Assessing the Effectiveness of Neurofeedback for Drug-Resistant Focal Epilepsy: A Preliminary MRI Study

Abstract

Objective: While there is evidence that neurofeedback (NF) can reduce seizure frequency and enhance sensorimotor rhythm (SMR) in patients with drug-resistant focal epilepsy, the neural mechanisms underlying such effects are not well understood. The objective of this study was to investigate the neuromodulatory effects of SMR NF training on functional and structural connectivity in patients with drug-resistant focal epilepsy.

Methods: Four patients with drug-resistant focal epilepsy underwent functional magnetic resonance imaging (fMRI), diffusion MRI (dMRI), quantitative electroencephalogram (QEEG), and Integrated Visual and Auditory (IVA-2) test before and after 6 to 8 weeks of SMR NF training. We assessed alterations in functional and structural connectivity within and between six brain networks based on the automated anatomical labeling (AAL) atlas.

Results: All four patients showed a reduction in seizure frequency ranging from 35% to 100% after SMR NF training, with two patients experiencing a reduction within the first week of treatment. IVA-2 scores increased for all patients compared to the pre-treatment baseline, indicating cognitive improvement. Post-treatment fMRI revealed no significant differences in functional connectivity between patients and control cases, despite significant differences in some brain networks observed in pre-treatment fMRI. We also found increased fractional anisotropy (FA) values between subcortical and auditory networks after SMR training.

Significance: Our study provides promising evidence for the neural basis of SMR NF training in the treatment of drug-resistant focal epilepsy. The observed reductions in seizure frequency, improvements in cognitive abilities, and increased FA values suggest that SMR NF training may be an effective treatment for patients with drug-resistant focal epilepsy.