Peak Stability: Seizure & Migraine

Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning

Self-regulation of Slow Cortical Potentials in Children with Migraine: An Exploratory Study

Migraine patients are characterized by increased amplitudes of slow cortical potentials (SCPs), representing pronounced excitability of cortical networks. The present study investigated the efficiency of biofeedback training of SCPs in young migraineurs. Ten children suffering from migraine without aura participated in 10 feedback sessions. They were compared with 10 healthy children for regulation abilities of cortical negativity and with 10 migraineurs from the waiting list for clinical efficacy. During the first two sessions, the migraine children were characterised by lacking ability to control cortical negativity, especially during transfer trials, compared with healthy controls. However, there was no difference following 10 sessions of training. Feedback training was accompanied by significant reduction of cortical excitability. This was probably responsible for the clinical efficacy of the training; a significant reduction of days with migraine and other headache parameters was observed. It is suggested that normalization of the threshold regulation of cortical excitability during feedback training may result in clinical improvement.

Changes in EEG Power Spectra During Biofeedback of Slow Cortical Potentials in Epilepsy

The goal of the study was to explore parallel changes in EEG spectral frequencies during biofeedback of slow cortical potentials (SCPs) in epilepsy patients. Thirty-four patients with intractable focal epilepsy participated in 35 sessions of SCP self-regulation training. The spectral analysis was carried out for the EEG recorded at the same electrode site (Cz) that was used for SCP feedback. The most prominent effect was the increase in the θ2 power (6.0–7.9 Hz) and the relative power decrement in all other frequency bands (particularly δ1, α2, and β2) in transfer trials (i.e., where patients controlled their SCPs without continuous feedback) compared with feedback trials. In the second half of the training course (i.e., sessions 21–35) larger power values in the δ, θ, and α bands were found when patients were required to produce positive versus negative SCP shifts. Both across-subject and across-session (within-subject) correlations between spectral EEG parameters, on the one hand, and SCP data, on the other hand, were low and inconsistent, contrary to high and stable correlations between different spectral variables. This fact, as well as the lack of considerable task-dependent effects during the first part of training, indicates that learned SCP shifts did not directly lead to the specific dynamics of the EEG power spectra. Rather, these dynamics were related to nonspecific changes in patients' brain state.

Neurofeedback treatment of pseudoseizure disorder

Background: Previous research has shown that the suppression of theta wave activity and the enhancement of sensorimotor rhythm (SMR) through electroencephalographic (EEG) biofeedback is an effective treatment for epilepsy. The current research reports the results of EEG biofeedback treatment for patients presenting with seizure behaviors in the absence of eliptiform EEG activity. Methods: In addition to psychotherapy, 3 patients, 2 women and 1 man, were trained, using EEG feedback once per week, to reduce the ratio of theta band to SMR band EEG amplitudes. Results: The results showed that reductions in seizure activity were related to reductions in the theta–SMR ratio. Conclusions: These findings support the view that theta–SMR feedback training, in conjunction with psychotherapy, is an effective adjunctive treatment for pseudoseizure disorder.

Slow cortical potential biofeedback and the startle reflex

The negativity of slow cortical potentials (SCP) of the surface EEG is a measure of brain excitability, correlating with motor and cognitive preparation. Self-control of SCP positivity has been shown to reduce seizure activity. Following SCP biofeedback from a central EEG electrode position, subjects gained bidirectional control over their SCP. The current study used a modified feedback methodology, and found a positive relationship between negativity and magnitude of EMG startle response (a measure of cortical and subcortical arousal, particularly aversive response disposition). Greater success in SCP differentiation was associated with self-report of less relaxation during negativity training.

Cortical self-regulation in patients with epilepsies

The present study aimed at investigating to what extent the regulation of excitability in cortical networks, as indicated by surface-negative slow cortical potentials (SCPs), is impaired in epileptic patients and to what extent training of SCP self-regulation by means of biofeedback and instrumental learning procedures might affect seizure frequency. Twenty-five patients suffering from drug-refractory epilepsies (complex focal, grand mal, and absence type of seizures) participated in 28 1-h sessions of feedback and instrumental conditioning of their SCPs. Subjects' EEGs were obtained from the vertex. Depending on discriminative stimuli DC shifts towards increased or suppressed negativity relative to the pre-trial baseline were demonstrated by on-line visual feedback during intervals of 8 s each; each session comprised 110 trials. While performance on the SCP self-regulation task was initially below normal (as compared to healthy subjects), significant increases in SCP control were achieved by the patients across the 28 training sessions. In 18 patients at least 1-year follow-up data are available. Changes in seizure frequency were related to transfer of SCP control with six of the patients becoming seizure-free. Age affected the ability to acquire SCP control and its impact on seizure frequency.

Behavioural treatment of slow cortical potentials in intractable epilepsy: neuropsychological predictors of outcome.

The study aimed to explore the predictive value of neuropsychological tests within the context of acquisition of slow cortical potential (SCP) self-control, a technique which has beneficial effects on seizure frequency in epilepsy. Patients with epilepsy who successfully achieved SCP control had longer digit or block-tapping spans than less successful patients. Patients who showed a better learning rate across training also displayed better verbal memory and learning abilities. Seizure reduction was related to block-tapping spans only. The results indicate that measures of attention, as indicated by digit spans or block-tapping spans, offer some predictive value for acquisition of SCP control and treatment outcome, whilst measures of visuospatial or frontal lobe function are unrelated to SCP acquisition and seizure reduction.

Predictive factors for controlling seizures using a behavioural approach

A behavioural approach using EEG biofeedback for controlling complex-partial seizures has been successful at the Andrews/Reiter Epilepsy Research Program. Records for a random sample of 83 patients with uncontrolled seizures, one third of those receiving care between 1980 and 1985, document that 69 (83%) achieved control by completion of the programme. Additional data about initial age of seizure onset, number of years seizures had been uncontrolled and seizure frequency when treatment started were collected to determine whether these factors predicted seizure control. Only frequency was significantly related to whether seizures were controlled when treatment ended. Further study using discriminant analysis showed that earlier onset age and higher seizure frequency were associated with a significantly greater number of treatment sessions required. Thus, these two factors predicted difficulty in controlling seizures, as measured by number of sessions, although onset age did not predict whether control was eventually achieved. Since even the subgroup achieving the lowest rate of control (i.e., patients having daily seizures when treatment started) had 67% success, these results suggest that a behavioural approach can be useful for many people with currently uncontrolled complex-partial seizures regardless of their characteristics on factors examined in this study.

