EEG Neurofeedback

[Bernard]

[FAQ about this thread: I often get asked by folks who read this thread what exactly is neurofeedback. So I'm adding this explanation to clarify:

Neurofeedback is a specific form of biofeedback. It involves an apparatus to measure some biometric data and provide the subject with some feedback on the data. In classic biofeedback, heartrate/pulse or breathing are usually measured. In neurofeedback, EEG impulses are measured. The EEG impulses are monitored by a computer which analyzes the brain wave patterns within a couple of defined spectrums commonly called alpha, beta, theta, delta and gamma.

A neurofeedback system matches the subject's brain wave patterns against a known pattern that is considered normalized (a composite or average profile of brain wave patterns from numerous "healthy" individuals). The system then offers the subject feedback (audible tones, graphics on a computer screen, etc.) on how close his/her brain waves are to the normalized pattern. Using this feedback, the subject can learn to change their brainwave patterns towards the normalized pattern by learning how to manipulate the feedback signal (ie. learning how to make the tone sound pleasant or make the graphics on the screen do what he/she wants).

Thus, neurofeedback is ultimately a system that allows a subject to train their brain to work with a normalized brain wave pattern. When this happens, the subject is generally calmer, has better focus and greater clarity of thought. More importantly for people with epilepsy - it means less seizure activity]

Since my wife had such great success with EEG Neurofeedback using a NeuroCare Pro, I was really surprised at the lack of information about and discussion of the therapy/technic in the major epilepsy information sites that I could find. So I did a bit more digging for studies and came across the following resources:

• FAQ (Frequently Asked Questions) About Neurofeedback Training:

  Is there any government funding for neurofeedback research or training?
  
  The short answer is, "yes, but nowhere near the scale of medical research." It is growing, however. Public announcements about funding studies on neurofeedback from the US Veterans Administration and the National Aeronautics and Space Administration (NASA) have been made. Neurofeedback research is being conducted at US, UK, Canadian, German, Israeli, Czech, Austrian, and other public universities, government hospitals and treatment facilities, etc., and there a growing number of these studies being published. A few of the US states have funded programs utilizing neurofeedback training and research and from time to time, reports or research papers about these are published, too.

• Comprehensive Neurofeedback Bibliography (.PDF) - The International Society for Neuronal Regulation maintains a page that contains references to published studies for neurofeedback.
• Neurofeedback Research:

  Substantial validation research has also been completed on neurofeedback for epilepsy or seizure disorder. Several controlled studies have been completed, including three condition reversal studies. Several other open trials or case series have also been reported. A recent meta-analysis (combining results of numerous separate studies) indicated that 82% of patients demonstrated greater than 30% reduction in seizures, with an average greater than 50% reduction. This outcome is all the more significant in that most of the participants included in these studies did not improve with standard medical care; for many, neurofeedback was the only alternative to surgery. Recent clinical experience has shown significantly improved outcomes using neurofeedback which is individually targeted at abnormalities in the degree of co-activation of different brain sites, as guided by coherence findings in the QEEG.

• Reflections about Brain Mapping
  and Neurofeedback: A Perspective from Mexico (emphasis mine):

  If neurofeedback can bring about structural modification of the brain – as growing evidence suggests – then an ethical issue has to be outlined. So far, there have been no reports of iatrogenesis (a harmful effect produced by the healer or the healing process) through the use of neurofeedback. However, this does not guarantee that there cannot be harmful effects through changing the physiology and probably the structure of a brain area, where such changes are not needed. Homeostasis is a fundamental natural system preserving health. If neurofeedback can change homeostatic processes, then it is of the utmost importance to maintain a very careful and responsible attitude in order to help nature and not to disrupt it.

