The first convincing evidence for EEG feedback efficacy in the management of pathophysiology was with regard to generalized seizures. The early work by Sterman, Lubar, as well as the subsequent follow-up by others, therefore remains a crucial point of reference for the various feedback techniques that have built upon the early protocol of SMR reinforcement combined the theta-band and high-beta band inhibition. Remarkably, the essential features of the early approach have been retained in the various evolutionary pathways that have emanated from the early work. This essential similarity has perhaps obscured other aspects of the training approach that have changed substantially over time, the significance of which may not have been fully appreciated except in reflection. In this newsletter we consider some of these changes and their implications generally, as well as for seizure management in particular.

The common thread in most modern neurofeedback approaches is the combination of a reinforcement strategy on one EEG frequency or another and an inhibit strategy based on detection of excursions into dysregulation. Some issues relating to the inhibit side have been relegated entirely to the software, thus removing them from ready visibility. Artifact detection and the division of labor between that and the conventional inhibits is a case in point. Specific targeting strategies typically remain to the discretion of the practitioner, as for example with respect to thresholding, placement, and frequency band selection. The general thrust over time has been to broaden the “field of view” of this EEG-based disregulation detector, mainly with respect to the frequencies being targeted, but sometimes also in terms of placement. Multi-channel instruments allow independent choice of placement for the reward and the inhibit strategies. Fortuitously, the various inhibit strategies being actively used—-though differing significantly from each other—-have not been wrapped up in much controversy.

(more…)