Abstract
The aim of this study was to determine whether the reduction of seizures in patients with intractable epilepsy after self-regulation of slow cortical potentials (SCPs) was maintained almost 10 years after the end of treatment. Originally, 41 patients received training with SCP-neurofeedback. A control group of 12 patients received respiratory feedback while another group of 11 patients had their anticonvulsant medications reviewed. Nineteen patients in the experimental group participated at least in parts of the long-term follow-up, but only two patients from each control group agreed to do so. The follow-up participants completed the same seizure diaries as in the original study. Patients of the experimental group also took part in three SCP-training sessions at the follow-up evaluation. Due to the small sample size, the results of participants in the control groups were not considered in the analysis. A significant decrease in seizure frequency was found about 10 years after the end of SCP treatment. The clinical significance of this result is considered medium to high. All patients were still able to self-regulate their SCPs during the feedback condition. This success was achieved without booster sessions. This is the longest follow-up evaluation of the outcome of a psychophysiological treatment in patients with epilepsy ever reported. Reduced seizure frequency may be the result of patients continued ability to self-regulate their SCPs. Given such a long follow-up period, the possible impact of confounding variables should be taken into account. The small number of patients participating in this follow-up evaluation diminishes the ability to make causal inferences. However, the consistency and duration of improvement for patients who received SCP-feedback training suggests that such treatment may be considered as a treatment for patients with intractable epilepsy and as an adjunct to conventional therapies.
Highlights
About one-third of patients with epilepsy do not respond to antiepileptic drugs (AED)
For the group of patients treated with slow cortical potentials (SCPs) feedback in the main study (Kotchoubey et al, 2001) who improved diagnosed as “intractable” the long-term outcome is of special interest
Reduction of seizures after neurofeedback in 74% of patients has been already reported in a meta-analysis (Tan et al, 2009) but long-term www.frontiersin.org data are not available, except the 1 year follow-up of the study reported from our group before (Kotchoubey et al, 2001)
Summary
About one-third of patients with epilepsy do not respond to antiepileptic drugs (AED). New AED and surgery are the standard treatment for those patients but still a considerable percentage of patients are left being drug resistant The majority of these patients suffer from focal seizures. A decrease of seizures after enhancement of the sensory motor rhythm in patients with poorly controlled epilepsies was reported in 1972 for the first time (Sterman and Friar, 1972) This treatment was motivated by earlier animal studies. Protocols for increasing SMRactivity and in some studies decreasing slow rhythms (delta and theta) of EEG have been used in the following years for research and practice mainly in the United States (for a review see Tan et al, 2009) In parallel to this development, Rockstroh et al (1993) were able to reduce seizures after feedback of slow cortical potentials (SCPs)
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