2010
American Epilepsy Society Poster (Abst. 1.328)
Modification and improvement of an existing group treatment for psychological non-epileptic seizures
Authors: M. Fiorito Grafman, L. Myers, C. Zaroff, C. Haward and M. Lancman
Rationale:
In 2002, two of the authors (CM Zaroff, L Myers, et al, 2004) designed a group treatment for psychological non-epileptic seizures (PNES). Seven patients completed the treatment and were assessed on seizure frequency, stress management strategies, trauma, anger, quality of life and dissociative symptoms. Although there was no change in terms of seizure frequency post-treatment, there were changes in dissociative symptoms and quality of life. The present treatment model utilized this as a starting point, modified pre and post assessment and further refined the actual treatment program.
Methods:
Assessment: In 2002, pre and post measures included the Davidson Trauma Scale (DTS), Curious Experiences Survey (CES), Quality of Life in Epilepsy-31 (QOLIE-31), State Trait Anger Expression Inventory (STAXI-2), and the Coping Inventory for Stressful Situations (CISS). In the present format, the QOLIE-31, STAXI and CISS were maintained and the Toronto Alexithymia Scale (TAS) was added. The CES and DTS were replaced by the Trauma Symptom Inventory (TSI). Seizure frequency continued to be monitored weekly. Treatment: In 2002, treatment was completed over 10 weeks. The following topics were addressed in this order of presentation: PNES, anger, trauma and abuse, depression and anxiety, somatization tendencies, quality of life, paths toward health, stress coping techniques, and review. The current treatment further refined the targets and shifted the order of topics: PNES, PTSD, anxiety, depression, healing PTSD, anxiety reduction 1, anxiety reduction 2, assertiveness training, complementary healthy behaviors, positive psychology, alternative treatments, review). The guiding premise that greater understanding about one’s illness provides greater control remains prevalent. However, the new model concentrates increasingly on anxiety management (breathing and visualization strategies are practiced), post-traumatic healing (targeting avoidance behaviors, keeping of gratitude diary) and assertiveness training (anger management and script writing). A comparative analysis of results from pre- and post- self-report measures was performed to determine the effectiveness of group treatment upon the completion of the 12-session period. Seizure frequency was also determined.
Results:
Nine of the 14 patients completed the treatment program. As for seizure frequency, 3 patients became seizure free, one was seizure free at the outset, two patients went from weekly to monthly seizures and one went from “every 2 hours” to weekly. Two experienced no change. The mean TAS score fell 14 points following treatment. The mean score on the CISS Emotion scale went from high average to average. Overall quality of life improved post treatment in comparison to a normative sample.
Conclusions:
Refinements made to the preliminary PNES group treatment model resulted in notable improvements, including seizure elimination or reduction. A positive trend regarding quality of life and alexithymia were also noted. Two month follow up revealed that gains had been maintained.