Abstracts

Rationale: Published studies suggest that augmentation of the sensorimotor rhythm (SMR), a commonly-used neurofeedback protocol for patients with epilepsy, can be an effective means of reducing seizure frequency, even in patients with drug-refractory seizures. However, SMR protocols are limited to training a few frequency bands over sensorimotor cortex. Newer neurofeedback technology allows for the selection of multiple frequency bands in multiple head regions for training purposes and thus allows for training of neural networks. Functional MRI studies have shown abnormal connectivity within the default mode network (DMN) in patients with both focal-onset and primary generalized epilepsy syndromes. The DMN has also been implicated in the rapid spread of focally-generated ictal discharges. The effectiveness of newer neurofeedback techniques in reducing seizure frequency for patients with drug-refractory seizures has not yet been established. This case series will explore the potential effectiveness of using LORETA z-score training within the DMN in reducing seizure frequency in patients with drug-refractory seizures. Methods: The records for all consecutive patients seen in the Neurofeedback Clinic at a single academic medical center between November 1, 2013 and May 31, 2014 (n=5) were retrospectively reviewed. All patients had medically-refractory epilepsy and were either not candidates for epilepsy surgery (based on consensus decision of the center's faculty) or had refused to consider surgery for personal reasons. Data on patient demographics, duration of epilepsy prior to training, seizure types and frequencies, antiepileptic drugs (AEDs), psychiatric and medical comorbidities, imaging results, neurophysiological results, and the duration of neurofeedback training were abstracted and analyzed. Patient-reported seizure frequency was also analyzed. Results: 71 total training sessions were reviewed. Mean patient age was 34.8 +/- 7.2 years with mean duration of epilepsy prior to training of 17 +/- 3.9 years. Four out of five patients had focal onset epilepsy. None of the patients had a structural lesion on MRI that correlated with their seizure focus. Four out of five patients had a history of comorbid mood disorder. No patient had ever been seizure free for more than 1 year. Patients had been trained using LORETA z-score training within the DMN for an average of 15 weeks (1-2 sessions per week for 20-30 minutes per session) at the time of analysis. Four out of five patients trained had a subjective reduction in reported weekly seizure frequency after LORETA z-score neurofeedback training began (Figure 1). Conclusions: In this small case series, DMN training using LORETA z-score neurofeedback techniques resulted in subjective improvement in seizure frequency from reported baseline for four out of the five patients in this series. Larger studies are needed to more definitively assess the effectiveness of these techniques for reducing seizure frequency in patients with drug-refractory seizures who are not, for either medical or personal reasons, candidates for surgical intervention.