EEG-Biofeedback and Epilepsy: Concept, Methodology and Tools for (Neuro)therapy Planning and Objective Evaluation

Objective diagnosis and therapy evaluation are still challenging tasks for many neurological disorders. This is highly related to the diversity of cases and the variety of treatment modalities available. Especially in the case of epilepsy, which is a complex disorder not well-explained at the biochemical and physiological levels, there is the need for investigations for novel features, which can be extracted and quantified from electrophysiological signals in clinical practice. Neurotherapy is a complementary treatment applied in various disorders of the central nervous system, including epilepsy. The method is subsumed under behavioral medicine and is considered an operant conditioning in psychological terms. Although the application areas of this promising unconventional approach are rapidly increasing, the method is strongly debated, since the neurophysiological underpinnings of the process are not yet well understood. Therefore, verification of the efficacy of the treatment is one of the core issues in this field of research. Considering the diversity in epilepsy and its various treatment modalities, a concept and a methodology were developed in this work for increasing objectivity in diagnosis and therapy evaluation. The approach can also fulfill the requirement of patient-specific neurotherapy planning. Neuroprofile is introduced as a tool for defining a structured set of quantifiable measures which can be extracted from electrophysiological signals. A set of novel quantitative features (i.e., percentage epileptic pattern occurrence, contingent negative variation level difference measure, direct current recovery index, heart rate recovery ratio, and hyperventilation heart rate index) were defined, and the methods were introduced for extracting them. A software concept and the corresponding tools (i.e., the neuroprofile extraction module and a database) were developed as a basis for automation to support the methodology. The features introduced were investigated through real data, which were acquired both in laboratory studies with voluntary control subjects and in clinical applications with epilepsy patients. The results indicate the usefulness of the introduced measures and possible benefits of integrating the indices obtained from electroencephalogram (EEG) and electrocardiogram for diagnosis and therapy evaluation. The applicability of the methodology was demonstrated on sample cases for therapy evaluation. Based on the insights gained through the work, synergetics was proposed as a theoretical framework for comprehending neurotherapy as a complex process of learning. Furthermore, direct current (DC)-level in EEG was hypothesized to be an order parameter of the brain complex open system. For future research in this field, investigation of the interactions between higher cognitive functions and the autonomous nervous system was proposed.