Abstracts

Rationale: Augmentation of the sensorimotor rhythm (SMR) is the most commonly-used neurofeedback protocol for seizure reduction in patients with epilepsy. Neurophysiological studies suggest that SMR neurofeedback training enhances inhibitory control over thalamocortical somatosensory and somatomotor pathways, raising seizure thresholds. Recent meta-analyses assessing neurofeedback training in patients with medically-refractory epilepsy showed that up to 80% of patients had a post-therapy reduction in seizure frequency. However, data on neurofeedback outcomes outside of seizure frequency are currently limited. This case series will explore whether SMR neurofeedback training potentially impacts overall quality of life in patients with epilepsy .Methods: The records for all consecutive patients seen in the Neurofeedback Clinic at the University of Colorado Hospital between July 1, 2012 and May 31, 2013 (n=9) were retrospectively reviewed. Data on patient demographics, duration of epilepsy prior to training, seizure types and frequencies, antiepileptic drugs (AEDs), degree of seizure control, psychiatric and medical comorbidities, imaging results, neurophysiological results, the duration of neurofeedback training and the neurofeedback protocols used were abstracted and analyzed. Patients in this clinic routinely complete the Quality of Life in Epilepsy- 31 (QOLIE-31) survey as a part of their clinic intake interview and at intervals throughout their training. Patients also report seizure frequency and neurobehavioral symptom severity before each session. Results: 137 total training sessions were reviewed. Mean patient age was 47.4 +/- 5.9 years with mean duration of epilepsy prior to training of 18.7 +/- 3.6 years. Eight of nine patients had focal onset epilepsy. Four of nine patients had a structural lesion on MRI that correlated with their seizure focus. Seven of nine patients had a history of comorbid mood disorder. The average total QOLIE-31 baseline score in our nine patients was 52.3 +/- 7.6. To date, four patients have completed follow-up QOLIE-31 surveys after an interval of training with an average score of 58.7 +/- 17.9. One of the four patients remained seizure-free throughout training. The other three patients reported a subjective decline in seizure frequency or severity.Conclusions: In this small case series, SMR neurofeedback training modestly improved short-term follow-up QOLIE-31 scores in patients with epilepsy. Larger studies are needed to confirm the value of the QOLIE-31 as an outcomes measure for SMR neurofeedback training, as well as to determine the psychosocial constructs that may underlie changes in quality of life after neurofeedback training in patients with epilepsy.