BEHAVIOR MODIFICATION FOR EPILEPSY: Raising The Seizure Threshold

Everyone has a seizure threshold, a tolerance point beyond which a seizure can be induced. People who develop seizure disorders have a lower threshold for seizures than others. Sleep deprivation, prolonged or acute stress, exhaustion, fear, illness, sudden changes in breathing rates or in blood sugar levels are just a few factors known to lower the seizure threshold.

One of the more debilitating, self-certainty-robbing aspects of seizures is their apparent unpredictability. Seizures can disrupt any function of psyche or soma. Generally, the person in charge of managing seizures is the attending physician, usually a neurologist or family doctor. Losing, or giving full responsibility for treating seizures to a physician can leave an individual feeling powerless to control her body, level of consciousness, or the quality of her daily life. Yet, history shows those of us living with seizures may have a greater ability to influence them than is usually realized.

Since at least the time of ancient Greece, physicians, researchers, and people with seizure disorders have observed seizures are often neither random nor entirely beyond the conscious, willful, control of the person who has them. Reports of behavioral strategies used to stop and sometimes cure seizures, are found throughout the recorded history of western medicine. Hypnosis, progressive relaxation, operant conditioning, auto-suggestion, training in respiration control, and EEG biofeedback training, are among behavioral methods studied and found successful in learning seizure control.

Seizures may only seem to represent chaos in the brain. Writing in the second century A.D., the Greek physician, Galen, found seizures sometimes follow a pattern, beginning in a characteristic way, and then continuing in a predictable manner. One early Greek sufferer described being slapped by a breeze (aura) as the spirit came and seized him. Thus, "aura" became the term used to identify the symptoms preceding seizure onset. Even in those who do not experience an aura, seizures may adhere to some routine, such as only occurring during sleep, or upon waking.

Another early Greek physician, Aretaeus, observed that seizures might begin with a contraction in the hand or foot, then spread to cause a "crash." By intervening at the aura stage, he discovered a seizure can frequently be stopped. Interrupting the seizure, sometimes by binding the limb, was often sufficient to stop the seizure altogether.

A half century after Pavlov trained his famous dog to salivate upon hearing a particular sound, conventional science was still teaching that the activities of the nervous system, heart rate, blood pressure, respiration, etc., cannot be learned and consciously controlled. Because they violated the then current doctrinal assumptions about the nervous system, the findings of Pavlov's studies were disputed.

In the early nineteen sixties, psychologist Neal Miller further eroded the foundations of this doctrine when his research demonstrated supposedly involuntary actions of the nervous system, such as blood pressure and heart rate, can indeed be learned and voluntarily controlled. About the time of Miller's studies, other scientists were realizing that even brain waves can be consciously controlled.

By the late nineteen sixties, the experiments of several scientists, Miller, Tassarini, and Sterman, confirmed seizure activity can be influenced by EEG brain wave training. In 1969 the term "biofeedback" was coined to describe behavioral conditioning taught by using external feedback such as EEG, heart, or blood pressure monitors. Later, "neurofeedback" became the term used for EEG biofeedback.

Dr. M.B. Sterman and his colleague. L. Friar, published the first report of successfully training a woman to control her seizures using neurofeedback in 1972. Several years earlier, Sterman had conditioned a group of cats to produce a particular range of EEG activity, 12-14 Hz, in response to pleasure reward. Because he was training the brain wave activity over the sensory motor cortex, Sterman dubbed this pattern SMR, sensory motor rhythm.
In an unrelated study, Sterman found cats trained to produce the SMR rhythm had developed a higher seizure threshold than untrained cats when exposed to noxious fumes. He then experimented, teaching people with seizures change their brain wave activity to produce more of the SMR frequency.

Sterman's work gave rise to the development of neurofeedback training to teach people to gain conscious control of their seizures. As with the skepticism of Pavlov's and Miller's research, after thousands of studies demonstrating its usefulness, neurofeedback for seizures is still characterized as "fringe" or "experimental." It has been effective in treating seizure disorders for three decades. In some cases its success equals that of drug therapy.