[Bernard]

Here's some more resources:

• (sigh - it's not there any more) http*//www.adhd-biofeedback.com/proof.html - Proof of EEG Biofeedback Training Effectiveness - I didn't double check it, but it appeared to be a copy of the bibliography listed above. However, there is some information at the bottom of the page that (supposedly) is a summary of the published studies.
• (&^%&^ - site no longer exists) http*//www.minderlabs.com/Efficacy.htm - The Efficacy of Neurofeedback - A letter to the editor which has a overview of the studies listed in the bibliography in the previous post:

  As a joint committee representing the Society for Neuronal Regulation and the Association for Applied Psychophysiology and Biofeedback, we are writing to express our concerns about a recent article in The Behavior Therapist. Lohr et al. (2001) published a review of neurofeedback, concluding that it does not qualify as an empirically supported treatment. Unfortunately, the review was not comprehensive and demonstrated systematic bias in failing to include the most rigorous research on neurofeedback.
  
  Sterman (2000) comprehensively reviewed the literature on the neurofeedback treatment of uncontrolled epilepsy. Overall, this literature documented that 82% of the most severe, uncontrolled epileptics demonstrated a significant reduction in seizure frequency. Although 3 studies found significant seizure reductions regardless of the EEG feedback contingencies which were rewarded, "the vast majority of patients responded only when feedback contingencies provided reward for SMR activity and normalization of the sensorimotor cortex EEG" (p. 49).

[Bernard]

The more I read, the more it appears that a treatment's efficacy must be documented by double blind placebo controlled studies in order to be accepted by the medical establishment. Unfortunately, because of the nature of neurofeedback training, it does not appear that such a study is possible.

Some more items of interest along these lines (some added emphasis is mine):

• Explaining Neurofeedback:

  The operant conditioning of the EEG was first demonstrated in cats, where placebo effects are assumed to be absent. Those studies done with control groups have shown the technique to be a robust and valid intervention. Many more studies are of a case series variety, without control groups. Though this latter category is not held in high regard, now with the newer studies using some randomization and controls, perhaps this is changing. Recent New England Journal of Medicine reviews of research design have cast doubt on the need for placebo controlled designs. Their review has shown that when there is a preponderance of case series reports, the concordance between those results and those of the "gold standard" (double blind placebo controlled studies) was very high. Many in the field are now arguing against doing a double blind study due to the lack of proper humane treatment of those in the control group (receiving no treatment), an approach which is also now considered unethical by the World Health Organization when known treatments exist.

• Pills, Politics and Placebos:

  Randomized double blind placebo controlled clinical trials (RCT) are the current “gold standard” for demonstrating clinical efficacy of new drugs or therapies. It is very difficult for new therapeutic interventions to gain broad acceptance in the absence of such trials. Recent events have raised serious questions about the conditions under which placebo (sham) controls can be used. The international standards published by the World Medical Association (Declaration of Helsinki) prohibit placebo-controlled studies when known effective treatments exist. Additionally, there is new interest in identifying the mechanisms underlying the placebo response, which may challenge the “placebo” as a legitimate control condition. Both of these events should be of considerable interest to those interested in clinical psychophysiology in general and neurotherapy in particular.

• Reply to Kline, Brann, and Loney (2002), "A Cacophony in the Brainwaves":

  The main impetus of our earlier studies was to initiate the field and to show that there is a rationale, specifically, that EEG differences exist between individuals with ADD and nonclinical controls. Furthermore, training these differences toward the normal range results in considerable improvement. It is true that the earlier studies, with one exception, were not highly controlled in terms of being randomized, double-blind crossover studies or matched, randomized group studies. Actually, our first study was published in 1976 on a single case. A 1977 chapter that I wrote for the first volume of Advances in Clinical Child Psychology reviews our initial studies in the area of epilepsy research as well as research on ADD. The ADD study described is the only ABA crossover blind study that has been conducted. If it had not yielded the positive results it did, I would probably have not pursued developing this area. The blind component involved independent observers in the classroom who had no knowledge of which portion of the study the patients were engaged in, and the patients were blind in terms of not knowing which conditions were being reinforced and inhibited. Unfortunately, because of the Declaration of Helsinki we are now no longer allowed to conduct studies of this kind because we are subjecting individuals to a condition that might be deleterious, namely, the reversal of the positive feedback conditions. However, other designs are equally appropriate.

