Skip to main content
SpringerLink
Log in

Foundation and Practice of Neurofeedback for the Treatment of Epilepsy

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

This review provides an updated overview of the neurophysiological rationale, basic and clinical research literature, and current methods of practice pertaining to clinical neurofeedback. It is based on documented findings, rational theory, and the research and clinical experience of the authors. While considering general issues of physiology, learning principles, and methodology, it focuses on the treatment of epilepsy with sensorimotor rhythm (SMR) training, arguably the best established clinical application of EEG operant conditioning. The basic research literature provides ample data to support a very detailed model of the neural generation of SMR, as well as the most likely candidate mechanism underlying its efficacy in clinical treatment. Further, while more controlled clinical trials would be desirable, a respectable literature supports the clinical utility of this alternative treatment for epilepsy. However, the skilled practice of clinical neurofeedback requires a solid understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as an in-depth appreciation of the ins and outs of the various hardware/software equipment options open to the practitioner. It is suggested that the best clinical practice includes the systematic mapping of quantitative multi-electrode EEG measures against a normative database before and after treatment to guide the choice of treatment strategy and document progress towards EEG normalization. We conclude that the research literature reviewed in this article justifies the assertion that neurofeedback treatment of epilepsy/seizure disorders constitutes a well-founded and viable alternative to anticonvulsant pharmacotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

REFERENCES

  • Abel, T., & Lattal, K. M. (2001). Molecular mechanisms of memory acquisition, consolidation and retrieval. Current Opinion in Neurobiology, 11, 180–187.

    Article  PubMed  Google Scholar 

  • Andrews, D. J., & Schonfeld, W. H. (1992). Predictive factors for controlling seizures using a behavioral approach. Seizure, 1(2), 111–116.

    Article  PubMed  Google Scholar 

  • Babb, M. I., & Chase, M. H. (1974). Masseteric and digastric reflex during conditioned sensorimotor rhythm. Electroencephalography and Clinical Neurophysiology, 36, 357–365.

    Article  PubMed  Google Scholar 

  • Birbaumer, N. (1997). Slow cortical potentials: Their origin, meaning, and clinical use. In G. J. M. Boxtel & K. B. E. von Böcker (Eds.), Brain and behaviour—past, present and future (pp. 25–39). Tilborg: University Press.

    Google Scholar 

  • Birbaumer, N. (2005). Breaking the silence: Brain–computer interfaces in paralysis. Proceedings of the Annual Conference, Int. Soc. for Neuronal Reg., 13, 2.

    Google Scholar 

  • Brodal, P. (1992). The basal ganglia. In The central nervous system: Structure and function (pp. 246–261). New York: Oxford University Press.

    Google Scholar 

  • Brogden, W. J. (1951). Animal studies of learning. In S. S. Stevens (Ed.), Handbook of experimental psychology (pp. 568–612). New York: Wiley.

    Google Scholar 

  • Chase, M. H., & Harper, R. M. (1971). Somatomotor and visceromotor correlates of operantly conditioned 12–14 c/s sensorimotor cortical activity. Electroencephalography and Clinical Neurophysiology, 31, 85–92.

    Article  PubMed  Google Scholar 

  • Chevalier, G., & Deniau, J. M. (1990). Disinhibition as a basic process in the expression of striatal functions. Trends in Neuroscience, 13, 277–280.

    Article  Google Scholar 

  • Cott, A., Pavloski, R. P., & Black, A. H. (1979). Reducing epileptic seizures through operant conditioning of central nervous system activity: Procedural variables. Science, 203, 73–75.

    Article  PubMed  Google Scholar 

  • DeLong, M. R. (1990). Primate models of movement disorders of basal ganglia origin. Trends in Neuroscience, 13, 281–285.

    Article  Google Scholar 

  • Egner, T., & Gruzelier, J. H. (2001). Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans. NeuroReport, 12(18), 4155–4160.

