Abstracts

Rationale: Electrodermal Biofeedback Therapy for Epilepsy was established by Nagai and colleagues [2004a] more than a decade ago. The first randomized controlled trial reported a reduction in seizure frequency of over 50% in more than half those patients within the active biofeedback therapy group. The biofeedback therapy was developed following the identification of an inverse relationship between cortical excitability (indexed by slow cortical potentials using electroencephalography), and peripheral sympathetic arousal (indexed by electrodermal activity; EDA)[Nagai et al., 2004b; Nagai et al., 2009]. Accompanying functional neuroimaging studies implicated thalamo-cortical circuitry in the generation of slow cortical potentials [Nagai et al., 2004c], and showed that ventromedial prefrontal cortex/orbitofrontal neural activity is inversely coupled to biofeedback-driven changes in the tonic level of EDA (Nagai et al., 2004d). We also reported a long lasting effect of therapy (three years period after the termination of the therapy (Nagai and Trimble, 2014). Here we report a second controlled trial of Electrodermal Biofeedback Therapy in a larger group of patients with Drug-Resistant Temporal Lobe Epilepsy. Methods: Thirty-eight patients with drug-eesistant Temporal Lobe Epilepsy were allocated to either an active electrodermal biofeedback therapy group, or to a control (treatment as usual) group. Patients in the active electrodermal biofeedback therapy group were given 45 minutes of therapy training three times a week for four weeks (total 12 sessions). All patients (in both active and control groups) kept seizure diaries over the three months before and the three months after the therapy period, from which changes in seizure frequency were calculated. Results: After the month of biofeedback training, therapy elicited a significant reduction in the patients' seizure frequency: A reduction in seizure frequency of over 50% was observed in 9/20 (45%) patients in the active therapy group. The average seizure reduction was 42%, in the active therapy group compared to 7% in the control (treatment as usual) group (p = 0.002). Two patients (one each from the both groups) dropped at the follow up period. Conclusions: Therapy using electrodermal biofeedback appears efficacious in the management of drug-resistant Temporal Lobe Epilepsy. Although behavioural therapies are typically perceived as low-key adjuncts in epilepsy management, the therapy using electrodermal biofeedback represents a promising intervention that is effective, non-invasive, and low cost compared to pharmaceutical and surgical procedures, including Vagus Nerve Stimulation. Interest in the therapy from patients and clinicians has recently attracted media coverage (e.g. BBC, national newspapers, Medscape). Over the next decade, it is anticipated that the therapy will gain increasing importance in its application to patients with drug-resistant epilepsy. BBC News https://www.youtube.com/watch?v=YhHqTu4GQPM AES meeting interview 2016 https://www.youtube.com/watch?v=2x9D-A-O4-0 Medscape http://www.medscape.com/viewarticle/855754 Nagai Y, et al. Epilepsy & Behaviour 2004a, 5: 216-223. Nagai Y, et al. Epilepsy Res 2004b, 58:185-193. Nagai Y, et al. Neuroimage 2004c, 22:243-251. Nagai Y, et al. Neuroimage 2004c, 22:243-251. Nagai Y, et al. Psychosomatic Medicine 2009, 71: 84-92. Nagai Y and Trimble MR. Epilepsy Research, 2014, 108: 149-52. Funding: Wellcome Trust