[Neurofeedback therapy influence on clinical status and some EEG parameters in children with primary generalized epilepsy]. / Wplyw terapii neurofeedback na stan kliniczny i wybrane parametry zapisu EEG u dzieci chorych na padaczke z napadami pierwotnie uogólnionymi.

INTRODUCTION: Pharmacological treatment of epilepsy in some patients is ineffective and alternative methods of treatment are need. These include neurofeedback (EEG biofeedback, NF). The aim of this study was to evaluate the clinical and neurophysiological effectiveness of NF in children with epilepsy with primary generalized seizures. MATERIAL AND METHODS: The study involved a group of 63 children with primary generalized seizures, aged 6-16 years, including 39 girls and 24 boys. As the efficacy of pharmacotherapy was not satisfactory for them, they have been referred to Neuromedica Institute in Krakow for NF treatment. The evaluation of preliminary clinical and neurophysiological parameters was performed. Individual NF therapy protocols were elaborated and trainings were conducted for 0.5-4 years. Individual therapy protocols were prepared by biofeedback specialist and trainings were conducted by biofeedback therapists. The same specialist also made a comparison of selected elements of the EEG in children before and after NF therapy. RESULTS: The children enrolled into the study were diagnosed with epilepsy at the age of 6 months to the age of 16 years Tonic-clonic seizures and absence seizures were the most often seizure types in the examined group. Seizures occurred in 19 children every day. In 33/63 children clinical manifestation of seizures and EEG pattern when taken together allow the specific epilepsy syndrome diagnosis in 7 cases. In 27 children two or more antiepileptic drugs were used, and in 36 monotherapy was used. NF therapy had a significant impact on the clinical condition of the children, causing subsidence of seizures in most of them. In 23/63 children antiepileptic treatment was withdrawn and in 15 reduction of treatment was achieved. The impact of the NF therapy on the EEG parameters was beneficial, both in terms of the background activity and other parameters. Paroxysmal EEG pattern subsided in the vast majority of children (63 to 16) including a continuous paroxysmal activity from 12 to 4, interrupted from 51 to 12 and generalized from 63 to 21, with reduced susceptibility to photostimulation from 31 to 18 and hyperventilation from 39 to 17. CONCLUSIONS: In half of children with primary generalized epilepsy with a characteristic EEG pattern specific epilepsy syndrome was diagnosed. In half of children subsidence of epileptic graphoelements in EEG was observed after NF therapy. In % of children paroxysmal bioelectric pattern subsided and sensitivity of EEG to hyperventilation and photostimulation decreased significantly. NF therapy had a positive impact on all the parameters of background bioelectrical activity. In 1/3 of children treated with NF pharmacotherapy of epilepsy was discontinued and in 1/4 reduced.

[Clinical and neurophysiological data of neurofeedback therapy in children with ADHD]. / Wyniki kliniczne i neurofizjologiczne terapii neurofeedback u dzieci z zespolem ADHD.

INTRODUCTION: ADHD occurs in 3% of school-age children (and in 70% of them in adulthood) and represents an important medical and social problem. It is characterized by attention deficits, hyperactivity and impulsiveness. Neurofeedback therapy (EEG biofeedback, NF) is carried out based on the analysis of EEG. OBJECTIVE: To investigate the effect of NF therapy on clinical status and parameters of the EEG in ADHD. MATERIALS AND METHODS: In the years 2007-2014, 287 children (191 boys), aged 6-17 years were included into the study. Some children with ADHD had other coexisting disorders like: tics, dyslexia, emotional or behavior disorders. Visual analysis of EEG was made and 7 selected parameters of bioelectrical activity were assessed. EEG tracing before and after NF therapy were compared. NF therapy lasted from 9 months to 3 years (mean 1.5 years). 60-240 NF training sessions were performed with the use of NF device, video-games and 16-channel Elmiko devices. Statistical analysis of the results was made. RESULTS: Children with ADHD additionally presented low self-esteem, anxiety and sleep disorders. The baseline theta/beta ratio in children with ADHD and ADHD with cooccurring dyslexia was >4.0 and in children with ADHD and coexisting tics 3.0-3.8, with coexisting behavioral disorders 3.7-4.0 and emotional disorders 3.3-3.7. After therapy, this ratio decreased significantly in all groups, but most significantly in ADHD and ADHD with dyslexia group. In the group with dyslexia theta and alpha activity in the left fronto-temporo-parietal region (the speech centers) has been increased. In children with ADHD and behavior disorders right-sided paroxysmal changes in the form of slow and sharp waves in the temporo-centro-parietal regions were found. In emotionally disturbed children increased fast beta activity in the right hemisphere (anxiety, fear) was observed. Initially NF therapy reduced hyperactivity and impulsivity of children, subsequently improvement of attention was observed and eventually reduction of emotional and behavior disturbances was noticed. Noticeable improvement in the self-esteem was observed as well. The therapy had a positive impact on the spatial organization of EEG in each group. It proved to be particularly useful in children with ADHD and dyslexia. CONCLUSIONS: Neurofeedback therapy is a valuable tool with beneficial impact on children with ADHD and accompanying disorders. Characteristics of brain bioelectric activity provides a reliable basis to establish individual EEG bio-feedback protocols of therapy in children and monitor the effectiveness of treatment. In the last 4 years the number of children with ADHD and cooccurring tics who applied for neurofeedback therapy has increased significantly.