Improvement of seizure control by psychological methods in patients with intractable epilepsies.

Recent attempts to clarify the pathogenesis of pharmacoresistant epilepsies arrive at the conclusion that intractable epilepsies might be prevented by earlier, more effective pharmacotherapy. In this paper the problem of intractability is examined from a psychological point of view. Sixteen patients with intractable epilepsies were trained in techniques of self control (SC) in addition to ongoing pharmacological treatment. The SC training consisted of detailed self observation which aimed at identifying warning signals of a beginning seizure and seizure-provoking factors and the development of 'counter measures' (behavioural measures to interrupt a beginning seizure and to neutralize provoking factors). After SC training, all those patients who successfully managed to deal with their identified problems (strong psychic stress and/or poor intuitive SC abilities) achieved a significant improvement of seizure control: 68% obtained 80-100% reduction and 12% obtained 60-70% reduction of seizures. None changed for the worse. These findings suggested that psychological methods of seizure control can contribute to improving long-standing intractable epilepsies. Offered early in the process of epilepsy they may even help to prevent the development of intractability. A new kind of polytherapy is proposed, consisting of a combination of pharmacological and SC therapy.