    Article  PubMed  Google Scholar 

  • Egner, T., & Gruzelier, J. H. (2004). EEG biofeedback of low beta band components: Frequency-specific effects on variables of attention and event-related brain potentials. Clinical Neurophysiology, 115, 131–139.

    Article  PubMed  Google Scholar 

  • Etevenon, P. (1986). Applications and perspectives of EEG cartography. In F. H. Duffy (Ed.), Topographic mapping of brain electrical activity (pp. 113–141). Boston: Butterworth.

    Google Scholar 

  • Felsinger, J. M., Gladstone, A. L., Yamaguchi, H. G., & Hull, C. L. (1947). Reaction latency (StR) as a function of the number of reinforcements. Journal of Experimental Psychology, 37, 214–228.

    Article  Google Scholar 

  • Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. New York: Appleton-Century-Crofts.

    Google Scholar 

  • Finley, W. W., Smith, H. A., & Etherton, M. D. (1975). Reduction of seizures and normalization of the EEG in a severe epileptic following sensorimotor biofeedback training: Preliminary study. Biological Psychiatry, 2, 189–203.

    Article  Google Scholar 

  • Froemke, R. C., Poo, M. M., & Dan, Y. (2005). Spike-timing-dependent synaptic plasticity depends on dendritic location. Nature, 434, 221–225.

    Article  PubMed  Google Scholar 

  • Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28, 1–12.

    Article  PubMed  Google Scholar 

  • Grice, G. R. (1948). The relation of secondary reinforcement to delayed reward in visual discrimination learning. Journal of Experimental Psychology, 38, 1–16.

    Article  PubMed  Google Scholar 

  • Harper, R. M., & Sterman, M. B. (1972). Subcortical unit activity during a conditioned 12–14 Hz sensorimotor EEG rhythm in the cat. Federation Proceedings, 31, 404.

    Google Scholar 

  • Hauri, P. (1981) Treating psychophysiologic insomnia with biofeedback. Archives of General Psychiatry, 38, 752–758.

    PubMed  Google Scholar 

  • Hirshberg, L. M., Chiu, S., & Frazier, J. A. (2005). Emerging brain-based interventions for children and adolescents: Overview and clinical perspective. Child and Adolescent Psychiatric Clinics of North America, 14, 1–19.

    Article  PubMed  Google Scholar 

  • Howe, R. C., & Sterman, M. B. (1972). Cortical-subcortical EEG correlates of suppressed motor behavior during sleep and waking in the cat. Electroencephalography and Clinical Neurophysiology, 32, 681–695.

    Article  PubMed  Google Scholar 

  • Howe, R. C., & Sterman, M. B. (1973). Somatosensory system evoked potentials during waking behaviour and sleep in the cat. Electroencephalography and Clinical Neurophysiology, 34, 605–618.

    Article  PubMed  Google Scholar 

  • Johnstone, J., Gunkelman, J., & Lunt, J. (2005). Clinical database development: Characterization of EEG phenotypes. Clinical EEG and Neuroscience, 36, 99–107.

    PubMed  Google Scholar 

  • Kaiser, D. A. (2000). QEEG: State of the art or state of confusion. Journal of Neurotherapy, 4, 57–75.

    Article  Google Scholar 

  • Kaiser, D. A., & Sterman, M. B. (2001). Automatic artifact detection, overlapping windows, and state transitions. Journal of Neurotherapy, 4(3), 85–92.

    Article  Google Scholar 

  • Kaiser, D. A., & Sterman, M. B. (2005). Correcting sampling bias of tapering windows. International Journal of Psychophysiology Manuscript submitted for publication.

  • Kaplan, B. J. (1975). Biofeedback in epileptics: Equivocal relationship of reinforced EEG frequency to seizure reduction. Epilepsia, 16, 477–485.

    Article  PubMed  Google Scholar 

  • Klimesch, W., Schimke, H., & Pfurtscheller, G. (1993). Alpha frequency, cognitive load and memory performance. Brain Topography, 5, 241–251.