[Bernard]

I found a web site promoting a book about epilepsy and alternative therapies. There is an excerpt from Chapter 3 discussing neurofeedback that has some nice graphics showing what the brain waves look like:

Biofeedback, Neurofeedback and Epilepsy

[Bernard]

Here's a news report from a Dallas TV station regarding an ice skater from Ohio who is being treated for seizures with neurofeedback at a clinic in Dallas (for free!). The doctor mentions in the video that he has successfully treated 12 consecutive patients.

Tom and his wife Penny have brought their daughter from Toledo, hoping the neurofeedback intervention of Dr. Jonathan Walker can help.

"On twelve consecutive patients that we've treated, we couldn't control their seizures with drugs (but) we were able to eliminate their seizures with this technique," Walker said.

Walker first uses a portable EEG and electrodes to track her brain waves as she skates, and when she comes off the ice.

On this day of treatment, Cassandra's right anterior temporal lobe is the focus. It controls creativity and artistic expression, which is a big part of ice skating.

The neuorological team then helps Cassandra eliminate the waves associated with the seizures. They hope she'll be seizure-free in another two weeks.

The original story isn't available any more - http*//www.wfaa.com/sharedcontent/dws/news/localnews/tv/stories/wfaa050523_am_skater.2a2d63b10.html - Treatment helping eliminate seizures

[Bernard]

Robert Reynolds, a spokesman for the American Psychological Association and a psychologist in private practice in Middletown, Conn., told UPI a newer treatment option is something called EEG neurofeedback. This technique involves using video games and electrodes that monitor brain waves to teach the brain to better regulate and prevent ADHD tendencies.

Studies suggest EEG neurofeedback can have the same success rate as medication but without the side effects, said Reynolds, who runs a clinic for children and adult with ADHD.

"Many people really believe this is the way of the future," he added.

Another dead link...sigh... - http*//www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20050524-08112300-bc-us-adhd.xml - ADHD may cause $77 billion in lost income

Count me in the group considering neurofeedback as the way of the future. I hope it starts getting the same level of recognition and support for treating epilepsy as it currently does for treating ADHD.

[Bernard]

Another form of neurofeedback is in the news lately. See the article that BirdBomb posted in the Thought control brings pain into line thread.

[Bernard]

... Fear of the unknown, option paralysis and lethargy are common, but for these three people they became severe disabilities. A specialist at a Lansing psychiatry clinic says she’s made great progress with all three, and others like them, using an old treatment method that’s making a comeback in modern computerized garb.

Neurofeedback, called “biofeedback” in the ‘70s, is quietly returning to American health care radar screens.

...

While many of it trappings are new, neurofeedback has a long therapeutic pedigree. “It’s classic operant conditioning,” Hoogterp says, invoking a famous reward-and-punishment scheme going back to Skinner’s pigeons and Pavlov’s dogs.

...

Proponents say neurofeedback has helped people with attention deficit disorder, epilepsy, alcohol and drug addiction, and any number of anxieties and neuroses.

“This is often done with people who have focus problems when they’re reading, kids that have ADD,” Morse says. “They can bring their homework in and do it to the sound of the rewards. I’m told this really makes a difference when they do their homework at home.”

...

Morse and Hoogterp have other success stories from their first six weeks working together. The woman who couldn’t leave the house finally went to the gallery and bought the peanuts in downtown Lansing.

Another patient, Michael Rosencrantz, was diagnosed with Asperger’s disorder, a variant of autism with a whole complex of symptoms, including social isolation.

“I had problems with getting up in the morning,” he says. “Another person who had Asperger’s described it like being covered in molasses and climbing a mountain.”

So far, Rosencrantz has gone through 15 sessions with Morse. “Since starting this, getting up in the morning is what I imagined as normal,” he says. “I’m not quite as stuck on ideas as I used to be. It’s like I can shift gears now.”

Hoogterp says insurance companies generally don’t pay for neruotherapy, because its benefits are still considered unproven by the medical community. Although there are lots of case studies showing clinical success with neurofeedback, she says, full-blown studies, with control groups, take a lot of money to fund. Needless to say, Hoogterp says, the large pharmaceutical companies have been less than anxious to underwrite studies exploring a treatment with potential to limit public reliance on drugs for a large array of physical and mental disorders.

