1Director of Tallahassee NeuroBalance Center, Tallahassee, FL 32309, USA
2CEO-Brain Enhancement Inc, USA
*Corresponding author: J. Lucas Koberda, M.D., Ph.D, Director of Tallahassee NeuroBalance Center, Tallahassee,FL 32309, USA, Tel: +850-459-8263; E-mail: JLKoberda@yahoo.com
Article Type: Editorial
Citation: Koberda JL (2015) Application of Z-score LORETA Neuro-feedback in Therapy of Epilepsy. J Neurol Neurobiol, Volume1.1: doi http://dx.doi.org/10.16966/2379-7150.e101
Copyright: © 2015 Koberda JL. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Neurofeedback; seizures; epilepsy; Z-score; LORETA; EEG; QEEG
Unfortunately despite major progress in the treatment of epilepsy approximately 30% of patients are still refractory to medical therapy. Surgical treatment may be an option for some of those patients, however many may not be interested or eligible. There is a demand to develop alternative treatments which would offer substantial reduction of seizures and improve quality of life. Currently a mainstay of therapy in epilepsy is pharmacological. Multiple medications are available on the market for different types of epilepsy. Some of these are broad-spectrum medications which cover both primary generalized and secondary generalized epilepsy. Other relatively narrow spectrum medications are effective mostly for certain types of epilepsy. The patients with epilepsy who do not respond to pharmacological treatment are classified as medically refractory. In these cases other forms of therapy need to be applied in order to reduce frequency of seizures. In the pediatric population the ketogenic diet has been found to be effective in reducing seizure numbers in selected patients . Surgical options include minor surgery such as vagus nerve stimulator implantation , or major surgery including lesion resection .
A decrease of seizures after enhancement of the sensory motor rhythm (SMR) in patients with poorly controlled epilepsies was reported in 1972 for the first time by Dr. Sterman and his group [4,5]. This EEG based biofeedback also called neurofeedback (NFB) has been subsequently found to be an effective treatment modality in patients who do not respond to pharmacological treatment. Dr. Sterman’s NFB experiments which have proven the effectiveness of SMR entrainment in epilepsy treatment [6,7] were based on the use of systems utilizing one or two NFB sensors. Approximately 60% seizure frequency reduction was noted in clinical studies with SMR entrainment. One or two sensor based NFB therapy required in many instances 50 or more NFB sessions in order to achieve the therapeutic goals.
Currently newer NFB protocols based on modernized equipment are being tested for effectiveness in the treatment of epilepsy hoping that similar therapeutic results could be reached in fewer number of NFB sessions. One of the potential candidates is Z-score Low Resolution Electromagnetic Tomography Analysis (LORETA) NFB . It is a 19-electrode (cap system) that was introduced to the market by Applied Neurosciences, Inc. This system has the potential for faster results based on the larger number of electrodes (scalp sensors) applied to treatment . Z-Score NFB uses a real-time comparison to an age-matched population of healthy subjects for data acquisition which simplifies protocol generation and allows clinicians to target modules and hubs that indicate dysregulation/instability in networks related to the patient’s symptoms . Z-score NFB increases specificity in operant conditioningproviding a guide that links extreme Z-score outliers to symptoms and then reinforcing Z-score shifts toward states of greater stability. The goal is increased efficiency of information processing in brain networks related to the patient’s symptoms .
LORETA-based therapy also enables targeting a dysregulated electrical activity in the cerebral cortex much deeper than monitored by standard EEG-based NFB. In addition to that, it is arelatively inexpensive computer software and EEG hardware which makes this procedure potentially cost-effective. This technology has also been shown to be effective in therapy of many neuropsychiatric disorders including: chronic pain, depression, attention deficit disorder, autistic spectrum disorder, stroke rehabilitation as well as cognitive dysfunction [11-18].