Neuropsychological Assessment of Subjects with Uncontrolled Epilepsy: Effects of EEG Feedback Training

Summary: A battery of neuropsychological tests was administered at baseline, postcontrol period, and post-training period to 24 drug-refractory subjects with epilepsy participating in a study of sensorimotor electroen-cephalographic (EEG) normalization feedback training. Results revealed the following. First, subjects exhibited significant baseline deficits in psychosocial, cognitive and motor functioning. Second, certain tests discriminated subjects before training who were subsequently above and below the median in seizure reduction following EEG training. Subjects who showed the greatest seizure reduction performed better on a test of general problem-solving ability but not on other cognitive tests and worse on tests involving strong motor components and were more intact psychosocially. These subjects also took significantly fewer medications in combination than did less successful subjects. Third, improvement on several measures occurred following participation in the study. Cognitive and motor functioning improved only in subjects with the greatest seizure reduction and only after actual training as opposed to control conditions. Psychological functioning, as measured by the Minnesota Multiphasic Personality Inventory (MMPI) improved in both outcome groups. MMPI improvement, unlike cognitive improvement, was as likely to occur after control conditions, when seizure reduction had not yet occurred, as after EEG training. Thus, MMPI changes apparently reflected the nonspecific benefits of participation in this study. RÉSUMÉ Une batterie de tests neuropsychologiques àété administerée péndant la periode de base, pendant la période suivant le contrôle et pendant la période post-entrainement à 24 patients présentant une épilepsie réfractaire inclus dans un programme d'entraînement à la normalisation de ľEEG par feedback sen-sorimoteur. Les résultats ont montré: 1) que les patients présentaient au départ des défecits significatifs de leur fonctionnement psychosocial, cognitif et moteur; 2) que certains tests se révélaient discriminants pour la sélection avant entraînement de sujets qui se situaient au-dessous ou au-dessus de la moyenne pour la réduction du nombre de crises après entraînement. Les sujets qui ont obtenu la plus forte réduction du nombre de crises ont eu de meilleurs scores lors ľun test explorant la capacityé générale à résoudre des problèmes, mais pas aux autres tests cognitifs, et des scores inférieurs aux tests impliquant une forte composante motrice; ils étaient aussi plus intacts sur le plan psychosocial. Ces patients avaient en outre significativement moins de médicaments associés que les sujets moins perfor-mants; 3) qu'une amélioration portant sur plusieurs paramètres a été observée après entraînement. Le fonctionnement cognitif et moteur n'a été amélioré que chez les sujects qui ont obtenu la plus forte réduction du nombre de crises, et seulement après entrainement réel, et non après la période contrôle. Le fonctionnement psychologique, mesuré par le MMPI, fut amélioré dans tous les groupes. ľamélioration au MMPI, contrairement a ľamelioration des fonctions cognitives, a été constatée tant après la phase contrôle. Le fonctionnement psychologique, mesuré par le MMPI, fut amélioré dans tous les groupes. ľamélioration au MMPI, contrairement àľamélioration des fonctions cognitives, a été constatée tant après la phase contrôle, pendant laquelle aucune réduction du nombre de crises n'avait encore été obtenue, qu'après ľentraînement par ľEEG. ľamélioration du MMPI semble done refléter le bénéfice non spécifique retiré de la simple participation àľétude. RESUMEN A 24 sujetos con epilepsía refractaria al tratmiento que participaban en un estudio de normalización del EEG mediante entrenamiento por “feed back” sensitivo-motor, se ha administrado una bateria de tests neuropsicológicos en el periodo basal, en el periodo post-control y en el periodo post-entrenamiento. Los resultados revelaron lo siguiente: (a) individuos que mostraron deficits significativos en el periodo basal en las funciones psico-sociales. cognitivas y motoras. (b) ciertos tests discriminaron los sujetos antes del entrenamiento que posteriormente mostraron una reducción de los ataques, por encima y por debajo del promedio, tras el entrenamiento del EEG. Los individuos que mostraron la mayor reducción de los ataques dieron resultados mejores en un test que medía la habilidad para resolver problemas generales pero no en otros tests cognitivos; mostraron peores resultados en los tests que medían fuertes componentes motores y aparecieron más intactos desde el punto de vista psicosocial. Estos sujetos también tomaban menos combinaciones medica-mentosas que los sujetos con resultados menos satisfactorios. (c) Se observo una majoría en las diversas medidas que occurió después de la participación en el estudio. Las funciones cognitivas y motoras mejoraron solamente en los sujetos con la mayor reducción en los ataques y sólo después de un entrenamiento reciente en contrapositión a las condiciones de control. La función psicológica medida con el MMPI, majoró en ambos grupos. Esta majoría en el MMPI, en discrepancia con la majorá en ambos grupos. Esta majoría en el MMPI, en discrepancia con la majorá cognitiva, tenía las mismas posibilidades de ocurrir después de las condiciones de control, cuando la reducción de los ataques no había ocurrido todavia, como después del entrenamiento del EEG. Asi pues los cambios en el MMPI aparente-mente reflejan beneficios no específicos de participación en este estudio.

EEG biofeedback and relaxation training in the control of epileptic seizures

Research utilizing sensorimotor rhythm (SMR) biofeedback with epileptics suggests that it is useful in decreasing seizures. Subjects were 6 young adults with a diagnosis of epilepsy of at least two years who had been unable to control their seizures with different regimens of anticonvulsant medications. Subjects ranged from severely mentally handicapped to above average functioning. Seizure type, frequency, and duration were recorded by subjects and caretakers. Measures of operant learning were percent time in SMR. The experiment utilized a single subject multiple baseline design which consisted of 6 phases: baseline one, relaxation training; baseline two, biofeedback training one; baseline three, biofeedback treatment two and follow-up. The results of this study are in agreement with other studies using SMR biofeedback. All subjects were able to significantly increase percent time in SMR. Five out of the 6 subjects demonstrated decreases in seizure frequency during the treatment phase. Two of the 6 subjects benefited from relaxation training. Four subjects demonstrated significant negative correlations between percent SMR and seizure rates. Consistent with other studies utilizing multiple baseline designs, a majority of the subjects did not follow the design of the study.

The response of a case of petit mal epilepsy to EEG sensorimotor rhythm biofeedback training

A 14-year-old girl, with a long history of absence seizures, sudden rages, spatial disorientation, and academic difficulties received long-term (33 sessions) EEG sensorimotor rhythm biofeedback training. Operantly conditioned increases in the average amplitude of the 14 Hz neural discharge rhythm, over the central Rolandic cortex and cerebrolongitudinal fissure, resulted in a total cessation of her absence seizures; which had, prior to the EEG sensorimotor rhythm biofeedback training, occurred at the rate of 4–5 absences per hour. Concurrently, her sudden rages, spatial disorientation, and academic functioning all evidenced significant remediation.

