Biofeedback Reduces Seizures in Intractable Epilepsy

Pauline Anderson

December 10, 2015

PHILADELPHIA — New research is showing that biofeedback, a technique using the mind to control physiologic responses, such as heart rate and respiration, can reduce seizure frequency.

The intervention is safe, easy to learn, and noninvasive, Yoko Nagai, PhD, Clinical Imaging Science Center, Brighton and Sussex Medical School, University of Sussex, United Kingdom, said at a press briefing during the American Epilepsy Association (AES) 69th Annual Meeting.

For the intervention — called electrodermal (EDA) biofeedback — patients attach small sensors to their two middle fingers. A small electrical current measures connectivity on the skin surface. Dr Nagai is named as the inventor on the patent of EDA biofeedback; this study was funded by the Wellcome Trust.

Dr Yoko Nagai

Patients sit at a computer with an animated program on the screen. Their increased skin conductivity drives the computer screen forward, changing the animation, while they strive to attain a final goal. Most patients enjoy the experience, which is similar to playing a video game, said Dr Nagai.

This therapeutic approach, called autonomic cognitive rehabilitation therapy, consists of both physiological and psychological components. "The idea is to build new habits or new reactions both from the psychological and physiological side," she said.

Over time, patients learn to anticipate and perceive seizure triggers and to respond effectively to them.

Dr Nagai's earlier trial showed that 60% of 18 patients receiving the biofeedback reduced their seizure frequency by more than 50% after twelve 45-minute sessions over 4 weeks.

Her work has shown that increased skin conductivity can reduce electroencephalographic signatures of cortical excitability in patients with epilepsy. This effect, she said, is similar to that seen with some antiepileptic drugs.

Quantifying Connectivity

This new study quantified how functional neural connectivity is altered following the EDA biofeedback treatment. It included eight patients with treatment-resistant temporal lobe epilepsy, mean age 44.9 years, who had at least four seizures per month.

These patients received the biofeedback therapy three times a week for 4 weeks. They also underwent functional neuroimaging at the first and final therapy sessions.

The study found a significant reduction in seizure frequency (P = .002). One patient became seizure free. Two patients had greater than 50% seizure reduction. The average reduction in seizure frequency was 40.54%.

The smaller clinical effect compared to the earlier study is due to the more homogeneous study sample, said Dr Nagai.

There was increased functional neural connectivity to the orbitofrontal cortex (OFC) and the adjacent ventromedial prefrontal cortex (VMPFC) in the tempestas piriform cortex, inferior temporal gyrus, anterior cingulate, and precentral gyrus. There was decreased OFC/VMPFC connectivity with the superior temporal gyrus and angular gyrus.

"One of the most interesting findings is a weakened connection between this frontal part of the amygdala, which is responsible for stress and anxiety," said Dr Nagai. "The implication of this result is that it seems that patients become less vulnerable to anxiety-related or stress-related seizures."

Anyone can learn the biofeedback technique, said Dr Nagai. Although she has studied this only in adults, she said that children, even young ones, can learn to do it, and once learned, it's a skill can be used in an ongoing way.

Dr. Ngai has trained other researchers — from as far away as Japan — on her technique. "They have gotten exactly the same results; it's really promising," she said. Currently, she's working on a digital version of the therapy that can be more widely disseminated.

But she recognizes that in the grand scheme of epilepsy therapy, behavior therapy takes a back seat to pharmacologic approaches. "I didn't see any lecture on this here," at the AES meeting, she noted.

Dr Nagai's project is "terrific," said Joseph I. Sirven, MD, professor, neurology, Mayo Clinic, Phoenix, Arizona, said when asked to comment.

"It demonstrates that indeed biofeedback, a tool that has been at our disposal for some time, can have benefit."

The study results are "similar to what a Cochrane review has suggested," Dr Sirven told Medscape Medical News. "This adds yet another therapy that helps patient self-manage or empowers them with a therapy at their fingertips."

Dr Nagai's research was funded by the Welcome Trust. She is named as the inventor of EDA biofeedback therapy for epilepsy in the patent (US7734338).

American Epilepsy Society (AES) 69th Annual Meeting. Abstract 3.277.

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