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TREATMENT PROGRAM
1.EEG Biofeedback. EEG normalization rather than selective enhancement of specific frequency ranges is most clearly associated with a reduction of seizures (Lubar (151). Accordingly, individuals were reinforced for normalizing their awake, relaxed EEG pattern. To reduce possible muscle artifact from the EEG recordings, subjects were first trained to maintain relaxed scalp muscle tonus via anterior temporalis EMG feedback. Audio output and threshold were set to produce a loud tone burst (65 db) if 2 uV/sec was exceeded for 0.5 seconds. The tone also interrupted subsequent EEG normalization training as a time-out when these values were exceeded. Each subject was able to maintain normal resting muscle scalp tonus.
EEG biofeedback began with the therapist observing five minutes of baseline recording. Minimum amplitude of 10-uV/sec and dominant frequency were selected on an individualized basis. The goal was to achieve an amplitude greater than 10-uB/soc and selectively to shape the frequency toward the 8 to 12 Hz range. Then the individual was trained to increase the amplitude within this range.
2.Behavioral Counseling. Behavioral counseling was conducted in 15-minute sessions preceding and following EEG biofeedback sessions. The sessions took place at weekly intervals for six months and monthly intervals for six months.
Counseling involved three objectives: Identifying the pre-seizure warning and/or aura; identifying emotional, behavioral, physiological and/or environmental mechanisms which trigger seizure activity; and learning a suitable relaxation technique which is effective in aborting seizure activity.
a. Pre-seizure Warning and Aura. Patients were taught the importance of identifying the symptoms that precede seizure activity. These symptoms are consistent in individuals and are subtle and varied, ranging from rushes of thought to focal disturbances. In most patients, the pre-seizure symptoms are consistent and therefore a reliable indicator of impending seizure activity. At the start of the project, two subjects were aware of pre-seizure symptoms; by the end of the month, two others were, and the fifth one discovered these symptoms in the fourteenth month.
b. The second objective was to help the individuals become aware of stressful factors in their lives which tend to trigger their seizures. They were made aware of common life stresses that tend to aggravate their seizure condition such as sleep loss, poor eating habits, personal conflicts, job or school pressure. They were encouraged to allow self-awareness to develop through the use of a daily log of seizures. This log focuses attention on the relationship between daily activity and seizure frequency.
c. Relaxation. The third objective involved instruction in relaxation techniques. Our patients were taught deep breathing techniques to initiate relaxation. They were instructed then to use progressive muscle relaxation exercises. A written instructional hand-out was given for home use. During weekly EEG biofeedback sessions, individuals were given reinforcement for producing awake relaxed EEG patterns (alpha range 8-12 Hz and 50 uV or greater). These weekly sessions were intended to enhance relaxation gained by doing daily breathing and relaxation exercises. The individuals were encouraged to use these techniques when they felt tense or in a pre-seizural state. | 