“Drugs are more of an illusion,” says Rosencrantz, who tried drugs for his Asperger’s before turning to neurofeedback. “If you’ve ever been sober with a bunch of your friends who are drunk, you know they think they’re much smarter and funnier than they really are.”

Anothed news article that no longer exists...sigh... - http*//www.lansingcitypulse.com/060118/health/index.asp - Training brainwaves to comb down, with a mirror

[POSITIVEPERSON]

Thank you for posting that site, I checked it out and I got a few names of
pple in Portland and I will see if I can afford it . Its sounds promising .

Thanks Again
Positive Person

[Bernard]

Which site did you find helpful? I posted links to a lot of different places in this thread!

Bear in mind that when Stacy tried the neurofeedback the first time, it took a long time (like 3-4 months) before we started to notice any results. It may take a commitment (of both time and money) to see it through for the 5-6 months or so.

I hope you find a suitable doctor in your area to try it out. Let us know how it goes.

[POSITIVEPERSON]

This is the site I found the info:

"I found a web site promoting a book about epilepsy and alternative therapies. There is an excerpt from Chapter 3 discussing neurofeedback that has some nice graphics showing what the brain waves look like:

Biofeedback, Neurofeedback and Epilepsy"
_________________

From their I was able to access Drs in each state who do nuerofeedback.

I didn't expect it to work on the first treatment,I expected it to take time.
I will check it out first,see if I can afford it.

thanks again for the info
Positive person[/i]

[Bernard]

The NYU Comprehensive Epilepsy Center is conducting a study of neurofeedback for medically refractory (uncontrolled) epilepsy:

If your seizures have not been controlled by either anti-epileptic drugs (anti-epileptic drug’s) or surgical intervention you may be a good candidate for this study. The study entails medical record reviews with a board-certified neurologist, EEG therapy sessions, and follow-up reviews. If you would like to learn more about this study and whether you are a suitable candidate please contact the research coordinator, Anjanette Naga, at ...

http*//www.med.nyu.edu/cec/alternatetherapies/neurofeedback_1104.html

Follow the link for the contact info if you are interested. Kudos to NYU and FACES for funding another study on neurofeedback.

[Bernard]

Biofeedback has won approval from a top watchdog group -- the American Health Care Policy Review board, Baskin says. The board conducted an exhaustive review of all reports on biofeedback as treatment for common and difficult-to-treat disorders like epilepsy and migraines.

"That group gave biofeedback a Grade A effectiveness rating, the highest level," Baskin tells WebMD.

...

Epilepsy: Neurofeedback is helping epilepsy patients reduce the frequency of their seizures.

"In people with epilepsy, part of the brain has become unstable, and occasionally it triggers the rest of the brain into seizure," explained Siegfried Othmer, PhD, an Encino, Calif., physicist who trains biofeedback therapists, in a previous interview. Neurofeedback may help stabilize those circuits and reduce the occurrence of seizures.

Biofeedback Trains Mind, Body to Make Changes

[Bernard]

Dr Soren Andersen, of Swansea University's School of Human Sciences, said: 'Neurofeedback has been around for about 30 years, and has successfully been applied to conditions such as ADD/ADHD and epilepsy but the technique is relatively unknown here in the UK.'

"Ultimately, we are trying to develop a neurofeedback treatment for anxiety which has its roots in over 40 years of theory and research - the end result will be a non-drug based intervention, which has a sound, scientific basis," added Dr Roger Moore, a psychologist at the University of Portsmouth.

Professor Philip Corr, also of Swansea University's School of Human Sciences, said: 'This is an exciting new application of recent advances in our understanding of how the brain controls emotional experiences; and shows how knowledge of fundamental brain systems can have very real benefits in terms of reducing distressing psychological states of worry and anxiety.'

'This is likely to be only the start of a whole new technology that allows individuals to learn to regulate their own brain states and, thereby, control the emotions controlled by these brain states.'

