A Behaviour Medicine Approach to Epilepsy - Time for a Paradigm Shift?

Abstract

The major contribution of the behavioural approach to the understanding and treatment of epilepsy has been the construction of a self-management model comprising: (i) recognition that external factors influence the occurrence and inhibition of the epileptic seizure and (ii) teaching people with epilepsy to recognize and utilize these factors to influence seizure occurrence. The behavioural medicine model regards the epileptic seizure as any behaviour, amenable to classical and operant conditioning. Part one of this paper presents a literature review of behavioural medicine treatment of people with epilepsy. Part two presents a study illustrating spontaneous means by which people with epilepsy predict, prevent and inhibit seizure occurrence. A total of 160 children and adults with refractory seizures were studied over a 10-year period. This study addresses the issues of which types of seizures or what categories of people with epilepsy might be more amenable to learning factors and thus respond to behavioural treatment. The need for a paradigm shift from the traditional medical concept of epilepsy to a behavioural medicine concept, as has been the case with chronic pain, is discussed.