Recent Developments in the Diagnosis and Therapy of Epilepsy

Recent advances in the diagnosis of epilepsy include the development of a clinically useful classification of epileptic seizures and the recognition of specific epileptic disorders. These advances have been aided by the advent of x-ray computed tomography, long-term electroencephalographic telemetry, and video monitoring. Techniques for functional imaging of the human brain promise even greater diagnostic capabilities. New antiepileptic drugs have improved medical management, and technical and theoretical advances in pharmacokinetics have permitted physicians to design balanced dosing for individual patients. Although currently underused, surgical treatment of partial complex epilepsy can be safe and effective when used appropriately. Operant conditioning of electroencephalography may become another practical alternative therapy. Contributions of basic research to understanding the complications of status epilepticus have influenced treatment protocols and greatly improved the prognosis of this potentially lethal condition.

A double-blind investigation of the relationship between seizure activity and the sleep EEG following EEG biofeedback training

The sleep EEGs of eight medically refractory epileptic patients were examined as part of a double-blind, ABA crossover study designed to determine the effectiveness of EEG biofeedback for the control of seizures. The patients were initially reinforced for one of three EEG criteria recorded from electrodes placed over sensorimotor cortex: (a) suppression of 3- to 7-Hz activity, (b) enhancement of 12- to 15-Hz activity, or (c) simultaneous suppression of 3- to 7-Hz and enhancement of 11- to 19-Hz activity. Reinforcement contingencies were reversed during the second or B phase, and then reinstated in their original form during the final A′ phase. All-night polysomnographic recordings were obtained at the end of each conditioning phase and were subjected to both visual and computer-based power spectral analyses. Four of the patients showed changes in their nocturnal paroxysmal activity that were either partially or totally consistent with the ABA′ contingencies of the study. The spectral data proved difficult to interpret, though two trends emerged from the analyses. Decreases in nocturnal 4- to 7-Hz activity were correlated with decreases in seizure activity, and increases in 8- to 11-Hz activity were correlated with decreases in seizure activity. These findings were shown to strengthen the hypothesis that EEG biofeedback may produce changes in the sleep EEG that are related to seizure incidence.

Eight to Twelve Hertz Occipital EEG Training with Moderate and Severely Retarded Epileptic Individuals

Three retarded epileptic individuals, with a variety of seizure disorders, were provided with 8-12 Hz occipital EEG biofeedback training. While seizures were not totally eliminated in any of the subjects, the results of the study indicated that all subjects exhibited decreases in some aspect of their seizure activity. The inability of all of the subjects to increase 8-12 Hz activity may best be explained in terms of the differing degree of effectiveness of the feedback stimuli in terms of their functionality as reinforcers. The results of the study indicate that changes in procedures will be necessary in order to determine if 8-12 Hz occipital EEG training is effective in reducing epileptic seizures.

EEG operant conditioning in intractable epileptics

Eight epileptic patients with mixed seizures refractory to medical control participated in a double-blind crossover study to determine the effectiveness of operant conditioning of the EEG as an anticonvulsant procedure. Baseline levels of seizures were recorded for four months prior to the beginning of treatment. participants then received false (noncontingent) feedback for two months followed by an ABA-patterned training program lasting a total of ten months. Subjects were assigned to three treatment groups based on different schedules of EEG feedback. They were first trained (A1, phase) either to suppress slow activity (3 to 8 Hz), to enhance 12- to 15-Hz activity, or to simultaneously suppress 3- to 8-Hz and enhance 11- to 19-Hz activity. This was followed by a B phase, in which patients were trained to enhance slow activity (3 to 8 Hz). In the final phase (A2), the initial training contingencies were reinstated. Neuropsychological tests were performed before and after training, and changes in EEG activity as determined by Fast Fourier spectral analyses were analyzed. Five of eight patients experienced a decrease in their mean monthly seizure rate at the completion of feedback training as compared with their initial baseline level.

Sensorimotor rhythm feedback training and epilepsy: Some methodological and conceptual issues

This study examined the hypothesis that the enhancement of a 12–16 Hz sensorimotor rhythm in the EEG is inhibitory to epileptic seizure activity. The effects of training to enhance 12–16 Hz central EEG, to enhance 8–10 Hz central EEG, to suppress high voltage EEG activity, and of random feedback were compared over a period of 12 months in three adult patients suffering from chronic, drug-refractory epilepsy. All three patients experienced a significant reduction in seizure rate by the end of the study, but this was not related to any one particular training condition. It is suggested that the therapeutic mechanism might involve placebo effects, relaxation training, or a facilitation of EEG desynchronization, the effect being idiosyncratic to the individual patient.

Reducing Epileptic Seizures Through Operant Conditioning of Central Nervous System Activity: Procedural Variables

Operant conditioning of the sensorimotor rhythm of the human electroencephalogram with time-outs contingent on epileptiform activity reduces epileptic seizure rates in patients whose seizures are not well controlled by medication. A comparison of this procedure with time-out training alone demonstrates that operant conditioning of the sensorimotor rhythm is neither necessary nor sufficient for seizure reduction.