Training the brain to stop worrying

[Bernard]

Here's a new study on rats which highlights the importance of the theta brainwave with relation to the septum/hippocampus region of the brain:

The study "Septo-hippocampal networks in chronically epileptic rats: Potential antiepileptic effects of theta rhythm generation," by Luis V. Colom, Antonio García-Hernández, Maria T. Castañeda, Miriam G. Perez-Cordova and Emilio R. Garrido-Sanabria, The University of Texas at Brownsville/Texas Southmost College, appears in the June issue of the Journal of Neurophysiology, published by The American Physiological Society.

...

In this study, the researchers induced epilepsy by injecting anesthetized rats with pilocarpine, a drug that excites the brain's neurons and activates the synapses between the neurons to produce status epilepticus, in which sustained seizures occur. The rats received diazepam three hours later to interrupt the seizures, but became chronically epileptic, experiencing 3-5 seizures weekly.

The researchers then used electrodes to record individual neurons within the septum of the anesthetized rats to see what happened within the nerve pathways. They found that the epileptic rats suffered significantly more epileptic episodes when the brain did not have the proper theta rhythm.

The researchers also found that when the theta rhythm was induced in the rats, it reduced epileptic discharges 86-97 percent. (The researchers induced theta in one of three ways – by regulating the rats' anesthesia, by stimulating the septum directly with an injection of carbachol, or by using the sensory stimulation method of pinching the tail.)

Septum Keeps Neurons In Synch, Can Reduce Epileptic Seizures By 90 Percent

The theta wave is one of five wave frequencies that the brain learns to normalize with EEG neurofeedback.

[Bernard]

While reviewing and updating this thread, I ran across this:

Practitioners announce new applications regularly, yet as a field we fail to discriminate among first line well documented treatments, and experimental new applications. The current health care movements toward evidence based medicine and "best practices" standards will leave biofeedback behind, unless we better validate/support and rate our own treatment protocols.

The Task Force worked diligently for four months, reviewing a massive body of research reports on methodology and efficacy studies. The American Psychological Association addressed many similar issues in developing its guidelines on the empirical validation of psychological treatments (APA, 1995; Task Force on Promotion and Dissemination, 1995; Chambless et al, 1996, 1998). Review of the APA efforts provided significant guidance and some of the framework for the AAPB/SNR Task Force in developing guidelines for rating the efficacy of biofeedback and neurofeedback treatments. The Task Force also reviewed ethical issues regarding research on humans subjects, addressed in two critical documents, the Declaration of Helsinki (World Medical Association, 2000) and the Belmont Report (Department of Health and Human Services, 1979).

The Task Force produced a "Template," which has now been approved as a policy guideline by both the AAPB and SNR Boards. This Template provides our field with a strong set of methodological standards, by which we can classify applications at one of five levels of efficacy, according to the quality and quantity of outcome research which has supported each application: Level 1. Not empirically supported, Level 2. Possibly efficacious, Level 3. Probably efficacious, Level 4. Efficacious, and Level 5. Efficacious and specific. Regular use of this new template to assess the efficacy of mind-body therapies will give credence to our better treatment protocols.

Task Force Report on Methodology and Empirically Supported Treatments

The template is described on the referenced page. This is what they say about neurofeedback and epilepsy (emphasis is mine):

Overview Efficacy: One small controlled study and numerous clinical studies have shown that neurofeedback (brainwave biofeedback) can be very helpful in teaching people to avoid seizures. This therapy is rated as probably efficacious (level 3 on a scale of 1 - 5 with 5 being the best). The relatively low rating is due to the lack of controlled studies as there are sufficient studies with good baselines and follow-ups to warrant a higher rating.

Neurofeedback and Epilepsy

[Bernard]

Our resources page lists links to EEG Neurofeedback resources (including a couple of sites with searchable indexes to find practitioners around the world).

[Bernard]

Here's another page describing neurofeedback research for epilepsy (scroll down to the QEEG Biofeedback section).

[Bernard]

I found an interesting blog about Neurofeedback and brain functioning.

[Mike]

Ive been reading and you seem to know alot about nerofeedback did you know that N.A.S.A and Dr. Sterman first developed S.M.R nerofeedback because rocket fuel made astronauts seize?