by Judy L. Van Raalte, Ph.D.
Professor of Psychology
Springfield College

Effective Treatment for Epilepsy Without Side Effects
O ur son’s epilepsy began just before he started kindergarten. We were shocked when he had his first tonic-clonic seizure and was rushed to the emergency room. The doctors started him immediately on anticonvulsant medication and we (his two college professor parents) actively read the scientific and medical literature to learn more about what was happening to him.

By the time 6 months had passed, we were no longer naïve. We had been through a mountain of meds and our son had received the diagnosis “intractable epilepsy.” An initial scientific study we read indicated that permanent brain damage was less likely to occur in people who had fewer than 100 seizures in their lifetimes. At this point, our son was having over 100 seizures a day and was stoned on a cocktail of medications that affected his coordination and made him confused, irritable, aggressive, and unable to learn. We didn’t know what damage the drugs were doing to his liver, kidneys and other internal organs that we couldn’t see but we knew that pumping over $1,200 of drugs a month into a small child was likely to have some negative repercussions.

When it became clear that the usual drug therapies were not working for our son, we looked elsewhere for answers. At age 5, he seemed too young for brain surgery and a Vagus nerve stimulator. He was overwhelmingly unwilling to try the ketogenic diet, and we were skeptical about various touch therapies. The only alternative treatment that had significant scientific merit indicating that it was effective for treating epilepsy was neurofeedback (also known as EEG biofeedback).

To make a long story short, we found a neurofeedback practitioner to work with our son. After four weeks of daily treatment his seizures stopped. He was still on his meds but he was seizure free. Since that time he has continued to improve. He is a “normal” college freshman who is learning, involved in school, and playing sports.

Things are not completely perfect; our son does continue to have erratic brainwave patterns indicative of abnormal activity. He also has times when it is hard for him to focus and times when he gets angry that appear to be related to his epilepsy. But compared to where he was only a few short years ago, his (and our) lives are much better because of neurofeedback.

What is neurofeedback?
Neurofeedback (also known as EEG biofeedback) as a treatment modality for epilepsy. Participants put electrodes on their heads and “play” computer games using their brainwaves to control the games. Players earn points when their brainwave patterns are normal. By practicing and reinforcing normal brainwave patterns, people learn to generate and maintain normal patterns and prevent seizures even when they are not playing.

What proof is there that neurofeedback works?
Over 30 years ago, researchers found that operant conditioning on EEG frequency distributions effected significant behavior alterations in cats. Researchers found that the cats that had been trained via neurofeedback had reduced susceptibility to chemically-induced seizures. There was little basis for understanding these startling results at the time. Since then, it has emerged that rhythmicity may be a general property of brain self-regulatory activity, and that operant conditioning on such rhythmic properties can significantly reduce seizure rates in patients with epilepsy.

In 2000, Sterman wrote a review of neurofeedback studies published in scientific journals. Results showed that neurofeedback caused clinically significant improvement for 82% of epilepsy patients studied. These promising results led to larger studies comparing neurofeedback to other treatments including new medications, behavioral interventions, and relaxation training. In 2009, Tan and colleagues conducted a meta-analysis of all EEG biofeedback/neurofeedback studies published between 1970 and 2005. Results confirmed that EEG biofeedback produces a significant reduction in seizure frequency. This finding is especially noteworthy because the patients included in the studies reviewed were intractable epileptics who had been unable to control their seizures with medical treatment.

For whom is neurofeedback effective?
Effectiveness of neurofeedback does not depend on sex, age, education, seizure history, seizure rate, or medication. Patients who benefit most have been found to be those who have high emotional reactivity in situations of social stress. Patients who benefit least have epilepsy with a left temporal lobe focus. Nevertheless, approximately 1/3 of patients with left temporal lobe focus benefit from neurofeedback training. Further research is needed to help identify those patients who can gain the most from neurofeedback.

