Skin conductance biofeedback training in adults with drug-resistant temporal lobe epilepsy and stress-triggered seizures: A proof-of-concept study

Micoulaud-Franchi, Jean-Arthur; Kotwas, Iliana; Lanteaume, Laura; Berthet, Christelle; Bastien, Mireille; Vion‐Dury, Jean; McGonigal, Aileen; Bartolomei, Fabricē

doi:10.1016/j.yebeh.2014.10.017

Cited by 35 publications

(32 citation statements)

References 48 publications

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“…This observed effect of EDA biofeedback was sustainable: a subset of patients voluntarily kept a seizure diary for a much longer term (over 3 years after treatment) and these records suggesting that the treatment may prompt long term neurobiological changes that maintain efficacy in seizure control (Nagai and Trimble, 2014 ). The clinical trial findings were recently replicated and showed similar results to the initial clinical trial (Micoulaud-Franchi et al, 2014 ).…”

Section: Modulation Of Autonomic Activity As a Treatment For Epilepsysupporting

confidence: 59%

Modulation of autonomic activity in neurological conditions: Epilepsy and Tourette Syndrome

Nagai

2015

Front. Neurosci.

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This manuscript considers the central but neglected role of the autonomic nervous system in the expression and control of seizures in epilepsy (small) and tics in Tourette Syndrome (TS). In epilepsy, consideration of autonomic involvement is typically confined to differential diagnoses (e.g., syncope), or in relation to Sudden Unexpected Death in Epilepsy (SUDEP). Investigation is more limited in Tourette Syndrome. The role of the autonomic nervous system in the generation and prevention of epileptic seizures is largely overlooked. Emotional stimuli such as anxiety and stress are potent causes of seizures and tic activity in epilepsy and TS, respectively. This manuscript will describe a possible neural mechanism by which afferent autonomic projections linked to cognition and behavior influence central thalamo-cortical regulation, which appears to be an important means for controlling both seizure and tic activity. It also summarizes the link between the integrity of the default mode network and autonomic regulation in patients with epilepsy as well as the link between impaired motor control and autonomic regulation in patients with TS. Two neurological conditions; epilepsy and TS were chosen, as seizures and tics represent parameters that can be easily measured to investigate influences of autonomic functions. The EDA biofeedback approach is anticipated to gain a strong position within the next generation of treatment for epilepsy, as a non-invasive technique with minimal side effects. This approach also takes advantage of the current practical opportunity to utilize growing digital health technology.

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Section: Modulation Of Autonomic Activity As a Treatment For Epilepsysupporting

confidence: 59%

Modulation of autonomic activity in neurological conditions: Epilepsy and Tourette Syndrome

Nagai

2015

Front. Neurosci.

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“…stress or deep sleep) or using EDA biofeedback for training patients to prevent epileptic seizures 42 .…”

Section: Limits and Future Workmentioning

confidence: 99%

“…41 Finally, a seizure detector incorporating EDA could be suitable for other important applications, such as identifying triggering factors reflected in autonomic activations (e.g., stress or deep sleep) or using EDA biofeedback for training patients to prevent epileptic seizures. 42…”

Section: Limits and Future Workmentioning

confidence: 99%

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Onorati¹,

Regalia²,

Caborni³

et al. 2017

Epilepsia

177

169

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Running title: Wearable multimodal motor seizure detectors Onorati et al. 2 Summary Objective:New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive, automated and provide false alarm rates bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods:Hand-annotated video-electroencephalography seizure events were collected from 69 patients at 6 clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 hours of data, including 55 convulsive epileptic seizures (6 focal tonic-clonic seizures and 49 focal-to-bilateral-tonicclonic seizures) from 22 patients. Recordings were analyzed off-line to train and test two new machine learning classifiers and a published EDA and ACM-based classifier. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results:The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and false alarm rate (FAR) of 0.2 events/day.No nocturnal seizures were missed. Most patients had less than 1 false alarm every 4 days with FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures) the FAR is up to 13 times lower than the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median: 29.3 s, range: 14.8-151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of post-ictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Onorati et al. 3 Significance:The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behaviour and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning.

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“…Thus, heart rate based biofeedback paradigms have the potential to enhance ‘interoceptive exposure’ in the management of anxiety disorders. There is evidence to support the notion that autonomic biofeedback training may also diminish symptoms in other patient groups with stress-sensitive neuropsychiatric and medical disorders, including epilepsy ( Nagai et al, 2004a ; Micoulaud-Franchi et al, 2014 ), tic disorder ( Nagai et al, 2009 ) and cardiovascular disease ( Moravec and McKee, 2011 ). There is therefore broader utility of biofeedback approaches in managing dissociative neuropsychiatric symptoms ( Sedeño et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Neuroanatomical substrates for the volitional regulation of heart rate

et al. 2015

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The control of physiological arousal can assist in the regulation of emotional state. A subset cortical and subcortical brain regions are implicated in autonomic control of bodily arousal during emotional behaviors. Here, we combined human functional neuroimaging with autonomic monitoring to identify neural mechanisms that support the volitional regulation of heart rate, a process that may be assisted by visual feedback. During functional magnetic resonance imaging (fMRI), 15 healthy adults performed an experimental task in which they were prompted voluntarily to increase or decrease cardiovascular arousal (heart rate) during true, false, or absent visual feedback. Participants achieved appropriate changes in heart rate, without significant modulation of respiratory rate, and were overall not influenced by the presence of visual feedback. Increased activity in right amygdala, striatum and brainstem occurred when participants attempted to increase heart rate. In contrast, activation of ventrolateral prefrontal and parietal cortices occurred when attempting to decrease heart rate. Biofeedback enhanced activity within occipito-temporal cortices, but there was no significant interaction with task conditions. Activity in regions including pregenual anterior cingulate and ventral striatum reflected the magnitude of successful task performance, which was negatively related to subclinical anxiety symptoms. Measured changes in respiration correlated with posterior insula activation and heart rate, at a more lenient threshold, change correlated with insula, caudate, and midbrain activity. Our findings highlight a set of brain regions, notably ventrolateral prefrontal cortex, supporting volitional control of cardiovascular arousal. These data are relevant to understanding neural substrates supporting interaction between intentional and interoceptive states related to anxiety, with implications for biofeedback interventions, e.g., real-time fMRI, that target emotional regulation.

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Skin conductance biofeedback training in adults with drug-resistant temporal lobe epilepsy and stress-triggered seizures: A proof-of-concept study

Cited by 35 publications

References 48 publications

Modulation of autonomic activity in neurological conditions: Epilepsy and Tourette Syndrome

Modulation of autonomic activity in neurological conditions: Epilepsy and Tourette Syndrome

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Neuroanatomical substrates for the volitional regulation of heart rate

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