzapfel, S., Blankenhorn, V., Froscher, W., & Birbaumer, N. (1999). Negative potential shifts and the prediction of the outcome of neurofeedback therapy in epilepsy. 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). Clinical efficacy of galvanic skin response biofeedback training in reducing seizures in adult epilepsy: a preliminary randomized controlled study. Epilepsy & Behavior, 5(2), 216-223.

Monderer, R. S., Harrison, D. M., & Haut, S. R. (Jun. 2002). Neurofeedback and epilepsy. Epilepsy & Behavior, 3(3), 214-218.
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). Nonpharmacological Treatment Options for Epilepsy Seminars in Pediatric. Neurology, 12(2), 106-113.

Seifert, R., Lubar, J. F. (Nov. 1975). Reduction of epileptic seizures through EEG biofeedback training. Biological Psychology, 3(3), 157-184A.

Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. 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). Suppression of seizures in an epileptic following sensorimotor training.Electroencephalography and Clinical Neurophysiology, 33, 89-95.

Sterman, M. B., Macdonald, L. R. (1978). Effects of central EEG feedback training on incidence of poorly controlled seizures. Epilepsia, 19, 207-222.

Sterman, M. B., Macdonald, L. R., Stone, R. K. (1974). Biofeedback training of the sensorimotor electroencephalogram rhythm in man: effects on epilepsy. Epilepsia, 15, 395-416.

Sterman, M. B., & Shouse, M. N.(1980). Quantitative analysis of training, sleep EEG and clinical response to EEG operant conditioning in epileptics. Electroencephalography and Clinical Neurophysiology, 49, 558-576.

Sterman, M. B., Wyrwicka, W., & Roth, S. R. (1969). Electrophysiological correlates and neural substrates of alimentary behavior in the cat. Annals of New York Academy of Science, 157, 723-739.

Swingle, P. G . (1998). Neurofeedback treatment of pseudoseizure disorder. Biological Psychiatry, 44(11), 1196-1199.

Uhlmann, C., & Fröscher, W. (2001). Biofeedbacknext term treatment in patients with refractory epilepsy: Changes in depression and control orientation. Seizure, 10(1),34-38.

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.


View other applications of Neurofeedback and Biofeedback

Research on Sensory Motor Rhythm (SMR) & Slow Cortical Potential (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