Preliminary data from my center indicates successful primary and secondary generalized seizure response to this type of therapy. This editorial serves as an introduction to two upcoming articles that will report on the effectiveness of Z-score LORETA NFB for therapy of intractable epilepsy. One of these papers comes from my neurological practice and another one is authored by Dr. Lauren Frey et al. based on the data analysis from the academic university epilepsy clinic in the University of Colorado. Both of these centers use a similar approach for NFB programming, frequency of visits, and identical equipment. Dr. Frey uses as a potential target the default network, however my patient’s therapy was based mostly on more variable and individualized protocols. Both centers have achieved major seizure reductions in most of the epilepsy patients--some of them reported a marked seizure reduction just after a few sessions. The accomplishment of similar positive results in two independent clinical sites (community setting and tertiary academic center) makes these findings even more encouraging. A larger (possibly placebo controlled) study may be beneficial in the future to further document efficiency of this type of NFB therapy in epilepsy patients.
- Lima PA, Sampaio LP, Damasceno NR (2014) Neurobiochemical mechanisms of a ketogenic diet in refractory epilepsy. Clinics (Sao Paulo) 69: 699-705. [Ref.]
- Fisher RS, Eggleston KS, Wright CW (2015) Vagus nerve stimulation magnet activation for seizures: a critical review. Acta Neurol Scand. 131: 1-8. [Ref.]
- Jobst BC, Cascino GD (2015) Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA 313: 285-293. [Ref.]
- Sterman MB, Friar L (1972) Suppression of seizure Sinan epileptic following sensorimotor EEG feedback training. Electroencephalogr Clin Neurophysiol 33: 89-95. [Ref.]
- Sterman MB (1976) Effects of brain surgery and EEG operant conditioning on seizure latency following monomethylhydrazine intoxication in the cat. Exp Neurol 50: 757-765. [Ref.]
- Sterman MB, Egner T (2006) Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback 31: 21-35. [Ref.]
- Sterman MB (2010) Biofeedback in the treatment of epilepsy. Cleve Clin J Med 77 3:S60-7. [Ref.]
- Koberda JL, Moses A, Koberda L, Koberda P (2012) Comparison of the Effectiveness of Z-Score surface/LORETA 19-Electrodes Neurofeedback to Standard 1-Electrode Neurofeedback. J. of Neurotherapy, 4: 302 [Ref.]
- Thatcher RW (2010) LORETA Z-Score Biofeedback. Neuroconnections, winter edition-December, 14 – 17.
- Thatcher RW (2013) Latest Developments in Live Z-Score Training: Symptom Check List, Phase Reset, and Loreta Z-Score Biofeedback. J Neurotherapy 17: 69-87. [Ref.]
- Koberda JL, Moses A, Koberda L, Koberda P (2012) Cognitive Enhancement Using 19-electrode Z-score Neurofeedback. J Neurotherapy 3: 224-230.[Ref.]
- Koberda JL (2012) Autistic Spectrum Disorder (ASD) as a Potential Target of Z-score LORETA Neurofeedback. Neuroconnection- winter 2012 edition (ISNR): 24-25. [Ref.]
- Koberda JL, Koberda P, Bienkiewicz A, Moses A, Koberda L (2013) Pain Management Using 19-Electrode Z-Score LORETA Neurofeedback. J Neurotherapy 17: 179-190. [Ref.]
- Koberda JL (2014) Z-score LORETA Neurofeedback as a Potential Rehabilitation Modality in Patients with CVA. J Neurol Stroke 1: 00029. [Ref.]
- Koberda JL (2014) Z-score LORETA Neurofeedback as a Potential Therapy in Cognitive Dysfunction and Dementia. J Psychology and Clinical Psychiatry. [Ref.]
- Koberda JL, Paula Koberda, Andrew Moses, Jessica Winslow, Andrew Bienkiewicz, et al. (2014) Z-score LORETA Neurofeedback as a potential therapy of ADHD. Special Edition-Biofeedback Magazine-2014. [Ref.]
- Koberda JL (2015) Z-score LORETA Neurofeedback as a Potential Therapy in Depression/Anxiety and Cognitive Dysfunction in “Z Score Neurofeedback: Clinical Applications". Editors-Thatcher, RE and Lubar, JF-Academic Press, San Diego, CA. [Ref.]
- Koberda JL (2015) LORETA Z-score Neurofeedback in Chronic Pain and Headaches- in “Z Score Neurofeedback: Clinical Applications". Editors-Thatcher, RE and Lubar, JF-Academic Press, San Diego, CA. [Ref.]
Download Provisional PDF Here