Original Article

Short Communication

A psycho-educational approach to epilepsy

To investigate the effects of an original education program on patients with epilepsy (PWE). The effects on knowledge about epilepsy, attitude to epilepsy, depression scales, and quality of life were investigated.

Thirty-five PWE participated in a lecture-style educational program using an original knowledge-oriented textbook. All patients were administered a total of four rating scales: the Knowledge about Epilepsy Scale (KES), the Attitude toward Epilepsy Scale (AES), and the Japanese version of the Quality of Life in Epilepsy Inventory (QOLIE-31-P), the Beck Depression Inventory (BDI). The KES and AES of patients (pKES and pAES) were compared to those of medical students (St) and residents (Rd).

After education, pKES improved and showed significant differences among pre-and post-education and six months later. Before education, pKES was inferior to St and Rd. However, after education, pKES changed and became superior to St and Rd. Six months later, the advantage was lost, but not significantly. PAES also improved after education, with significant differences before, after, and six months later after education. PAES was statistically inferior to St and Rd before education, but the difference disappeared after education, and the effect persisted after six months.

The non-depressed (BDI < 20) and depressed groups (BDI ≧ 20) improved in the KES after education. About the AES, the non-depressive group has a statistical tendency, but not the depressive group. At six months, the depressed group's AES is significantly lower than the non-depressed group.

While correct knowledge about epilepsy can improve attitudes and perceptions of epilepsy in PWE, special measures are needed for PWE with depression.

The continual development of newer antiepileptic drugs designed to maximize seizure control and minimize side effects has enabled the majority of individuals with epilepsy to have a better quality of life. The role of psychological therapies in controlling seizures is explained, which comprises numerous studies, such as lifestyle behaviors, relaxation therapy—relaxation therapy involves a certain amount of sessions with a trainer who teaches the techniques to an individual or group who are then encouraged to practice them at home for 20-minute sessions twice daily, and biofeedback—biofeedback is the ability of an individual to identify and alter their physiological state. Psychological therapies allow a patient control over his or her epilepsy to a certain extent. It has been established that behaviors, stress, and other external stimuli can either trigger or predispose individuals to seizures, but equally, there is a growing body of evidence to show that behaviors can also be used to prevent them.

The understanding individuals have about their epilepsy may influence the success with which that individual copes with his/her epilepsy. This paper presents the first evaluation of a video-assisted brief educational package for adults with mild learning disabilities and epilepsy (‘Epilepsy and You’; Paul, 1996 21). Utilizing a deferred entry to treatment design to evaluate intervention effects eighteen subjects participated in the study. Their knowledge about epilepsy before and after training was assessed using a checklist of knowledge and the Epilepsy Knowledge Questionnaire—Revised for use with people with learning disabilities. Results demonstrated significant gains in knowledge which were durable over a short follow-up period (1 month). ‘Epilepsy and You’ was found to be suitable for use with a wide range of individuals and subjects’ opinions demonstrated they enjoyed taking part. This study is a preliminary investigation from which other research can develop. Therefore, criticisms and suggestions for further research have been made.

This study was designed to assess the effects of behavioural treatment on seizure recurrence, on seizure precipitants, and on associated psychiatric disturbances in 22 adolescents and young adults (age range 16–32 years, male : female ratio 10 : 12) with juvenile myoclonic epilepsy (JME) who showed seizure relapses despite rational AED therapy. The neurological assessment and a systematic search for seizure precipitants preceded to the use of psychiatric interviews and rating scales for anxiety and depression. After a structured counselling aiming at the elimination of seizure precipitants, the patients were assigned to one of two treatment modalities (an antistress programme or an individual cognitive behavioural therapy). Structured counselling was associated with complete seizure control in eight patients . In other 14 subjects with uncontrolled seizures, the psychotherapeutic treatment had two types of effects. First, the patients’ fears and other unadapted responses, in the form of anxiety states and/or insomnia were significantly decreased during behavioural treatment. Second, a significantly lower rate of relapses occurred during behavioural treatment than during the baseline period. The results encourage the use of adjunctive behavioural treatment methods in decreasing seizure frequency, seizure precipitants and some types of comorbid psychopathology in patientswith JME.

This study was set up in order to investigate the prevalence and nature of seizure precipitants and self-control behaviours in adults with intractable seizures. A semi-structured interview was conducted with 100 patients attending neurology or neuropsychiatry epilepsy out-patient clinics. The interview included six questions regarding seizure precipitants, the extent to which the patients seek and avoid precipitants, and their ability to induce or abort seizures. The study revealed that over 90% of the participants could identify at least one seizure precipitant. Stress, depression, tiredness and the menstrual cycle were the most common precipitants reported. In addition, 65% of the participants could identify at least one ‘low-risk’ situation in which seizures were unlikely to occur. Fifteen percent reported they could induce a seizure, 52% said that they consciously try to avoid seizure precipitants and 47% said they could sometimes stop their seizures from happening. These results indicate that the majority of the sample could identify factors which trigger their seizures, and that some of the participants engage in attempts to reduce their seizure frequency by avoiding these factors and by controlling the onset of their seizures. The possible mechanisms involved in the relationship between precipitants and seizure genesis are discussed.

A preliminary investigation of the efficacy of a group intervention combining a range of psychological approaches and techniques for seizure management in adults with poorly controlled epilepsy. An uncontrolled AB group design was employed. Seven adults with intractable seizures took part in 8, weekly group sessions which included providing information, employed cognitive-behavioural techniques and addressed emotional difficulties. Weekly seizure logs were kept by participants during the intervention and the following 3 months. Five questionnaires were administered before and after the intervention and at 2-months follow-up to provide an indication of psychosocial well-being. Seizure frequency and scores on the questionnaires were used as outcome measures. There was a significant reduction in seizure frequency in the group, which persisted at follow-up. There were no significant changes on any of the questionnaires. The results suggest that a group-based intervention incorporating a range of psychological techniques may be effective for improving seizure control. The link between seizure reduction and psychological and psychosocial well-being needs further investigation.