Psychological treatment of epilepsy

Abstract

Associated psychopathology and stress-related seizures are two indications for psychotherapy in epilepsy. Support psychotherapy and autohypnotic or relaxation methods are the two most frequently recommended therapies. In the present study, we compared autogenic therapy with support psychotherapy in the 9 months treatment of 20 epileptics with high scores of psychiatric pathology. 18 patients had temporal focii, and none of them had achieved complete control of their seizures with medication. Treatment was blindly evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Cornell Medical Index. Both groups improved on the Total Pathology Score of the BPRS, although the degree of improvement was significantly higher in the autogenic therapy group. In the Cornell Medical Index only, the group on autogenic therapy showed significant improvement, although there was a trend in the support group. Autogenic therapy was particularly effective on symptoms of inadequacy, anxiety, irritability and psychosomatic complaints. Both intensity and frequency of seizures decreased with autogenic therapy during the treatment period, particularly in patients with high seizure frequency. The EEG showed no basic changes after the 9 months treatment period. However, there were significant changes in the EEG recordings of the autogenic-therapy group when the patients were asked to practice passive concentration on the first autogenic formula. The most consistent of those EEG changes during the autogenic state was a diffuse low amplitude slow wave activity, recorded over both hemispheres, interrupted by a well regulated alpha rhythm. There was also a tendency to exaggerated manifestations of the epileptic EEG abnormalities, particularly on the temporal regions. The clinical improvement with autogenic therapy may be related to subclinical neuronal discharges during the autogenic state. This hypothesis is substantiated by the EEG findings and by the tendency to seizure activity during long autogenic exercises, observed in some patients during the initial period of therapy.