Outside of the epilepsy research domain, a number of elite performers use neurofeedback as a way to improve focus, mood, and sport or musical performance. For example, neurofeedback is one of the interventions available to athletes at West Point through the Center for Enhanced Performance. Neurofeedback has also been used to treat anxiety, depression, and ADHD.

Why didn’t I know about this before? Why isn’t everyone using neurofeedback?
Neurofeedback made a huge difference for our son and our family. Given the solid research basis of the effectiveness of this treatment, I am not sure why it is not widely used. It is possible that the status of neurofeedback as a non-traditional approach, and the fact that large pharmaceutical companies do not reap profits from neurofeedback, has affected the rate at which it is prescribed by neurologists. I believe that if there were a drug available for epilepsy with a similar success rate and similar side effects (none!) then it would be the first choice drug of treatment.

What are the drawbacks of using neurofeedback?
Using neurofeedback is more time consuming than popping a pill. It also takes a while to have an effect (about 10-20 sessions). Aside from these minor drawbacks the benefits are effective treatment and no side effects.

Will my insurance pay for neurofeedback treatment?
Our initial request to have our insurer cover neurofeedback treatment was rejected. Because of the severity of our son’s illness, and with the strong support of his pediatrician, we were forced to begin neurofeedback treatment without insurance coverage. When we appealed the decision to the insurer, presenting a strong letter, copies of the scientific research articles supporting the treatment, and an endorsement from our son’s doctor, the insurance company decided to cover the treatment.

What scientific references can I show my doctor or insurance company to support the value of neurofeedback for epilepsy?

· Duffy FH (2000). The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor’s opinion Clinical Electroencephalography, 31, v-vii.

· Egner T, & Gruzelier JH (2004). The temporal dynamics of electroencephalographic responses to alpha/theta neurofeedback training in healthy subjects. Journal of Neurotherapy, 8, 43-57.

· Fernández T et al (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children Clinical Electroencephalography, 34, 145-52

· Hirshberg LM (2005). Emerging brain-based interventions for children and adolescents: overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, 14, 1-19

· Kotchoubey, B, Strehl, U, Uhlmann, C et al (2001). Modification of slow cortical potential in patients with refractory epilepsy: A controlled outcome study Epilepsia, 42, 406-416

· Lubar JF & Lubar JO (1999). Neurofeedback assessment and treatment for attention deficit/hyperactivity disorders (pp. 103-143). In JR Evans & A Abarbanel (Eds), Introduction to quantitative EEG and neurofeedback. San Diego: Academic Press.

· Rossiter T (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part I. Review of methodological issues. Applied Psychophysiology and Biofeedback, 29, 95-112; Part II, Replication. 29, 233-43

· Sterman, MB (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation Biofeedback and Self-Regulation, 21, 3-33

· Strehl U, Kotchoubey B, Trevorrow T, Birbaumer N (2005). Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy. Epilepsy and Behavior, 6, 156-166

· Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA (2009). Meta-analysis of EEG biofeedback in treating epilepsy. Clinical EEG and Neuroscience, 40, 173-179

· Trudeau DL (2005). Applicability of brain wave biofeedback to substance use disorder in adolescents. Child and Adolescent Psychiatric Clinics of North America, 14, 125-36

Conclusion
The epilepsy situation with our son still has its ups and downs. He occasionally has behavioral outbursts, which we believe are related to brainwave problems. Things are much better, but they are not perfect. We continue to help our son deal with epilepsy.

After seeing the effectiveness of neurofeedback for our family, we bought a neurofeedback training set-up and used it at home. Our son is off all medication, but has done over 3000 sessions of neurofeedback and trained daily until he was 16. After so many sessions, neurofeedback became pretty boring for him so we are confident that he continued with the treatment simply because it worked.

Judy L. Van Raalte, Ph.D.
Professor of Psychology
Springfield College

This entry was posted on Monday, November 10th, 2014 at 3:18 pm and is filed under Neurofeedback. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.