Neurofeedback Treatment of Pseudoseizure Disorder

Category of seizure activity Coefficient p 

Multiple-seizure days      .56 .07

Severe seizures      .75 .05

Seizure-free days      .07  þu

Total seizures      .78 .05

      The data indicate that the theta/SMR ratio is associated with the self-rated seizure activity, and that the treatment protocol resulted in a significant deduction in the theta/SMR ratio.

Case Two

The second patient, a Caucasian man in his early forties, was referred for treatment of “paranoid/panic” attacks.  This patient complained that his hands would tremble, and he would become frightened, perspire heavily, experience a numbing of the left side of his body, and feel as though a policeman was standing close to his left side.

      The referring psychopharmacologist had required the patient to maintain a record of the attacks, which indicated that for the month prior to neurotherapy treatment, the patient experienced 16% attack-free days (AFD) and 42% multiple-attack days (MAD) (two or more attacks).  Although EEG evaluations did not reveal any anomalous activity, this patient did manifest high theta amplitudes as measured at Cz with theta/SMR ratios in the 4 – 5 range (mean = 4.88, DF = 1.32).  Treatment consisted of theta suppression and SMR enhancement at Cz as described in case one.  The results indicate that the patient’s attacks were related to the theta/SMR ratio (r = .60, df = 26, p < .01, two tailed).

Case Three

The third case, a Caucasian woman in her mid sixties, was referred for treatment of “fainting spells.”  During these spells, the patient would appear to fall asleep, often falling from her chair.  Her right arm and her head would shake rhythmically during some of these spells.  This patient had multiple hospitalizations for conditions other than her pseudoseizures including obsessive-compulsive disorder and depression.

      Initial EEG baseline indicated a theta/SMR ratio of 1.5.  During the course of the initial assessment the patient experienced a fainting spell (there were no hand or head movements during this episode), during which time the theta/SMR ratio averaged 3.64.

      The treatment for this patient included EEG disentrainment and theta/SMR neurofeedback.  Because this patient experienced seizures in session, the relationship between the theta/SMR ratio and her fainting spells could be determined.  These data are shown in Figure 3.

      The pretreatment theta/SMR ratio on days when the patient experienced a fainting spell during treatment was not different from a seizure-free session but was significantly larger when the patient reported

Figure 3.  Two-minute baseline recording of the average that/SMR ratio at the beginning and end of neurotherapy sessions with a client with pseudoseizure disorder.  Measures took place during client-reported seizure-free, seizure, and depressed periods.  The theta/SMR ratios during an in situ seizure are presented with the data collected from the seizure period.

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