PHILADELPHIA -- A program that combined biofeedback and cognitive behavioral therapy (CBT) reduced seizures and led to changes in brain connectivity, researchers reported here.
In a small imaging study, patients who did 4 weeks of Autonomic Cognitive Rehabituation Training (ACRT) had, on average, a 40% reduction in seizures, according to Yoko Nagai, PhD, of Brighton and Sussex Medical School in England.
They also had changes in connectivity between the frontal cortex and the amygdala, which indicates "an increased resilience of patients to stress and anxiety-related seizures," Nagai reported during a press briefing at the American Epilepsy Society meeting.
"Our findings suggest that this is an accessible, non-pharmacological, and side effect-free treatment for patients with drug-resistant epilepsy," she added.
Nearly a third of epilepsy patients are resistant to drug therapies, Nagai explained, and other therapies such as biofeedback and CBT have gained more ground as these patients look for alternatives to drugs that aren't working.
Still, the funding of research into behavioral strategies is lacking. "Support for behavioral therapy is rare in epilepsy," Nagai said. "Most of the funding goes to anti-epileptic drug treatment."
ACRT is a combination of biofeedback and CBT. Electrodes are used to detect changes in skin conductance -- similar to a lie-detector test -- and, in real-time, provides biofeedback to patients in order for them to be able to control autonomic arousal while playing a video game. This serves as cognitive training that can enhance emotional stability, Nagai said.
The goal is for patients to develop a capacity to anticipate and perceive seizure triggers and to respond effectively to seizure events, she added.
In a previous study of 18 patients, Nagai and colleagues found that a month of ACRT reduced seizure frequency by more than 50% for 60% of those with drug-resistant epilepsy who used the program, and that these findings have been replicated internationally.
For the current study, Nagai and colleagues enrolled eight patients with temporal lobe epilepsy, mean age 45, who had at least four seizures per month. All patients had ACRT three times per week for 4 weeks, and fMRI scans were done at the start and end of the month-long period to measure brain changes.
The scans focused on regions in the orbitofrontal cortex and the ventromedial prefrontal cortex (OFC/VMPFC), which have previously been shown to be extensively modulated during the volitional modulation of skin conductance.
They found that the biofeedback cognitive training reduced seizure frequency by 40% overall (P=0.002).
One patient became seizure-free, and two patients had a greater than 50% reduction in seizure frequency, Nagai reported.
The brain scans revealed increased functional neural connectivity in the tempestas piriform cortex (TPC), the inferior temporal gyrus, the anterior cingulate, and the precentral gyrus. Conversely, there was decreased connectivity in the superior temporal gyrus and angular gyrus.
Changes in connectivity between regions of the OFC/VMPFC and the TPC/amygdala indicate greater resilience to stress and anxiety-related seizures, Nagai said.
She concluded that the therapy may be useful to patients with epilepsy who don't respond to pharmacologic treatment, but the next step is to conduct a clinical trial enrolling 400 to 500 patients.
The study was supported by the Wellcome Trust.
Nagai disclosed no relelvant relationships with industry.
- Reviewed by Rebecca Farber, MD Corinne Goldsmith Dickinson Center for Multiple Sclerosis, The Mount Sinai Hospital, New York, NY