title: Skin conductance biofeedback training in adults with drug-resistant temporal lobe epilepsy and stress-triggered seizures: a proof-of-concept study.
abstract: The present proof-of-concept study investigated the feasibility of skin conductance biofeedback training in reducing seizures in adults with drug-resistant temporal lobe epilepsy (TLE), whose seizures are triggered by stress. Skin conductance biofeedback aims to increase levels of peripheral sympathetic arousal in order to reduce cortical excitability. This might seem somewhat counterintuitive, since such autonomic arousal may also be associated with increased stress and anxiety. Thus, this sought to verify that patients with TLE and stress-triggered seizures are not worsened in terms of stress, anxiety, and negative emotional response to this nonpharmacological treatment. Eleven patients with drug-resistant TLE with seizures triggered by stress were treated with 12 sessions of biofeedback. Patients did not worsen on cognitive evaluation of attentional biases towards negative emotional stimuli (P>.05) or on psychometric evaluation with state anxiety inventory (P = .059); in addition, a significant improvement was found in the Negative Affect Schedule (P = .014) and in the Beck Depression Inventory (P = .009). Biofeedback training significantly reduced seizure frequency with a mean reduction of -48.61% (SD = 27.79) (P = .005). There was a correlation between the mean change in skin conductance activity over the biofeedback treatment and the reduction of seizure frequency (r(11) = .62, P = .042). Thus, the skin conductance biofeedback used in the present study, which teaches patients to achieve an increased level of peripheral sympathetic arousal, was a well-tolerated nonpharmacological treatment. Further, well-controlled studies are needed to confirm the therapeutic value of this nonpharmacological treatment in reducing seizures in adults with drug-resistant TLE with seizures triggered by stress.
authors.affiliation: Unité de Neurophysiologie (UNPN), Pôle de Psychiatrie "Solaris", Centre Hospitalier Universitaire de Sainte-Marguerite, 270 Bd de Sainte-Marguerite, 13009 Marseille, France; Laboratoire de Neurosciences Cognitives (LNC), UMR CNRS 7291, Aix-Marseille Université, Marseille, France. Electronic address: jarthur.micoulaud@gmail.com.
authors.forename: Jean-Arthur
authors.initials: JA
authors.lastname: Micoulaud-Franchi
authors.affiliation: Laboratoire Parole et Langage (UMR 7309), Aix-Marseille Université, Marseille, France.
authors.forename: Iliana
authors.initials: I
authors.lastname: Kotwas
authors.affiliation: CIC-CPCET - Centre de Pharmacologie Clinique et Evaluations Thérapeutiques, Aix-Marseille Université, Marseille, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Lanteaume
authors.affiliation: Unité de Neurophysiologie (UNPN), Pôle de Psychiatrie "Solaris", Centre Hospitalier Universitaire de Sainte-Marguerite, 270 Bd de Sainte-Marguerite, 13009 Marseille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Berthet
authors.affiliation: Laboratoire Parole et Langage (UMR 7309), Aix-Marseille Université, Marseille, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Bastien
authors.affiliation: Unité de Neurophysiologie (UNPN), Pôle de Psychiatrie "Solaris", Centre Hospitalier Universitaire de Sainte-Marguerite, 270 Bd de Sainte-Marguerite, 13009 Marseille, France; Laboratoire de Neurosciences Cognitives (LNC), UMR CNRS 7291, Aix-Marseille Université, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Vion-Dury
authors.affiliation: Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France; Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Aileen
authors.initials: A
authors.lastname: McGonigal
authors.affiliation: Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France; Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Hôpital Henri Gastaut, Etablissement hospitalier spécialisé dans le traitement des epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bartolomei
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000628:therapy*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology / Q000628:therapy*; D013315:Stress, Psychological / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult
keywords: Biofeedback; Drug-resistant epilepsy; Galvanic skin response; Psychological stress; Temporal lobe epilepsy; Therapeutics