Intractable Epilepsy Controlled by Neurofeedback and Adjunctive Treatments: A Case Report

Authors

  • Robert P. Turner Network Neurology Health, 2245-C Ashley Crossing Drive, PMB 163, Charleston SC
  • Vietta E. Wilson York University, Retired Professor; 72 University Ave W, Guelph, Ontario N1G 1N7, Canada
  • Jay D. Gunkelman Chief Science Officer, Brain Science International 5401 Norris Canyon Road, Suite #304, San Ramon, CA 94583, USA
  • Alexandra A. Harvison
  • Linda A. Walker Inland Seas Neurotherapy and Counseling

DOI:

https://doi.org/10.15540/nr.10.1.21

Keywords:

Epilepsy, QEEG, EEG, Neurofeedback, Mental Training, Case Report

Abstract

This case report documents the treatment of a female patient with intractable temporal lobe epilepsy with secondary generalization. At the age of 13, the patient was hospitalized with ~120 seizures in a day, some of which were life-threatening. After hospital discharge, despite a regimen of multiple antiseizure medications, the patient still experienced ~90 seizures per day. After the interventions described in this work, over 500 neurofeedback sessions guided by EEG or qEEG data and adjunctive treatments including mental skills coaching, the patient became seizure- and medication-free, progressing from poor academic performance and inability to carry out normal daily life to attending university as a student athlete playing an NCAA Division I sport. This case emphasizes that, with professional guidance and supervision, it is possible for people with epilepsy or their caregivers to provide the extensive, long-term neurofeedback and adjunctive training necessary for reduction and control of intractable seizures.

Author Biographies

Robert P. Turner, Network Neurology Health, 2245-C Ashley Crossing Drive, PMB 163, Charleston SC

Dr Robert ‘Rusty’ P. Turner is owner of Network Neurology Health LLC, an integrative neuroscience mentoring practice based out of Charleston SC, providing consultative mentoring, promoting whole-person brain and physiologic health, EEG & QEEG interpretation, and inpatient pediatric neurology/epilepsy hospitalist consultative work in states where there is a shortage of pediatric neuroscience practitioners. From 2013-2020, up until the COVID-19 pandemic, he owned Network Neurology LLC, a busy clinical neurology/neuromodulation practice performing neurological evaluations, treatments, and QEEG-guided neurofeedback.

As a neuroscientist with almost 40 years’ experience, Dr Turner is a skilled neurologist and epileptologist trained in EEG, clinical neurophysiology, electrodiagnostic medicine, pediatrics and child/adult neurology, epilepsy, neuromuscular diseases, neurodevelopmental medicine, clinical research, biostatistics, and epidemiology.

Dr Turner currently holds multiple academic, clinical, and research positions in South Carolina and several other states. After medical school, he completed an internship and residency in pediatrics at UNMC in Nebraska, completed two specialty fellowships in neurology and clinical neurophysiology at MCV in Richmond VA, followed by both academic and private practices. Dr. Turner has over 10 board and subspecialty certifications.

Vietta E. Wilson, York University, Retired Professor; 72 University Ave W, Guelph, Ontario N1G 1N7, Canada

Vietta E. "Sue" Wilson, PhD,  is  retired from teaching sport psychology, biofeedback-assisted self regulation, and counselling at  York University. She has worked in cerebral palsy,  in counselling centres and in corporations. She has been called the “grandmother” of biofeedback in sport. Sue co-authored Biofeedback &  Neurofeedback in Sport Psychology and other publications. She developed the Optimization in Sport Suite with her final project: building a virtual edumetric system of integrating biofeedback, neurofeedback,transfer and tracking skills with AI.

Jay D. Gunkelman, Chief Science Officer, Brain Science International 5401 Norris Canyon Road, Suite #304, San Ramon, CA 94583, USA

Jay Gunkelman, QEEG Diplomate Emeritus, has processed over 500,000 EEGs since 1972. He has served as president of The International Society for Neurofeedback and Research, as well as a board member and treasurer of the Association for Applied Psychophysiology and Biofeedback and is a past-president of the Biofeedback Society of California. Jay was the first to be certified in QEEG (1996). He has co-authored the textbook on EEG artifacting (2001). Jay remains busy with current projects and publications related to his seminal paper on EEG endophenotypes (2005, Clinical Electroencephalography). He is co-founder and Chief Science Officer of Brain Science International. 

