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Neurofeedback impacts cognition and quality of life in pediatric focal epilepsy: An exploratory randomized
Leon Morales-Quezada1, Diana Martinez2, Mirret M El-Hagrassy1
1Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.
Insights
Sensorimotor rhythm neurofeedback (NFB) improved cognitive function in children with epilepsy. All NFB types, including sham, enhanced quality of life, suggesting a significant placebo effect.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Science
Background:
- Children with epilepsy often face cognitive deficits and reduced well-being, impacting development.
- Current pharmacotherapy for epilepsy has limitations in addressing cognitive and well-being issues.
- Few interventions exist to enhance cognitive development or mitigate disease burden in pediatric epilepsy.
Purpose of the Study:
- To investigate the impact of sensorimotor rhythm (SMR) and slow cortical potentials (SCP) neurofeedback (NFB) on cognitive function and quality of life (QOL) in children with controlled focal epilepsy.
- To explore the effects of NFB on clinical outcomes and quantitative electroencephalography (EEG) analysis.
- To compare SMR NFB, SCP NFB, and sham NFB in pediatric epilepsy patients.
Main Methods:
- A randomized controlled trial involving 44 children and adolescents with controlled focal epilepsy.
- Participants were assigned to SMR NFB (n=15), SCP NFB (n=16), or sham NFB (n=13) for 25 sessions.
- Assessments included the attention switching task (AST), seizure severity, seizure frequency, and EEG analysis at baseline, post-intervention, and 3-month follow-up.
Main Results:
- SMR NFB significantly reduced reaction time in the AST (p=0.006), correlating with changes in theta power on EEG (p=0.03).
- The SMR group showed a significant decrease in beta coherence (p=0.03).
- All groups, including sham, demonstrated improvements in quality of life (QOL) (p<0.05).
Conclusions:
- This study presents novel findings on SMR and SCP neurofeedback in pediatric epilepsy, assessing cognitive, neurophysiological, and clinical outcomes.
- Sensorimotor rhythm neurofeedback demonstrated efficacy in improving cognitive functioning in children with epilepsy.
- Improvements in QOL across all groups highlight a notable placebo effect in the sham intervention group.
Objective:
Children with epilepsy experience cognitive deficits and well-being issues that have detrimental effects on their development. Pharmacotherapy is the standard of care in epilepsy; however, few interventions exist to promote cognitive development and to mitigate disease burden. We aimed to examine the impact of two different modalities of neurofeedback (NFB) on cognitive functioning and quality-of-life (QOL) measurements in children and adolescents with controlled focal epilepsy. The study also explored the effects of NFB on clinical outcomes and electroencephalography (EEG) quantitative analysis.
Methods:
Participants (n = 44) with controlled focal epilepsy were randomized to one of three arms: sensorimotor rhythm (SMR) NFB (n = 15), slow cortical potentials (SCP) NFB (n = 16), or sham NFB (n = 13). All participants received 25 sessions of intervention. The attention switching task (AST), Liverpool Seizure Severity Scale (LSSS), seizure frequency (SF), EEG power spectrum, and coherence were measured at baseline, postintervention, and at 3-month follow-up.
Results:
In children and adolescents with controlled focal epilepsy, SMR training significantly reduced reaction time in the AST (p = 0.006), and this was correlated with the difference of change for theta power on EEG (p = 0.03); only the SMR group showed a significant decrease in beta coherence (p = 0.03). All groups exhibited improvement in QOL (p = <0.05).
Conclusions:
This study provides the first data on two NFB modalities (SMR and SCP) including cognitive, neurophysiological, and clinical outcomes in pediatric epilepsy. Sensorimotor rhythm NFB improved cognitive functioning, while all the interventions showed improvements in QOL, demonstrating a powerful placebo effect in the sham group.