    Article  PubMed  Google Scholar 

  • Kotchoubey, B., Strehl, U., Holzapfel, S., Blankenhorn, V., Froscher, W., & Birbaumer, N. (1999). Negative potential shifts and the prediction of the outcome of neurofeedback therapy in epilepsy. Clinical Neurophysiology, 110(4), 683–686.

    Article  PubMed  Google Scholar 

  • Kotchoubey, B., Strehl, U., Uhlmann, C., et al. (2001). Modification of slow cortical potentials in patients with refractory epilepsy: A controlled outcome study. Epilepsia, 42, 406–416.

    Article  PubMed  Google Scholar 

  • Kuhlman, W. N., & Allison, T. (1978). EEG feedback training in the treatment of epilepsy: Some questions and some answers. Pavlovian Journal of Biological Science, 12(2), 112–122.

    Google Scholar 

  • Lantz, D., & Sterman, M. B. (1988). Neuropsychological assessment of subjects with uncontrolled epilepsy: Effects of EEG biofeedback training. Epilepsia, 29(2), 163–171.

    Article  PubMed  Google Scholar 

  • Levesque, J., & Beauregard, M. (2005). Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study. Neuroscience Letters.

  • Lorensen, T. D., & Dickson, P. (2004). Quantitative EEG Normative Databases: A comparative investigation. Journal of Neurotherapy, 8, 53–68.

    Article  Google Scholar 

  • Lubar, J. F., & Bahler, W. W. (1976). Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm. Biofeedback and Self Regulation, 7, 77–104.

    Article  Google Scholar 

  • Lubar, J. F., Shabsin, H. S., Natelson, S. E., et al. (1981). EEG operant conditioning in intractible epileptics. Archives of Neurology, 38, 700–704.

    PubMed  Google Scholar 

  • Malenka, R. C., & Nicoll, R. A. (1999). Long-term potentiation—a decade of progress? Science, 285, 1870–1874.

    Article  PubMed  Google Scholar 

  • Marczynski, T. J., Harris, C. M., & Livezey, G. T. (1981). The magnitude of post-reinforcement EEG synchronization (PRS) in cats reflects learning ability. Brain Research, 204, 214–219.

    Article  PubMed  Google Scholar 

  • Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27, 231–249.

    Article  PubMed  Google Scholar 

  • Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & LaVaque, T. J. (2005). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 30, 95–114.

    Article  PubMed  Google Scholar 

  • Monderer, R. S., Harrison, D. M., & Haut, S. R. (2002). Neurofeedback and epilepsy. Epilepsy and Behavior, 3, 214–218.

    Article  PubMed  Google Scholar 

  • Pearce, J. M., & Hall, G. (1978). Overshadowing the instrumental conditioning of a lever-press response by a more valid predictor of reinforcement. Journal of Experimental Psychology: Animal Behavior Processes, 4, 356–367.

    Article  Google Scholar 

  • Quy, R. J., Hutt, S. J., & Forrest, S. (1979). Sensorimotor rhythm feedback training and epilepsy: Some methodological and conceptual issues. Biological Psychology, 9, 129–149.

    Article  PubMed  Google Scholar 

  • Rossiter, T. R., & LaVaque, T. J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit hyperactivity disorders. Journal of Neurotherapy, 1, 48–59.

    Article  Google Scholar 

  • Rockstroh, B., Elbert, T., Birbaume, N., et al. (1993). Cortical self-regulation in patients with epilepsies. Epilepsy Research, 14, 63–72.

    Article  PubMed  Google Scholar 

  • Roth, S. R., Sterman, M. B., & Clemente, C. C. (1967). Comparison of EEG correlates of reinforcement, internal inhibition, and sleep. Electroencephalography and Clinical Neurophysiology, 23, 509–520.

    Article  PubMed  Google Scholar 

  • Seifert, A. R., & Lubar, J. F. (1975). Reduction of epileptic seizures through EEG biofeedback training. Biological Psychology, 3, 157–184.

    Article  PubMed  Google Scholar 

  • Soderling, T. R., & Derkach, V. A. (2000). Postsynaptic protein phosphorylation and LTP. Trends in Neuroscience, 23, 75–80.