Alexandra A. Harvison

Alexandra Harvison, PhD, Behavioral Psychology and former NCAA Division 1 athlete trained in Neurofeedback and Biofeedback and EEG recordings to help her daughter with intractable temporal lobe epilepsy manage and eliminate dehabilitating seizures to enable her to become independent and successful in school and sport. She trained over 600 training sessions with daughter for seizure control and over 200 training sessions with son to eliminate his epileptiform waves in his EEGs that would have given way to epilepsy. 

 

Linda A. Walker, Inland Seas Neurotherapy and Counseling

Linda Walker, PhD, LPC, QEEG-D, BCN, BCB has 28 years counseling experience and has used neurofeedback, biofeedback and qEEG in her practice for 23 years. She has worked in the ares of mental health, optimal performance, developmental disabilites, juvenile justice and corporate health. In addition to a private practice, she teaches and mentors and has served on several professional boards, including Midwest Society for Behavioral Medicine and Biofeedback and Behavioral Medicine Foundation.

References

Asadi-Pooya, A. A., Nei, M., Sharan, A., & Sperling, M. R. (2016). Patient historical risk factors associated with seizure outcome after surgery for drug-resistant nonlesional temporal lobe epilepsy. World Neurosurgery, 91, 205–209. https://doi.org/10.1016/j.wneu.2016.04.022

Balabhadra, A., Malipeddi, A., Ali, N., & Balabhadra, R. (2020). Abdominal epilepsy: A rare cause of unexplained abdominal pain. Cureus, 12(8), Article e10120. https://doi.org/10.7759/cureus.10120

Benevides, M. L., Costa Nunes, J., Guarnieri, R., Pauli, C., Wolf, P., Lunardi, M., Kondageski, C., Neves Linhares, M., Lin, K., & Walz, R. (2021). Quality of life long after temporal lobe epilepsy surgery. Acta Neurologica Scandinavica, 143(6), 629–636. https://doi.org/10.1111/ane.13406

Centers for Disease Control and Prevention. (2020). Epilepsy data and statistics: Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/data/index.html

Cerminara, C., El Malhany N., Roberto, D., & Curatolo, P. (2013). Focal epilepsy with ictal abdominal pain: A case report. Italian Journal of Pediatrics, 39, Article 76. https://doi.org/10.1186/1824-7288-39-76

Dozières-Puyravel, B., Danse, M., Goujon, E., Höhn, S., & Auvin, S. (2020). Views of adolescents and their parents on mobile apps for epilepsy self-management. Epilepsy & Behavior, 106, Article 107039. https://doi.org/10.1016/j.yebeh.2020.107039

Engel, J., Jr. (2013). Why is there still doubt to cut it out? Epilepsy Currents, 13(5), 198–204. https://doi.org/10.5698/1535-7597-13.5.198

Engel, J., Jr., Pitkänen, A., Loeb, J. A., Dudek, F. E., Bertram, E. H., 3rd, Cole, A. J., Moshé, S. L., Wiebe, S., Jensen, F. E., Mody, I., Nehlig, A., & Vezzani, A. (2013). Epilepsy biomarkers. Epilepsia, 54(Suppl. 4), 61–69. https://doi.org/10.1111/epi.12299

Fleming, M., Fitton, C. A., Steiner, M. F. C., McLay, J. S., Clark, D., King, A., Mackay, D. F., & Pell, J. P. (2019). Educational and health outcomes of children and adolescents receiving antiepileptic medication: Scotland-wide record linkage study of 766 244 schoolchildren. BMC Public Health, 9(1), Article 595. https://doi.org/10.1186/s12889-019-6888-9.