A behavioral approach to treating seizure disorders can be thought of as behavior modification for the nervous system. Discovering, then changing the habits and behaviors that lead to seizures, raises the threshold. In behavioral therapy, the emphasis is on the client acquiring practical, self-help strategies to manage and take responsibility for controlling seizures. Its aim is to restore personal control over one's health and life.

Just prior to it's onset, many people experience the aura, warning of a seizure coming on. These may be unusual sensations such as gut fear, muscle twitching, hallucinatory sounds, smells, tastes, or visual distortions. The most successful behavioral treatments involve learning to identify the aura then interrupting and aborting the seizure at this stage.
Keeping a journal, or seizure log, is a powerful tool for learning to recognize the patterns of seizures and breaking them.

Observing and noting all the events surrounding seizures helps find those symptoms which are the same for most seizures. These are very individual. Did the seizure happen while awake, while standing, or lying down? Was the person hungry, tired, stressed out? Did the seizure start after a meal, a sugar binge, while working, talking, reading, listening to music, when angry, or happy? Witness accounts can also help identify the behaviors that precede seizures. Developing strategies to avoid or change those circumstances leading to seizures is a key to learning to control them on one's own.

According to the Epilepsy Foundation of America's 1999 Report to the Nation, fewer than 25% of the several million Americans diagnosed with seizure disorders gain complete control of their seizures with drugs. Medical reports and research in this field over the past fifty years demonstrate behavioral therapies for seizures can be as successful as drugs in achieving seizure control. David I Mostofsky, Robert Fried, Niels Birbaumer, Joanne Dahl, Donna J. Andrews, and Joel Reiter, are some of the scientists whose research confirms the efficacy of a neurobehavioral approach to treating seizure disorders.

Most major hospitals have specialty centers for treating seizure disorders. Very few of them offer any of the neurobehavioral techniques for self-management of seizures in their treatment approaches. Interest is greater in Europe, where several German medical centers now incorporate neurobehavioral therapy into their seizure treatment programs. The Andrews\Reiter program helps people with seizure disorders learn self-control of seizures using behavior modification.

Sterman's discovery in the 1960s, that neurofeedback training can teach self-regulation of seizure activity, presented new opportunities for learning self-control of seizures. In the 1980s, Sally Fletcher published her account of learning to become seizure free using neurofeedback training, possibly the first book of its kind. Since that time, thousands of studies verify neurofeedback as a practical tool for teaching people techniques to control seizures on their own.

Neurofeedback training often results in a reduction in seizure frequency and a decreased need for medication. For some people, as in Sally Fletcher's case, neurofeedback training eliminates seizures altogether. It is a viable option for seizure management that is free of the risks and side effects of drug therapy.

Advances in EEG monitoring and magnetic resonance imaging are enabling researchers to learn more about the phenomena of seizures and ways to treat them. While the aura is the symptom preceding a seizure, slow cortical potentials (SCPs) represent the activity of the brain's neurons just before a seizure starts. It is now possible to monitor SCPs and teach people to control and alter them, changing the function of their own brain cells. The development of techniques teaching people how to alter the activity of individual groups of their own brain cells adds a potent new tool to the repertoire of behavioral therapies for seizure disorders.

Books on Behavioral Approaches to Treating Seizure Disorders:
" The Neurobehavioral Treatment of Epilepsy; David I Mostofsky and Ingve Loyning, eds; Lawrence Erlbaum Associates;1993; ISBN: 0-8058-1106-0.
" Epilepsy: A New Approach; Adrienne Richard and Joel Reiter, MD; Walker and Company; New York; 1995; ISBN: 0-8027-7465-2
" Epilepsy - a Behavior Medicine Approach to Assessment and Treatment in Children; Joanne Dahl;Paperback(May 1993); Hogrefe & Huber Pub; ISBN:0889371067

Further Information and Resources:
EEG EDUCATION & RESEARCH
" The Andrews\Reiter Epilepsy Research Program

Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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