Neurofeedback Therapy As a Treatment For Psychogenic Non-Epileptic Seizures (PNES)
Sep 23, 2011 |
by: William Lambos Ph.D. and Charles Stark,
| Category: Neurofeedback
The history of neurofeedback treatment of patients with epileptic seizures, particularly focal seizures originating in the temporal lobes, is well established. In the 1970s Barry Sterman discovered, quite serendipitously, that cats selectively reinforced to generate the sensory motor rhythm (SMR) were protected against seizures after exposure to monomethyl hydrazine (rocket fuel). Exposure to hydrazine causes severe seizures in mammals, but animals conditioned to produce SMR were far less susceptible to them.
This finding led to the successful treatment of human patients with epilepsy via SMR reinforcement using neurofeedback. However, a third or more of patients who present to epileptologists with seizure activity do not, when examined in video EEG studies, show the brain activity typical of epilepsy. That is, these patients experience the bodily symptoms of seizures, but no epiliptogenic or paroxysmal brain wave patterns are recorded in their EEG. Such patients are instead diagnosed with PNES, or Psychogenic Non-Epileptic Seizures.
PNES patients are characterized by a history of trauma, usually sexual or physical abuse in childhood. Because of this, PNES is thought to be related to post traumatic stress disorder (PTSD) rather than to epilepsy. For the PNES patient, the psychogenic seizures seem to represent an avenue to escape situations which would otherwise cause unbearable levels of stress. The client is, in this sense, experiencing a dissociative condition in which the non-epileptic seizures allow for escape from an unbearable context. It is important to understand that PNES are not factitious, and the patients that present with such seizures are not malingering: their seizures trouble them greatly and they wish them to cease.
K.G., a 47 year-old woman, was referred to us by a neurologist and a mental health counselor who determined that her seizures were non-epileptic and likely related to a history of ple deaths of significant individuals in her life. Karen had been given numerous incorrect diagnoses and prescribed numerous medications to control her seizures and associated symptoms (Tegretol, Lithium, Effexor, Neurontin, Lexapro, several benzodiazepines and others). In addition to the PNES, Karen presented to us with sleep disorder, depression and anxiety. These symptoms caused her difficulty at work, where they threatened her continued employment.
Prior to treatment, we assessed her with a QEEG (Q1) analyzed by both SKIL and Neuroguide databases and reporting software. In both cases, we found evidence of frontal hypercorrelation as measured by both coherence and comodulation. In the eyes closed recording, we also saw a finding that has become common in our PNES subjects: the presence of two frequency peaks in the alpha band. In her case, one peak showed at 8 Hz and we saw a second peak at 11 Hz. Figure 1a shows absolute amplitude and z score frequency distributions from the Neuroguide analysis (the same double peak was present in the SKIL analysis). We have come to regard the presence of two dominant frequencies in PNES subjects as indicative of psychogenic dissociation. ...continue reading --->
PNES patients are characterized by a history of trauma, usually sexual or physical abuse in childhood. Because of this, PNES is thought to be related to post traumatic stress disorder (PTSD) rather than to epilepsy. For the PNES patient, the psychogenic seizures seem to represent an avenue to escape situations which would otherwise cause unbearable levels of stress. The client is, in this sense, experiencing a dissociative condition in which the non-epileptic seizures allow for escape from an unbearable context. It is important to understand that PNES are not factitious, and the patients that present with such seizures are not malingering: their seizures trouble them greatly and they wish them to cease.
K.G., a 47 year-old woman, was referred to us by a neurologist and a mental health counselor who determined that her seizures were non-epileptic and likely related to a history of ple deaths of significant individuals in her life. Karen had been given numerous incorrect diagnoses and prescribed numerous medications to control her seizures and associated symptoms (Tegretol, Lithium, Effexor, Neurontin, Lexapro, several benzodiazepines and others). In addition to the PNES, Karen presented to us with sleep disorder, depression and anxiety. These symptoms caused her difficulty at work, where they threatened her continued employment.
Prior to treatment, we assessed her with a QEEG (Q1) analyzed by both SKIL and Neuroguide databases and reporting software. In both cases, we found evidence of frontal hypercorrelation as measured by both coherence and comodulation. In the eyes closed recording, we also saw a finding that has become common in our PNES subjects: the presence of two frequency peaks in the alpha band. In her case, one peak showed at 8 Hz and we saw a second peak at 11 Hz. Figure 1a shows absolute amplitude and z score frequency distributions from the Neuroguide analysis (the same double peak was present in the SKIL analysis). We have come to regard the presence of two dominant frequencies in PNES subjects as indicative of psychogenic dissociation. ...continue reading --->
