Seizures

Working with seizures is probably trickier than meets the eye. There may be some possibility of triggering seizures in people who have had a history of them. I would think twice about working with such a person without a fair amount of experience or tight supervision by a well-experienced person.

Seizure activity is normally related to extremely slow areas of the brain–as are ADHD and language-based learning problems.  In the neurofeedback world, below the level of diagnoses, they’re all pretty much the same thing, just with differences in symptoms.  One of the earliest uses of neurofeedback, published by Barry Sterman in the 60s, was work with seizure disorders (with excellent results).  The studies were so good, so well done by a UCLA neuropsychologist, and published in quality journals that one would assume neurologists would know about them, though of course nearly none actually do.

Slow frequencies are often strongly dominant in seizure prone brains, but the spike pattern (which is very fast) is also an indicator.  Seizures themselves are often a kindling fast-wave pattern.  Training down slow activity is a good way to help protect the brain.  Pushing it into certain fast speeds is a good way to trigger a seizure in one who is prone to them.  It is the pushing of light/sound driving technologies which is the problem.

One of the classic EEG trainings–perhaps the first to be used and published–was Sterman’s work with seizures, training C3/C4 one-channel bipolar, reducing slow activity and fast activity and increasing SMR.  The Othmers also did a lot of this training in the 90s using T3/T4, same protocol.  You can try each for a couple sessions and then, if both seem to be positive, combine them using the 2C Seizure protocol in the 2Specialty folder in the brain-trainer designs.

As with most training, it makes little sense to force the client to stop taking something that is working in order to try doing something else that might work. As stability improves with training, you can start trying to back down the dose of the meds and slowly work off them (with the support of you physician) as the brain can operate without them

Seizures are often responses by an unstable brain to excessive slowing in the EEG–the brain overdoes it trying to speed up and locks into hypercoherence in fast activity.

I would recommend against as simplistic a strategy as simply training at C4. Dr. John Hughes, the EEG/’QEEG specialist who heads the Epilepsy unit at University of Illinois taught me (as did Margaret Ayers) about a mirror phenomenon. For instance, let’s say you did bipolar training at T4-C4 to reduce seizures–the seizure focus may after while shift to homologous sites in the opposite hemisphere. Therefore, a better strategy can be to train at the same sites in each hemisphere for 15 minutes each.

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There are, of course, a dozen options for training seizure disorders.  My experience (and that of most of us) has been to take the ridiculously simple process developed by Sterman in the early days of neurofeedback.  He did something that neurologists said was very dangerous and should never be done, training across the midline with bipolar montages (C3/C4).  They said this would cause the seizures to cross over from one hemisphere to the other (the reason for split-brain “solutions” to the problem.)  In the 90s, when I began working, Sterman worked with the Othmers and they switched to T3/T4 bipolar training and used that for seizures.

I worked with a series of clients with seizures using the C sites.  At one point I had a home-training client (back in the days when we were still using BrainMaster 2E amps) who had very serious and intrusive seizure issues and wanted to fix it.  We started him off with C3/C4, and he improved.  Then I had him try T3/T4, and he improved.  We went on to have him train the C’s, then the T’s in each session and eventually train them both at the same time (the source of our “dual bipolar” protocols.)  He spent many sessions and worked consistently, keeping in touch with me from time to time.  The last I heard from him, the seizures had stopped.  He was off all meds and he was no longer training.

Since that time, I start seizures with C3/C4, then try adding T3/T4 over the first 5-10 sessions.  If the response is good, we go with dual bipolar and integrate that into the Whole-Brain Training (WBT) plan.  Depending on the seriousness of the seizure problem and its responsiveness to the training, I might use dual bipolar in every session, combined with other items from the plan, or even once in every 5-block cycle, eventually, as meds are cleared and seizure activity essentially ceases, dropping that protocol.

I consider seizure disorders, like autistic spectrum and head injuries to be items that benefit from more intensive focus in the plan (depending on how severe they are).  But as they begin to release, I’ve yet to see a person whose brain did not also have other issues that WBT could help resolve.

The shadowing feedback approach conceivably could have negative effects if the flash rate gets up around 17 or 18/second or very slow. My preference is to use fractal videos with MIDI sounds, allowing the fractals to Play/Pause rather than flash light or sound.

The protocol is usually either SMR%1C or IN 3-7 Hz and 19-38 Hz with 12-15 Hz reward.

Entrainment and Seizures

Ever hear the story of the Japanese cartoon that caused lots of kids in Japan (and reportedly other places as well) to have seizures while watching TV? May be an urban legend or may be true.  However, the idea of “driving” the brain with light/sound stimulation (there were flashing lights in the cartoon) at 17Hz or higher is related to potential for triggering seizure activity.  Kindling beta, large bursts that spread out from a focal point, is related to seizure activity, and in one prone to seizures anything that stimulates activity in that range has the potential to be dangerous. Don’t, as a general rule, use any driving–especially light–with potentially seizure-prone clients to avoid stimulating seizure activity.

Seizures in EEG

There are a variety of patterns on an EEG that are considered epileptiform. One question would be whether what was seen was actually seizure activity–that is the brain was in the seizure state–or was indicative of the potential for seizure.  Excessive slow wave activity is sort of the bed from which seizures spring, but the seizures themselves are usually very fast activity that “kindles” out from a central point and locks up an area of the brain with highly coherent fast activity.  One description I’ve always liked is that the brain is always sliding back and forth in a fairly narrow band between coma (excessive slow activity) and seizure (excessive fast).  Most brains perform this balancing act without much trouble, but when a brain has areas of instability, where it is less able to stay on the high-wire, when it feels itself starting to tumble toward coma, the brain tries to go in the opposite direction and may tumble into seizure.

Although many trainers prefer training for seizures in the sensory-motor cortex, that’s not necessarily where the seizure focus is.  It can be anywhere–often in the temporal lobes.  What IS in the sensory-motor cortex is sensorimotor rhythm (SMR).  Training SMR, since the early work done by Sterman in the 60s, has been one of the most effective ways of improving seizure activity and making a brain proof against them.  However, there are other trainings popular as well, including T3/T4 bipolar.

Some people, if they know where the focus of the seizures is, prefer to train to activate that area, to make it more stable on the high-wire, and to train up SMR as well.