EEG Operant Conditioning for Control of Epilepsy

Summary: We report the results of 23 severely epileptic patients who were given EEG feedback training. The paradigm reinforced the patients' 18 Hz activity over the scalp approximation of their focus while suppressing temporalis EMG and low frequency EEG activity. In contrast to other studies using EEG feedback, only 43% of patients showed significant changes in seizure occurrence and a lesser number were felt to have benefited clinically. None of our neuropsychological test parameters were helpful in identifying (prospectively or retrospectively) patients most likely to respond to this treatment. Although a few patients were significantly helped by this training, the mechanism for this effect is unclear. RÉSUMÉ Les auteurs rapportent les résultats obtenu chez 23 épileptiques graves qui ont été soumis a un appren-tissage de l'EEG par retroaction biologique (EEG feedback). Le principe de l'apprentissage etait de renforcer les activites EEG rapides a 18 cps et de supprimer les activites EEG lentes et l'activité des muscles temporaux. Contrairement a ce qui a ete observe dans d'autres etudes utilisant l'EEG feedback, 43% seulement des patients ont montre une modification significative du nombre de leurs crises et un nombre moins important encore ont donne l'impres-sion de tirer un benefice clinque. Aucun des parametres de nos tests neuropsychologiques utilises chez les patients à permis d'identifier (prospectivement ou retrospectivement) ceux d'entre eux qui etaient les plus aptes à repondre a ce traitement. Bien que quelques uns des sujets ont été significativement aidés par cet apprentissage, le mécanisme de cet effet n'est pas évident. RESUMEN Damos cuenta de los resultados obtenidos en 23 pacientes con epilepsia severa que fueron entrenados en el metodo de autocontrol del EEG. El ejemplo hizo que los pacientes pudiesen aumentar la actividad de 18 Hz sobre el area epiléptica mientras que suprimi'an las bajas frecuencias en el EEG y la actividad temporal en el EMG. En contraste con otros informes en los que se us6 el mismo metodo, sólo el 43% de nuestros pacientes mostrt un cambio significativo en el numero de crisis y tan sólo un numero menor de enfermos recibieron beneficios clfnicos. Ninguno de los parametros de las pruebas neurofisiolbgicas llevadas a cabo fueron utiles (prospectiva o retrospectiva-mente) determinando que pacientes eran mas probables de beneficiarse de este tratamiento. Aunque unos pocos pacientes fueron ayudados por este entrena-miento, el mecanismo de este efecto no esta claro. ZUSAMMENFASSUNG Wir berichten uber die Ergebnisse eines EEG-Feedback-Trainings bei 23 schwer epileptischen Patienten. Das Muster verstarkte beim Patienten die Fahigkeit, eine 18 Hz Aktivitat über der Schädelober-flache in Nahe ihres Fokus zu steigern und gleich-zeitig temporal das EMG und die niederfrequente EEG Aktivitat zu vermindern. Im Gegensatz zu anderen Untersuchungen, die mit dem EEG-Feedback arbeiteten zeigten nur 43% der Patienten signifikante Veranderungen der Anfallshäufigkeit und eine kleinere Anzahl schien klinisch gebessert zu sein. Keine unserer neuropsychologischen Testparameter half zu unterscheiden (prospektiv oder retrospektiv), welche Patienten hochstwahrscheinlich auf diese Behandlung ansprechen werden. Obgleich einigen wenigen Patienten durch dieses Training geholfen werden konnte, ist der Mechanismus dieses Einflusses unklar.

EEG feedback training of epileptic patients: Clinical and electroencephalographic analysis

To evaluate the clinical efficacy and mechanisms underlying EEG feedback training of epileptic patients, 5 adult patients with poorly controlled seizures were studied for 4–10 months during which quantitative analysis of seizures, the EEG, and serum anticonvulsant levels was conducted. Sustained seizure reduction did not occur during the first 4–5 weeks in which feedback signals were presented randomly in relation to the EEG. When feedback was then made contingent upon central 9–14 c/sec activity, seizures declined by 60% in 3 patients. Power spectral analysis showed upward shifts in EEG frequency, decreases in abnormal slow activity, and enhancement of alpha rhythm activity as a function of contingent training, but no specific EEG change was associated with seizure reduction in all patients. No evidence was obtained for the hypothesized involvement of a ‘sensorimotor rhythm’ or motor inhibition in the training effects. The lack of effect in two patients could not be attributed to insufficient training, lack of motivation, or to differences in seizure classification. A second phase of research showed that continued laboratory training was both sufficient and necessary for maintaining clinical and EEG effects. Results indicate that: (1) significant seizure reductions can occur with EEG feedback training which are not related to placebo effects, non-specific factors or to changes in medication; (2) EEG changes associated with such training can best be described as ‘normalization’; (3) continued clinical investigation of EEG feedback training as a non-pharmacological adjunct to conventional therapy appears justified.

Effects of Central Cortical EEG Feedback Training on Incidence of Poorly Controlled Seizures