    Article  Google Scholar 

  • Sterman, M. B. (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation. Biofeedback and Self Regulation, 21, 3–33.

    Article  PubMed  Google Scholar 

  • Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 31(1), 45–55.

    PubMed  Google Scholar 

  • Sterman, M. B. (2005). Principles of neurotherapy. Proceedings of the Annual Conference, Int. Soc. for Neuronal. Reg. 13, 23.

  • Sterman, M. B., & Friar, L. (1972). Suppression of seizures in an epileptic following sensorimotor EEG feedback training. Electroencephalography and Clinical Neurophysiology, 33, 89–95.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., & Kaiser, D. A. (2001). Comodulation: A new QEEG analysis metric for assessment of structural and functional disorders of the CNS. Journal of Neurotherapy, 4(3), 73–83.

    Article  Google Scholar 

  • Sterman, M. B., Kaiser, D. A., & Veigel, B. (1996). Spectral analysis of event-related EEG responses during short-term memory performance. Brain Topography, 9(1), 21–30.

    Article  Google Scholar 

  • Sterman, M. B., & MacDonald, L. R. (1978). Effects of central cortical EEG feedback training on incidence of poorly controlled seizures. Epilepsia 19, 207–222.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., MacDonald, L. R., & Stone, R. K. (1974). Biofeedback training of the sensorimotor EEG rhythm in man: Effects on epilepsy. Epilepsia 15, 395–417.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., Mann, C. A., Kaiser, D. A., & Suyenobu, B. Y. (1994). Multiband topographic EEG analysis of a simulated visuomotor aviation task. International Journal of Psychophysiology, 16, 49–56.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., Howe, R. D., & Macdonald, L. R. (1970). Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science, 167, 1146–1148.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., & Wyrwicka, W. (1967). EEG correlates of sleep: Evidence for separate forebrain substrates. Brain Research, 6, 143–163.

    Article  PubMed  Google Scholar 

  • Sterman, M. B., Wyrwicka, W., & Roth, S. R. (1969). Electrophysiological correlates and neural substrates of alimentary behavior in the cat. Annals of the New York Academy of Sciences, 157, 723–739.

    Article  PubMed  Google Scholar 

  • Thatcher, R. W. (1992). Cyclic cortical reorganization during early childhood. Brain and Cognition, 20, 24–50.

    Article  PubMed  Google Scholar 

  • Walker, M. P. (2005). A refined model of sleep and the time course of memory formation. Behavioral and Brain Sciences, 28, 51–64.

    Article  PubMed  Google Scholar 

  • Walker, J. E., & Kozlowski, G. P. (2005). Neurofeedback treatment of epilepsy. Child and Adolescent Psychiatric Clinics of North America, 14, 163–176.

    Article  PubMed  Google Scholar 

  • Williams, B. A. (1999). Associative competition in operant conditioning: Blocking the response–reinforcer association. Psychonomic Bulletin and Review, 6, 618–623.

    PubMed  Google Scholar 

  • Wyler, A. R., Robbins, C. A., & Dodrill, C. B. (1976). EEG operant conditioning for control of epilepsy. Epilepsia, 20, 279–286.

    Article  Google Scholar 

  • Wyrwicka, W., & Sterman, M. B. (1968). Instrumental conditioning of sensorimotor cortex EEG spindles in the waking cat. Physiology and Behavior, 3, 703–707.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Neurobiology and Biobehavioral Psychiatry, School of Medicine, UCLA, Los Angeles, USA

    M. Barry Sterman

  2. Functional MRI Research Center, Columbia University, Columbia, USA

    Tobias Egner

Authors
  1. M. Barry Sterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tobias Egner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Barry Sterman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sterman, M.B., Egner, T. Foundation and Practice of Neurofeedback for the Treatment of Epilepsy. Appl Psychophysiol Biofeedback 31, 21–35 (2006). https://doi.org/10.1007/s10484-006-9002-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-006-9002-x

KEY WORDS:

Search

Navigation