Neurofeedback Treatment of Pseudoseizure Disorder

“depression” (t = 2.87, df = 12, p < .02).  The  theta/SMR ratio during a seizure was significantly different from all the other averages (p < .01, two tailed in all cases).  The seizures remitted during the third week of treatment, when the theta/SMR ratio stabilized at an average of 1.06 (SD = 0.12).

Discussion

Lubar and Bahler (1976) have reported that if high amplitude slow-wave activity occurs in conjunction with SMR activity, either a transient increase in seizure rate or a lack of seizure decrease occurs with epileptic patients.  This reported finding is consistent with the findings reported here indicating a relationship between the theta/SMR ratio and seizure activity.  Further, the observation that seizure activity of the patient described in case one was also associated with her electrodermal activity suggests that pseudoseizure disorder may be essentially an arousal disorder.  The beneficial effects of SMR training may be that the SMR inhibits or suppresses excitation in the sensorimotor area.

      In summary, although psychological mechanisms appear prevalent in pseudoseizure disorder, and some patients experience reductions or elimination of seizures during the first year after diagnosis, the cases reported here had all been diagnosed a minimum of 7 years prior to theta/SMR treatment.  It is apparent, therefore, that seizure activity is directly related to the theta/SMR ratio, and that reductions in the theta/SMR ratio brought about by neurofeedback are associated with reductions in seizure behavior.  Due to the rare nature of this disorder, however, control groups are difficult to obtain, which in turn limits the extent of  these findings.  Nonetheless, the use of theta/SMR       

training to reduce seizure behavior concurrently with psychotherapy to address the contributing psychological issues seems prudent to facilitate enhanced social functioning of patients with pseudoseizure disorder.

Portions of the data from the first case report were presented at the meetings of the Society for the Study of Neuronal Regulation, Las Vegas, Nevada, 1994.

References

Ayers ME (1993):  A controlled study of EEG neurofeedback training and clinical psychotherapy for right hemisphere closed head injury [abstract].  In:  Proceedings of the Association for Applied Psychophysiology and Biofeedback.  pp 19-20.

Bowman ES (1993):  Etiology and clinical course of pseudoseizures:  Relationship to trauma, depression, and dissociation.  Psychosomatics  34:333-342.

Bowman ES, Markand ON (1996).:  Psychodynamics and psychiatric diagnoses of pseudoseizure subjects.  American Journal of Psychiatry,  153:57-63

Hoffman DA, Stockdale S, Hicks LL, Schwaninger JE (1995):  Diagnosis and treatment of head injury.  Journal of Neurotherapy,  1:14-21.

Lempert T, Schmidt E (1990):  Natural history and outcome of psychogenic seizures:  A clinical study in 50 patients.  Journal of Neurology,  237:35-38.

Lubar JF, Bahler WW (1967):  Behavioural management of epileptic seizures following biofeedback training of the sensorimotor rhythm.  Biofeedback and Self-Regulation,  1:77-104.

Lubar JF, Shouse MN (1976):  EEG and behavioural changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR):  A preliminary report.  Biofeedback Self Regulation, 3:293-306.

Mosmans PCM, Jonkman EF, Magnus O, Van Huffelen AC (1973):  Regional cerebral blood flow and EEG.  EEG and Clinical Neurophysiology,  33:122.

Ochs L (1994):  EEG-driven stimulation and heterogeneous mild head injured patients:  Extended observations.  Paper presented at the 2^nd Annual Conference of the Society for the Study of Neuronal Regulation, Las Vegas, Nevada.

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