Summary This study examined the clinical effects of central cortical EEG feedback training in 8 patients with poorly controlled seizures. After base‐line recordings, patients were trained in the laboratory and then initiated on a double or triple crossover design using portable equipment at home, with bimonthly laboratory test sessions. Performance at home was monitored by a strip chart recorder with the portable unit. Training was based on the simultaneous detection of two central cortical (C 3 ‐T 3 ) EEG frequency bands (6–9 Hz and either 12–15 or 18–23 Hz), with reward provided for the occurrence of one in the absence of the other. The design consisted of successive 3 month periods of training, with reward contingencies reversed after each period without the subject's knowledge. Seizure incidence records were compared statistically before, during, and after the design. Six of the 8 patients reported significant and sustained seizure reductions, which averaged 74%, following reward for either 12–15 or 18–23 Hz in the absence of 6–9 Hz. Response to positive reward for 12–15 Hz was specific, with seizure rates returning to base line when reinforcement contingencies were reversed. Reduced seizure rates following positive reward for 18–23 Hz were not altered with contingency reversals. A nonspecific interpretation of these effects is rejected in favor of an EEG normalizing hypothesis. RÉSUMÉ Cette étude envisage les effets cliniques de lapprentissage par rétroaction biologique (biofeedback) à renforcer l'EEG des régions centrales chez 8 épileptiques dont les crises étaient mal contrôlées par la thérapeutique. L'apprentissage a eu lieu au domicile des malades après un entrainement initial puis des contrôles bimensuels au laboratoire. L'unité portative comprenait un enregistreur sur papier pour surveiller la performance du malade. L'apprentissage avait pour but de permettre aux sujets de reconnaiire simultanément deux bandes de fréquences de l'EEG de la région centrale (6–9 Hz et 12–15 ou 18–23 Hz), la récompense étant donnée en présence d'une de ces fréquences et en l'absence de l'autré. On a utilise des périodes successives d'apprentissage durant 3 mois, avec une inversion des récompenses après chaque période, les inversions étant faites à l'insu du sujet. La fréquence des crises a été comparée statistiquement avant, pendant et après l'expérience. Six des huit malades ont rapporté une réduction significative de la fréquence des crises, avec une moyenne de 74%, dans le cas d'une récompense pour 12–15 ou 18–23 Hz en l'absence de 6–9 Hz. La réponse à une récompense positive pour 12–15 Hz était spécifique, avec un retour à la ligne de base lors de l'inversion des récompenses. La réduction de frequence des crises après une récompense positive pour 18–23 Hz n'a pas changé avec l'inversion des récompenses. L'interprétation non‐spécifique de ces résultats est rejetée, en faveur de l'hypothèse dune normalisation de l'EEG. RESUMEN En este estudio se han examinado los resultados clinicos en un grupo de ocho epilépticos mal controla‐dos que habian sido entrenados para la realización de un feedback electroencefalográfico central cortical. Después de practicar los registros de control, los enfermos fueron entrenados en el laboratorio y, posteriormente, iniciados en un plan de investigacibn con doble o triple superposición utilizando, en su domicilio, un equipo portatil de registro y estudios bimensuales en el laboratorio. Los resultados obtenidos en el domicilio se registraron en un registrador en banda portatil. El entrenamiento se basó en la detec‐ción simultánea de dos bandas de frecuencias elec‐troencefalograficas corticales centrales (C 3 ‐T 3 ) de 6–9 Hz y también de 12–15 6 18–23 Hz, dando una recompensa al sujeto cuando una banda de frecuencia apareciera en ausencia de la otra. El plan utilizado consistió en tres periodos sucesivos de entrenamiento, de tres meses cada uno, con contingencias de recompensa alternadas en cada periodo sin conocimiento del sujeto. Los registros de incidencia de los ataques se compararon estadisticamente antes, durante y después del plan. Seis de los ocho enfermos mostraron una reducción significativa y mantenida de los ataques que promedió un 74%, tras la recompensa de 12–15 ó 18– 23 Hz, en ausencia de 6–9 Hz. La respuesta a la recompensa positiva para 12–15 Hz fué especifica, con restauración de la frecuencia de ataques a los niveles previos cuando el refuerzo de las contingencias se alternaba. La reducción de la frecuencia de ataques conseguida con la recompensa positiva para 18–23 Hz no se modificó con la inversión de las contingencias. En favor de la hipótesis de la normalización del EEG se rechaza una interpretación inespecifica de los efectos descritos. ZUSAMMENFASSUNG Untersuchung über die klinischen Wirkungen des zentralen corticalen EEG feedback Trainings bei einer Gruppe von 8 schlecht kontrollierten Epileptikem. Nach Ableitung des Ausgangs‐EEGs wurden die Patienten im Labor geschult. Dann begann eine ambu‐lante Doppel‐ oder Dreifachcrossover‐Studie mit einer tragbaren Ausrilstung und 2‐monatlichen Labortests. Das Verhalten zu Hause wurde durch Lochstreifen‐aufzeichnungen mit der tragbaren Einheit festgehalten. Das Training beruhte auf der gleichzeitigen Ent‐deckung von 2 corticalen (C 3 ‐T 3 ) EEG‐Frequenz‐bandern(6‐9Hzundentweder 12–15 oder 18–23 Hz) mit Belohnungen fur das Erscheinen des einen in Abwesenheit des anderen Frequenzbandes. Der Ver‐suchszeitraum bestand aus aufeinanderfolgenden 3‐Monatstrainingsperioden mit Belohnungsquoten, die nach jeder Periode ohne Wissen des Patienten umge‐kehrt wurden. Die Häufigkeit der Anfälle wurde aufgezeichnet und statistisch verglichen vor während und nach dem Versuch. 6 von 8 Patienten berichteten signifikante und anhaltende Anfallsreduktionen (im Durchschnitt 74%) nach einer Belohnung für entweder 12–15 oder 18–23 Hz in Abwesenheit von 6–9 Hz. Die Reaktion auf eine Belohnung fur 12–15 Hz war spezifisch; die Anfallshäufigkeit kehrte zum Aus‐gangswert zurück, wenn die Verstärkerantwort umge‐kehrt wurde. Eine veränderte Häufigkeit nach Belohnung für die Erkennung von 18–23 Hz wurde nicht durch Umkehr der Belohnung geändert. Eine Interpretation dieser Wirkungen als nicht spezifisch wird zu Gunsten einer Hypothese der EEG‐Normalisierung zürtickgestellt.

Operant conditioning of the EEG in two patients with epilepsy: Methodologic and clinical considerations

Methodologic and clinical considerations are discussed in sensorimotor rhythm (SMR) biofeedback research on two dissimilar but severe epileptic males. The first case, an akinetic epileptic who prior to feedback training experienced 80–100 clinical seizures every 10 hours, showed considerable seizure reduction after 6 months of SMR and epileptiform training. A number of methodologic and instrumentation advances were pioneered with the akinetic patient: (1) development of and ultra-sharp band-pass filter; (2) use of epileptiform inhibit and feed-back circuitry; (3) use of monetary rewards as additional incentive; (4) use of correlational analysis for evaluation of acquisition in the major dependent variables and; (5) use of noncontingent feedback and rein-forcement as control techniques. The second case, a psychomotor epileptic, also showed therapeutic benefit from SMR training. Clinical information regarding the effect of anticonvulsant medications on the course and therapeutic outcome of SMR training are described. In conjunction with operant conditioning of 12 Hz activity, corresponding changes for other EEG parameters are examined.

Sensorimotor EEG operant conditioning: Experimental and clinical effects

Neurophysiological studies in cats have established a functional relationship between waking 12–15 Hz sensorimotor cortex rhythmic EEG activity (the sensorimotor rhythm or SMR) and a similar pattern during sleep, the sleep spindle. Both result from oscillatory thalamocortical discharge involving ventrobasal thalamus and sensorimotor cortex, and both are associated with a state of suppressed motor excitability. Enhancement of the SMR with operant conditioning methods in the cat clearly led to reduced seizure susceptibility. The experimental application of this approach to seizure control in epileptics has resulted in (A) evidence that EEG patterns can be manipulated significantly in man with operant conditioning, (B) suggestive observations concerning a potential component of pathology in epilepsy, and (C) strong preliminary evidence that SMR operant conditioning in epileptics is specifically therapeutic. Current research has focused upon the EEG during sleep in epileptics with primary motor symptomatology. This measure often reveals several hard signs of pathology. These include the presence of abnormal activity in the 4–7 Hz frequency band and the absence or disturbance of activity in the 11–15 Hz frequency band. Power spectral analysis is being utilized to quantify these sleep EEG components in five groups of epileptic patients, studied with different frequency patterns rewarded in an A-B-A design which provides for counterbalancing of order effects. Initial laboratory training is followed by 9–12 months of training at home with portable feedback equipment. Reward contingencies are reversed within each group at approximately three month intervals. Clinical EEG data, blood anticonvulsant measures and patient seizure logs supplement sleep EEG data obtained before training and after each phase of the design. Early results have again indicated specific therapeutic benefits following training of high frequency rhythmic central cortical activity.

Developing a biofeedback model: Alpha eeg feedback as a means for pain control

3 adept meditators voluntarily inserted steel needles into their bodies while physiological measures (EEG, EMG, GSR, EKG, and respiratbn)were recorded. Although each adept used a different passive attention technique, none reported pain. During the insertion, 2 of the 3 Ss increased their alpha EEG activity. The role of alpha EEG and its relationship to pain control is discussed.

