EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review.

Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.

Head first - Review of epilepsy head injury risk and protection.

INTRODUCTION: The causes of falls and resultant head injuries in people with epilepsy are complex and represent important clinical issues significantly impacting on safety, quality of life and long-term prognosis. A general solution for many years has been to provide helmets for head protection. There is poor understanding of the influencing risk factors and solutions to give person-centred clinical advice. METHODS: A focused narrative review was conducted to investigate the risk factors for seizure-related head injuries and evidence of current helmets to offer protection. Four databases were searched (Embase, Medline, PsycInfo and Cochrane Library) using combinations of text words and thesaurus terms for the retrieval of articles relating to seizure-related head injury. Articles for full analysis were selected by a ten item pre-defined inclusion criteria. RESULTS: Of 104 relevant studies longlisted 21 studies met four or more of the predefined criteria and included in this review. A further nine papers were included because they added additional relevant information. CONCLUSIONS: Seizure-related head injury, although rare, may have serious consequences. High doses of antiepileptic/antiseizure drugs (AEDs/ASDs) and a prescription for three or more AEDs/ASDs are significant, modifiable, risk factors for head injury. Differentiating confusion due to post-ictal changes or concussion can be challenging. Seizure-related cardiac causes leading to injury due to ictal bradycardia or asystole is under investigated. More research is required to validate the protective benefit of various helmet designs in seizure-related head injury. It is striking that there are no International Standards for protective helmets in seizures.