Frey, L. (2016). Impact of sensorimotor rhythm neurofeedback on quality of life in patients with medically-refractory seizures. NeuroRegulation, 3(1), 3–6. https://doi.org/10.15540/nr.3.1.3

Haut, S. R., Gursky, J. M., & Privitera, M. (2019). Behavioral interventions in epilepsy. Current Opinion in Neurology, 32(2), 227–236. https://doi.org/10.1097/WCO.0000000000000661

Kohlhase, K., Zöllner, J. P., Tandon, N., Strzelczyk, A., & Rosenow F. (2021). Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia, 62(4), 831–845. https://doi.org/10.1111/epi.16846

Mesraoua, B., Kissani, N., Deleu, D., Elsheikh, L., Ali, M., Melikyan, G., Hail, H. A., Wiebe, S., & Asadi-Pooya, A. A. (2021). Complementary and alternative medicine (CAM) for epilepsy treatment in the Middle East and North Africa (MENA) region. Epilepsy Research, 170, 106538. https://doi.org/10.1016/j.eplepsyres.2020.106538

Mohan, M., Keller, S., Nicolson, A., Biswas, S., Smith, D., Osman Farah, J., Eldridge, P., & Wieshmann, U. (2018). The long-term outcomes of epilepsy surgery. PLoS ONE, 13(5), e0196274. https://doi.org/10.1371/journal.pone.0196274

Morales-Quezada, L., Martinez, D., El-Hagrassy, M. M., Kaptchuk, T. J., Sterman, M. B., & Yeh, G. Y. (2019). Neurofeedback impacts cognition and quality of life in pediatric focal epilepsy: An exploratory randomized double-blinded sham-controlled trial. Epilepsy & Behavior, 101(Pt. A), 106570. https://doi.org/10.1016/j.yebeh.2019.106570

Nagai, Y., Jones, C. I., & Sen, A. (2019). Galvanic skin response (GSR)/electrodermal/skin conductance biofeedback on epilepsy: A systematic review and meta-analysis. Frontiers in Neurology, 10, 377. https://doi.org/10.3389/fneur.2019.00377

Nigro, S. E. (2019). The Efficacy of Neurofeedback for Pediatric Epilepsy. Applied Psychophysioly and Biofeedback, 44(4), 285–290. https://doi.org/10.1007/s10484-019-09446-y

Selaa, R., & Shaked–Toledanob, M. (2014, June). Neurofeedback treatments enable the EEG-normalization and total seizure control of epilepsy–A case study. Applied Psychophysiology and Biofeedback, 39(2), 142–143.

Singh, A., & Trevick, S. (2016). The epidemiology of global epilepsy. Neurologic Clinics, 34(4), 837–847. https://doi.org/10.1016/j.ncl.2016.06.015

Sterman, M. B., Macdonald, L. R., & Stone, R. K. (1974). Biofeedback training of the sensorimotor electroencephalogram rhythm in man: Effects on epilepsy. Epilepsia, 15(3), 395–416. https://doi.org/10.1111/j.1528-1157.1974.tb04016.x

Sterman, M. B., Wyrwicka, W., & Roth, S. (1969). Electrophysiological correlates and neural substrates of alimentary behavior in the cat. Annals of the New York Academy of Sciences, 157(2), 723–739. https://doi.org/10.1111/j.1749-6632.1969.tb12916.x

Strehl, U., Kotchoubey, B., Trevorrow, T., & Birbaumer, N. (2005). Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy. Epilepsy & Behavior, 6(2), 156–166. https://doi.org/10.1016/j.yebeh.2004.11.004

Tan, G., Thornby, J., Hammond, D. C., Strehl, U., Canady, B., Arnemann, K., & Kaiser, D. A. (2009). Meta-analysis of EEG biofeedback in treating epilepsy. Clinical EEG and Neuroscience, 40(3), 173–179. https://doi.org/10.1177/155005940904000310

Wyrwicka, W., & Sterman, M. B. (1968). Instrumental conditioning of sensorimotor cortex EEG spindles in the waking cat. Physiology & Behavior, 3(5), 703–707. https://doi.org/10.1016/0031-9384(68)90139-x

Yardi, R., Morita‐Sherman, M. E., Fitzgerald, Z., Punia, V., Bena, J., Morrison, S., Najm, I., Bingaman, W., & Jehi, L. (2020). Long‐term outcomes of reoperations in epilepsy surgery. Epilepsia, 61(3), 465–478. https://doi.org/10.1111/epi.16452

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Published

2023-03-30

Issue

Vol. 10 No. 1 (2023)

Section

Clinical Corner

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Copyright (c) 2023 Robert P. Turner, Vietta E. Wilson, Jay D. Gunkelman, Alexandra A. Harvison, Linda A. Walker

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