Clinical Application of Biofeedback Training in Epilepsy

The research on biofeedback training in epilepsy is reviewed, with special regard to 1) extinction treatment of sensory induced epilepsia, and 2) sensory motor rhytm (SMR) feedback, where increase in SMR is supposed to decrease clinical seizures. Two cases, one of each of the two treatment techniques, illustrate the procedures. It is concluded that the extinction procedure is ready for clinical application, whereas SMR biofeedback is in need of further study before it can be recommended for general clinical application.

Kontrolliertes EEG-Alpha-Feedback-Training bei Gesunden und Kopfschmerzpatientinnen

Headache patients and healthy controls underwent alpha-EEG feedback training in 12 sessions. The present study does not support the literature which reports alpha increase by feedback training. The study included a patient group receiving feedback, a patient control group receiving pseudofeedback, and a volunteer group receiving feedback. Increase of alpha EEG was observed under feedback and pseudofeedback. However, there was always more alpha during baseline times than during training times. Alpha increase over time is suggested to be a habituation effect. Headache pain decreased with training (within the boundaries of a placebo effect), and there was no difference in headache decrease between feed-back and pseudofeedback patients.

Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm

Eight severely epileptic patients, four males and four females, ranging in age from 10 to 29 years, were trained to increase 12–14 Hz EEG activity from the regions overlying the Rolandic area. This activity, the sensorimotor rhythm(SMR), has been hypothesized to be related to motor inhibitory processes(Sterman, 1974). The patients represented a crosssection of several different types of epilepsy, including grand mal, myoclonic, akinetic, focal, and psychomotor types. Three of them had varying degrees of mental retardation. SMR was detected by a combination of an analog filtering system and digital processing. Feedback, both auditory and/or visual, was provided whenever one-half second of 12–14-Hz activity was detected in the EEG. Patients were provided with additional feedback keyed by the output of a 4–7-Hz filter which indicated the presence of epileptiform spike activity, slow waves, or movement. Feedback for SMR was inhibited whenever slow-wave activity spikes or movement was also present. During the treatment period most of the patients showed varying degrees of improvement. Two of the patients who had been severely epileptic, having multiple seizures per week, have been seizure free for periods of up to 1 month. Other patients have developed the ability to block many of their seizures. Seizure intensity and duration have also decreased. Furthermore, the successful patients demonstrated an increase in the amount of SMR and an increase in amplitude of SMR during the training period. Spectral analyses for the EEGs were performed periodically. The effectiveness of SMR conditioning for the control of epileptic seizures is evaluated in terms of patient characteristics and type of seizures.

Effects of sham feedback following successful SMR training in an epileptic

After 1 year of SMR biofeedback training of a severe epileptic teenage male, incidence of atonic seizures decreased from 8/hr to less than 1/3 hr. SMR increased from 10% to 70%. Epileptiform discharges decreased from 45% to 15%. Unknown to the patient, his family, or certain members of our research staff, noncontingent feedback was introduced on 7/22/74, ending 9/11/74. A significant decrease occurred for SMR(down 8%), and a significant increase for epileptiform discharges(up 4%). Rate of seizures increased, but was not statistically significant over preceding months of contingent feedback. Incidence of seizures associated with urine loss increased from approximately 6/month to 23/month during noncontingent feedback, a significant increase. Urine-loss results suggest that although seizures did not become more frequent, those the patient did experience were “harder,” i.e., more severe. Contingent feedback was reinstituted following the 7-wk sham, and recovery of all variables to their former levels(prior to sham) occurred.

Reduction of seizures and normalization of the EEG in a severe epileptic following sensorimotor biofeedback training: Preliminary study

Sensorimotor rhythm (SMR) biofeedback training was attempted in a 13-year-old male with frequent epileptic seizures. Prior to training the subject was averaging almost eight clinical seizures an hour. The SMR filter was tuned sharply to 12 ± 1 Hz. Feedback was conducted over approximately six months and continues to the present. In that time the subject's percentage of SMR increased from about 10%, prior to training, to 65% after the 34th training session. Correspondingly, his rate of clinical seizures decreased by a factor of 10 and a significant reduction in percentage of epileptiform discharges was noted. Beginning with trial 35, the subject was provided feedback of epileptiform activity in combination with 12 Hz activity. The combined effect of these two treatment variables was to reduce the trial-to-trial variance in the dependent variables of interest.

Reduction of epileptic seizures through EEG biofeedback training

Biofeedback training of the sensorimotor rhythm (SMR) was carried out in three male and three female adolescent epileptics and in two normal controls. The patients represented a cross-section of epilepsies including grand mal, myoclonic, afocal and psychomotor types. Three of the cases were mentally retarded. 12–14 Hz (SMR) activity was detected by a combination of sharp analog filtering and digital processing. The patients were provided with feed-back whenever they produced 0.5 sec of 12–14 Hz activity of a specified amplitude. Additional feedback was provided for epileptiform activity slow waves or movement. Furthermore, feedback for SMR production was inhibited by digital logic circuitry when movement, slow waves or spikes were present. Seizure reduction was obtained in five of the six epileptics. Several patients showed increased percentage of SMR when feedback was provided and varying degrees of normalization in their EEG as demonstrated by fast Fourier, crossed power spectral density and coherence analyses.

The Effects of Feedback on Focal Epileptic Discharges in Man

SUMMARY: The history of the control of epileptic disturbances by conditioning techniques is reviewed. The preliminary results of a three year trial of feedback techniques in 13 epileptic patients are presented. Thirteen epileptic patients (age 2.5 → 39 mean, 15.1 years) with lateralized focal discharges in the EEG were given repeated trials of feedback, the focal discharges being used to trigger auditory and somatosensory stimuli. Dosages and serum levels of medication were unchanged throughout the experimental period. The number of epileptic spikes per 15 seconds was assessed by automatic trend analysis during 20 to 30 minute control, biofeedback and post-feedback epochs. Ongoing EEG activity was quantified by 8 channel frequency analysis over 10 second epochs. The patients made efforts to increase and decrease the number of spike discharges with and without feedback and the results of both triggered and random auditory, somatosensory, photic and combined stimulation were compared at various intervals over a period of up to three years. A marked reduction in the number of focal discharges was noted in eight (61.5%) patients during and immediately following the sessions. Intermittent biofeedback sessions were not associated with a serial reduction in the number of focal EEG discharges. There was a reduction in the number of clinical epileptic disturbances in six patients (46%) and possible reasons for this improvement are discussed. One patient suffered an increase in focal temporal lobe discharges during triggered and random auditory stimulation whereas there was a marked reduction in the number of discharges during minimal electrical stimulation of the contralateral arm. The need for careful assessment of each patient to determine appropriate feedback stimulation is stressed. One aim of this research has been to assess the feasibility of using miniature units for continuous feedback of focal discharges in epileptic patients.

