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Could brain-training techniques help epilepsy patients control their seizures?

Groundbreaking BSMS-led research trial being carried out among epilepsy patients who are resistant to drugs is reaping dramatic results, with more than half of patients in a clinical trial reporting a reduction in seizure frequency of 50% or more.

Carried out at BSMS, the research is trialling a promising alternative to medication in treating epilepsy by teaching patients to train their brains to be more ‘alert’.

Dr Yoko Nagai, Wellcome Trust Research Fellow at BSMS, is training patients to use biofeedback, a behavioural treatment that enables them to gain control over electrodermal activity (EDA), a physical process most people are not even aware of. EDA is frequently used in ‘lie detectors’ to detect neural activation through stress, measuring this activation from sweating response.

“While drugs are the mainstay in the management of epilepsy, around 30% of patients on medication continue to have seizures,” says Dr Nagai. “Therefore it’s important to look into other methods to help people manage their epilepsy.”

Dr Nagai first started research into biofeedback for her PhD in 1997. “At the time, research into the technique was relatively new in the UK and it was mostly associated with relaxation therapy. But I soon realised that biofeedback is much more than that, enabling the mind control of ‘hidden’ bodily signals by closing a loop that is usually open.”

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A surprise result

As it’s commonly known that mental stress can increase seizures, Dr Nagai expected that teaching patients to use relaxation techniques would reduce their susceptibility to seizures. However, she was surprised to learn through her research that, in fact, the opposite was true – and that training patients to increase their levels of alertness actually helped them to calm their brain and reduce the incidence of seizures.

Dr Nagai then established a treatment protocol for patients with drug-resistant epilepsy, using EDA biofeedback. As the essence of biofeedback training involves increasing control over the body’s system, she worked on developing an animated computer programme for epilepsy that responds to a person’s level of alertness.

Patients in the initial clinical trial were trained in biofeedback three times a week over a four-week period. They were shown how to increase their alertness, or ‘sympathetic arousal’, by learning to move the computer-generated animation towards a desired goal.

Not only did 60% of patients who learned the technique demonstrate a reduction in seizures of 50% or more, but two who went on to keep a record for three years after their ‘training’ continued to have a greatly reduced number of seizures.

Following these earlier studies, Dr Nagai is now conducting a wider clinical trial, funded by the Wellcome Trust Fellowship, in collaboration with Brighton and Sussex University Hospitals and University College London Hospitals.

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Changing lives

For Michael Meredith, learning the technique has meant he is seizure free for the first time since developing epilepsy six years ago.

“My epilepsy more or less came out of the blue,” he says. “Despite being on medication for the past six years, I continued to have between three and six seizures a month. I lost my driver’s licence, and as a self-employed carpenter this had a huge impact on my work.”

Mr Meredith, from Brighton, learned to use biofeedback with Dr Nagai in November 2014. “It was like playing a computer game but using your mind and body rather than controls – with two electrodes on your fingers to measure the biofeedback. You have to drive along an animation, to reach a goal. The first time it was quite tricky, but after a few sessions I really got the technique. Now I’m very happy to be seizure free, and I hope to reduce my medication in a couple of months,” he says.

A next generation treatment?

The current study, due to be completed in 2016, is using state-of-the-art neuroimaging techniques to scan patients both before and after treatment to further investigate the role of EDA biofeedback in reducing epileptic seizures.

“So far results look very promising, replicating those of the previous clinical trial,” says Dr Nagai. “We may well be looking at the next generation treatment for epilepsy – one that emphasises non-invasiveness, minimal side effects, strong patient involvement and a practical opportunity to utilise growing health technology.

I hope in the future this scientific discovery will lead to an accessible treatment that can be implemented both in the NHS and internationally.”