Cleveland Clinic Journal of Medicine, in press 2010
نویسنده
چکیده
This review traces the origin of the clinical application of EEG operant conditioning, or biofeedback, from empirical animal research to its emergence as an alternative treatment for the major types of seizure disorder. Initial animal studies that were focused on brain mechanisms mediating learned behavioral inhibition revealed a uniquely correlated 12-15 Hz EEG rhythm localized to sensorimotor cortex. We labeled this as the sensorimotor rhythm, or SMR. The similarity of the SMR to the known EEG “spindle” pattern during quiet sleep, both of which were associated with a state of motor quiescence, led to the novel idea of attempting to increase the SMR using EEG operant conditioning. It was hypothesized that this might produce a corresponding increase in sleep spindle activity, thus establishing a common underlying mechanism for this state. Results supported this hypothesis but also led accidentally to the discovery of an anticonvulsant effect as well. Continuing animal studies identified a physiological pattern of responses correlated with the SMR in primary motor pathways. Additionally, bouts of oscillating cellular discharge in the afferent somatosensory thalamic nuclei were found to mediate the cortical SMR pattern. All of these findings were indicative of reduced motor excitability. Simultaneously, we undertook a series of studies in human epileptic subjects which documented a significant reduction in seizure incidence and severity, together with EEG pattern normalization. This work expanded internationally, resulting in numerous well-controlled group and single case studies that are summarized in several recently published meta analyses of efficacy findings in this field. Further, exciting new findings in fMRI/EEG correlation studies have provided a rational model for the basis of these clinical effects. However, in recognition of the diversity of clinical applications of this method in general, and the complexity of seizure disorders in particular, the specific methods used in this authors program are reviewed here in detail.
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