Biofeedback in Epileptics: Equivocal Relationship of Reinforced EEG Frequency to Seizure Reduction

SUMMARY It has been reported that biofeedback training of 12- to 14-Hz activity recorded over Rolandic cortex was accompanied by a reduction in seizure incidence in four human epileptics (Sterman et al., 1974). Biofeedback training of 12- to 14-Hz activity was provided for two epileptics and had no effect on clinical EEGs, seizure incidence, or proportion of EEG spectral power in the frequency range being trained. Subsequently, biofeedback training of 6- to 12-Hz Rolandic activity was provided for three epileptics. Two patients experienced reductions in seizure not accompanied by medication changes. Since no learning- of 6- to 12-Hz activity was detected, the changes in seizure incidence are not attributed to EEG biofeedback. It is suggested that the experience in the feedback setting provided these two patients with new techniques of relaxation. In view of the lack of statistical evidence of EEG changes following EEG biofeedback and the small number of patients trained to date, it appears wise to maintain a cautious attitude until the issue of causality is clear. RÉSUMÉ On a rapporté que le “biofeedback training” des activités á 12–14 Hz enregistrees sur le cortex rolandique, etait accompagne d'une diminution de la frequence des crises chez quatre sujets epileptiques (Sterman et al., 1974). Un tel “biofeedback training” des activités a 12–14 Hz effectue chez deux sujets epileptiques est reste‘ sans effet sur les EEG, le nombre des crises et la proportion des spectres de puissance de l'EEG pour les frequences interessSes par l'apprentissage. Ensuite, le měme traitement a été applique aux activités rolandiques a 6–12 Hz chez trois epileptiques. Chez deux sujets, les crises ont diminue sans changement du traitement. Puisqu'on n'a pas trouve d'apprentissage pour l'activite a 6–12 Hz cette diminution des crises ne peut pas etre attribute au biofeedback EEG. On suggere qu'a travers la situation de biofeedback on a realise chez ces deux patients une nouvelle forme de relaxation. En tenant compte d'une part de l'absence de modifications EEG statistiquement valables apres le biofeedback EEG et d'autre par du nombre reduit de sujets jusq'a maintenant entraihes, il semble raisonnable d'avoir une attitude reservee tant qu'on ne pourra pas 6tablir un rapport de causality entre cette méthode et les variations de la frequence des crises. RESUMEN Se ha publicado que el entrenamiento de la bioretroalimentación (biofeedback) de la actividad de 12–14 Hz registrada en la corteza rolandica, se acompanaba de una reduccion de la incidencia de ataques en cuatro enfermos epile“pticos (Sterman y col., 1974). El entrenamiento de la retroalimentacion bioldgica de la actividad de 12–14 Hz se realizo en dos epilepticos sin que se produjeran mod-ificaciones en los EEGs, incidencia de ataques o en la proporcion del espectro del EEG enr los maVgenes de la frecuencia sometida a entrenamiento. Seguidamente el entrenamiento por biofeedback de la actividad rolandica de 12–14 Hz se realizo en tres enfermos ep-ilepticos. En dos enfermos, sin modificar la medicacion, los ataques disminuyeron ennu-mero. Puesto que no se detectd aprendizaje de la actividad de 6–12 Hz, la reduccion de la incidencia de ataques no se atribuyo a la bioretroalimentacion electroencefalografica. Como sugerencia se propone que en estos dos enfermos la tecnica de bioretroalimentacion proporciono nuevos procedimientos de re-lajacion. En vista de la falta de evidencia estadfstica de alteraciones electro-encefalograficas tras la bioretroalimentacion del EEG y el reducido nfimero de enfermos en-trenados hasta la fecha, parece logico mantener una actitud cautelosa hasta que se aclare el tema de causalidad. ZUSAMMENFASSUNG Es ist berichtet worden, dass ein Biofeedback-Training von 12–14 Hz-Aktivitätüiber dem Rolandi'schen Cortex bei 4 anfallskranken Patienten mit einer Reduktion der Anfallshäufigkeit einherging (Sterman u.a., 1974). Ein Biofeedback-Training der 12–14 Hz-Aktivität wurde bei 2 Anfallskranken durchgefiihrt und zeigte keine Auswirkungen auf das klinische EEG, die Anfallshäufigkeit oder den Anteil des trainierten Prequenzbereichs am Powerspektrum des EEG. Daraufhin wurde ein Biofeedback-Training mit 6–12 Hz-Aktivitätüiber der Rolandi'schen Region bei 3 Anfallskranken durchgefiihrt, Bei 2 Patienten wurden die Anfalle reduziert ohne dass die Medikation geandert worden war. Da ein Lerneffekt der 6–12 Hz-Aktivität nicht entdeckt wurde, kann die Veranderung der Anfallshäufigkeit nicht dem EEG-Biofeedback zugeschrieben werden. Es wird vermutet, dass die Erfahrungen dieser beiden Patienten mit der Feedback-Methode ihnen neue Moglichkeiten der Entspannung vermittelten. Angesichts fehlender statistisch nachgewiesener Veranderungen im EEG nach Biofeedback und der kleinen Anzahl von Patienten, die bis heute trainiert wurde, scheint es angebracht, zuriickhaltend zu sein, bis die kausalen Zussammenhange klar sind.

THE TREATMENT OF HEADACHE BY MEANS OF ELECTROENCEPHALOGRAPHIC BIOFEEDBACK

A method of treatment of tension headache by means of relaxation training augmented by feedback of alpha frequency EEG is presented. The alleviation of headache symptoms and associated musculoskeletal tension in the majority of patients suggests that it is an effective treatment method. It is more effective than induced relaxation alone and appears to be more effective than EMG biofeedback used with this particular disorder.

