Epilepsy

The most solid and extensive body of research in Neurofeedback / EEG Biofeedback relates to seizure disorders. In fact, the principal method employed in this technique was inadvertently discovered in animal research related to seizure susceptibility. Over the decades since, it has been established that Neurofeedback can be helpful for various kinds of seizures. The nature and locus of the seizure focus does not seem to matter. This is not as surprising as it may seem. The same is true of the medications. These impact upon the whole brain, not the seizure focus in particular. Neurofeedback trains the whole brain to be less susceptible to the onset of a seizure. The technique raises the threshold of onset of a seizure; it discourages the generalization of seizure-like activity at the focus into a full-blown seizure. It presumably does nothing for the seizure focus specifically.

For the particulars, the reader may wish to consult other sub-headings in this compilation: Motor seizures; temporal lobe epilepsy; absence (petit-mal) seizures. Most of the formal research on seizure suppression was done in the early decades of the field. Even with the more primitive techniques available at that time, overall seizure reduction averaged more than 50%, with more than 80% of trainees benefiting at a level of 30% or more in severity and incidence. Many became seizure free, and many also became medication-free. All of these data refer to patients who were stable on their meds but their seizures were still not controlled. So the above refers to the incremental benefit beyond the best that can currently be done with medication management.

No doubt if Neurofeedback / EEG Biofeedback were the first intervention rather than the last resort, the above percentages would look considerably better. At the present time, and with modern procedures, the percentage of cases that do not respond to a degree that is considered worthwhile is exceedingly small. Neurofeedback is to be recommended to anyone considering brain surgery for intractable seizures. The cost of a Neurofeedback trial is trivial compared to the cost of surgery, and the option of surgery is not foregone. A trial of Neurofeedback should be considered as a matter of prudent caution, of conservative medicine, and of ethical practice.

Neurofeedback should be considered particularly by those who face life-threatening descent into status epilepticus. Such individuals can be trained in the technique so that they also have it available on an emergency basis. The Neurofeedback capability can even be combined with continuous monitoring of the EEG for incipient excursions into disregulation.

Epilepsy and Brain Surgery
It is estimated that there are some 400,000 to 600,000 cases of medically intractable cases of epilepsy in the United States. Many of these are considered candidates for brain surgery to eliminate or reduce their seizures. However, the total number of such brain surgeries is only on the order of 3,000 per year. Some two-thirds of these see essential elimination of their seizures with the surgery in the year following, with perhaps some loss of function in the bargain. This is obviously insufficient to make real inroads on the reservoir of intractable cases.

Undoubtedly the brain surgery option is resource-limited, either financially or in terms of the availability of suitably skilled personnel. In addition, many candidates are reluctant to take such an extreme measure. Neurofeedback may be a useful screen for brain surgery. A potential candidate for surgery should do Neurofeedback first to see whether the brain surgery is in fact necessary. At the cost of about one to two percent of the cost of brain surgery, most surgery candidates are likely to see substantial improvement in their condition, and thus be in a much better position to make a decision respecting surgery. Most surgery candidates will find that they will be able to forego the procedure. Surgeries can then be targeted on those individuals whose seizure disorder does not substantially resolve with the Neurofeedback. - Siegfried Othmer, PhD