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Neurofeedback Treatment of Pseudoseizure Disorder

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Background:  Previous research has shown that the suppression of theta wave activity and the enhancement of Sensorimotor Rhythm (SMR) through electroencephalographic (EEG) biofeedback is an effective treatment for epilepsy.  The current research reports the results of EEG biofeedback treatment for patients presenting with seizure behaviors in the absence of epileptiform EEG activity.

Methods:  In addition to psychotherapy, 3 patients, 2 women and 1 man, were trained, using EEG feedback once per week, to reduce the ratio of theta band to SMR band EEG amplitudes.


Results:  The results showed that reductions in seizure activity were related to reductions in the theta – SMR ratio. 

Conclusions:  These findings support the view that theta – SMR feedback training, in conjunction with psychotherapy, is an effective adjunctive treatment for pseudoseizure disorder.  Biological Psychiatry 1998; 44(11); 1196-1199.  © 1998 Society of Biological Psychiatry 

Key Words:  Neurotherapy, electroencephalographic feedback, pseudoseizures, nonepileptic events, biofeedback 



Pseudoseizures are sudden changes in behavior that appear to be seizures but without any identifiable organic cause (Bowman and Markand 1996).  Such nonepileptic events (NEE) may be characterized by epileptic-like seizures, numbness in the face and extremities, fainting, and fugue-like states.  Because pseudoseizure patients manifest high levels of psychiatric comorbidity (Lempert and Schmidt 1990; Bowman 1993) and no identifiable neurological anomalies, it is assumed by many clinicians that such NEE are psychological in nature (Bowman and Markand 1996).

      Pseudoseizure disorder is puzzling because of the lack of significant EEG anomalies.  Such patients often  

From the School of Psychiatry, Ottawa University, Ottawa, Canada.

Address reprint requests to Paul G. Swingle, PhD, School of

      Psychology, Ottawa University, Ottawa, K1N 6N5, Canada.

Received November 4, 1996; revised August 27, 1997; accepted

      September 10, 1997 

© 1998 Society of Biological Psychiatry

have epileptic histories together with a history of traumatic abuse.  Hence, one hypothesis regarding pseudoseizure disorder is that the patient has learned, from past epileptic seizures, behaviors that serve to mask abreactive breakthroughs of past trauma.

      An alternative to the above conceptualization is to view NEE as essentially an arousal disorder.  Such a view is not inconsistent with the “breakthrough” hypothesis, but rather conceptualizes the NEE as being triggered by stimuli that intensify autonomic arousal.  Such arousal could be associated with environmental stimuli such as loud noises, stimulants such as caffeine, or emotional content such as traumatic memories.

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Paul G. Swingle, Ph.D. was Professor of Psychology at the University of Ottawa prior to moving to Vancouver. A Fellow of the Canadian psychological Association, Dr. Swingle was Lecturer in Psychiatry at Harvard Medical School from 1991 to 1998 and (more...)
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