Biofeedback Training of the Sensorimotor Electroencephalogram Rhythm in Man: Effects on Epilepsy

Summary Previous work in cats demonstrated a discrete 12–16 Hz rhythm in sensorimotor cortex (SMR), present only during absence of movement, that could be operantly conditioned. Trained cats were resistant to drug-induced seizures. Similar biofeedback training procedures were employed with epileptic and nonepileptic human subjects, utilizing lights, tones, and slides. Initially SMR activity was detected only at low voltage by tuned filters. Biofeedback training sessions resulted in a significant increase in this activity after 2 to 3 months. Learned SMR responses in nonepileptic subjects were trains of pure or polyrhythmic 12–16 Hz activity at 20 to 25 μV over central and frontal areas. Although epileptic subjects failed to develop the enhanced SMR amplitude, they did demonstrate increased occurrence of this frequency. Training in four epileptic patients, who previously were not controlled by chemotherapy, was accompanied by a significant reduction of EEG and clinical epileptic manifestations, as indicated by sequential power spectral analysis, clinical EEG records, and seizure logs. Tonic-clonic and myoclonic seizures were most markedly reduced. RÉsumé Des travaux antérieurs chez des chats ont démontré qu'il y a un rythme discret à 12–16 Hz dans le cortex sensorimoteur (SMR) évident seulement au repos mais suceptible d'étre conditioné. Les chats entrainés étaient résistants aux crises provoquées par des drogues. Des procédés analogues de biofeedback training ont été employeś chez des personnes avec ou sans épilepsie, en utilisant des lumières des sons et des diapositives. Au début, le rythme du cortex sensorimoteur était détecté seulement à des bas voltages avec des filtres à sonorisation appropriée. A la suite de séances de biofeedback training, il y avait après 2–3 mois, une augmentation significative de L'activité rythmique des régions sensorimotrices. Chez les sujets sans épilepsies, les activités acquises à la suite de L'apprentissage étaient constituées par des bouffées d'activités mono- ou polyrythmique à 12–16 Hz et de 20–25 μV d'amplitude, intéressant les régions centrales et frontales. Bien que les sujets avec épilepsie ne soient pas arriveés à augmenter L'amplitude des rythmes des régions sensorimotrices, ils ont cependant mis en évidence une augmentation quantitative de ces rythmes. Chez 4 sujets avec épilepsie qui avant L'entra înement n'étaient pas contrôlés par les médicaments, on a observéà la suite de L'entraînement une diminution significative des decharges paroxystiques sur L'EEG et des crises diminution objectiveée par L'analyse séquentielle des spectres de puissances et par le compte rendu du nombre des crises. Les crises tonico-cloniques et myocloniques etaient le plus remarquablement diminuées. RESUMEN Estudios previos en gatos nan demostrado que un discreto ritmo de 12 a 16 Hz en la corteza sensorial-motora (SMR), registrable solamente en ausencia de movimiento, podía ser condicionado. Los gatos entrenados eran resistentes a los ataques inducidos. Un entrenamiento semejante (bio-feedback) se utilizeó en enfermos epilépticos y en individuos sanos mediante el empleo de luces, tonos y diapositivas. Inicialmente la actividad SMR se registró solamente con voltajes bajos y filtros apropiados. El entrenamiento con retro-información boilógica (biofeedback) produjo un aumento significativo de esta actividad a los 2 o 3 meses. En individuos sanos, las respuestas SMR aprendidas, se expresaban en forma de trenes de una actividad, pura o polirítmica, de 12 a 16 Hz y de 20 a 25 micro-voltios en las areas frontal y central. Los enfermos epilépticos mostraron un aumento de estas frecuencias a pesar de que no se pudo conseguir un incremento de la amplitud SMR. En cuatro enfermos epilépticos entrenados sin posible control farmacológico previo, se consiguió una reducción significativa de las manifestaciones clínicas o electroencefalográficas de la epilepsyía, como demostró el análisis espectral secuencial y los trazados clónicos de EEG Los ataques tónico-clónicos y las mioclónias fueron los que más se redujeron. ZUSAMMEnfassung Frühere Untersuchungen bei Katzen liessen einen diskreten 12 bis 16 Hz-Rhythmus im sensomotorischen Cortex (SMR) erkennen. Er war nur bei Bewegungsruhe vorhanden und konnte konditioniert werden. Trainierte Katzen waren gegenüber medicamentös erzeugten Anfällen resistent. Ahnliche Programme mit biologischem Rückkopplungstraining wurden mit epileptischen und nicht epileptischen Patienten durchgeführt, wobei Licht, Töne und Dias verwendet wurden. Anfangs wurde die SMR.-Aktivität nur mit niedriger Amplitude durch abgestimmte Filter gefunden. Nach 2 bis 3 Monaten dauerndem Training der biologischen Rückkopplung wurde eine signifikante Zunahme dieser Aktivität gefunden. Bei nicht epileptischen Patienten bestanden die erlernten SMR-Ant-worten in Zügen reiner oder polyrhythmischer 12 bis 16 Hz-Aktivität mit 20 bis 25 μV über den zentralen und frontalen Ableitepunkten. Obwohl epileptische Patienten keine verstärkte SMR-Amplitude aufwiesen, zeigten sie doch eine vermehrte Häufigkeit dieser Frequenz. Das Training von 4 epileptischen Patienten, deren Anfälle durch Chemotherapie vorher nicht zu kontrollieren waren, wurde von einer signifikanten Verminderung der epileptischen Manifestationen im EEG und klinisch begleitet. Das zeigten die sequentielle Power-Spektrumanalyse, klinische EEG-Untersuchugnen und Anfallsaufzeichnungen. Tonisch-klonische und myoklonische Anfälle wurden am deutlichsten vermindert.

Suppression of seizures in an epileptic following sensorimotor EEG feedback training

Previous studies of a 12–14 c/sec slow wave rhythm localized to sensorimotor cortex in the cat indicated its functional relationship to thalamo-cortical inhibitory discharge, suppression of phasic motor behavior and suppression of drug-induced convulsions. Investigations in man showed the presence of a similar rhythm in rolandic cortex. Biofeedback techniques for the operant conditioning of this rhythm developed in studies of the cat provided a basis for similar EEG feedback training in man. The functional characteristics mentioned above suggested that this training could be of some benefit in the treatment of epilepsy. This communication reports preliminary findings from such a study in a 23-year-old female subject with moderately controlled major motor seizures of frontoparietal origin. Biofeedback training of this sensorimotor rhythm resulted in a striking enhancement of the rhythm's occurrence, differentiation from simultaneously recorded alpha rhythm activity, and a marked suppression of seizures. Changes in sleep patterns and personality were noted also.

Alpha enhancement as a treatment for pain: A case study

Drawing on past reports of raised pain thresholds of yogis in a meditative state, the high alpha content during meditation, and reports of operant alpha wave conditioning, a hypothesis was formulated that a high alpha state and pain are incompatible behaviors, and thus the production of alpha could be used for symptomatic treatment of pain. A patient, who suffered from severe headaches resulting from head injuries, went through 67 alpha conditioning sessions and increased his alpha activity from 20 per cent time alpha with eyes closed to 92 per cent time alpha with eyes closed and 50 per cent with eyes open. Although the patient was not able to rid himself of pain by achieving a high alpha state, he was in some instances able to prevent pain by going into a high alpha state before the headache began.