[Use of psychotherapy in patients with combined epileptic and nonepileptic seizures]

Nonepileptic seizures can be divided according to the aetiology of their origin into two main groups: as somatically or psychogenically determined. The group of psychogenical nonepileptic seizures has not been clearly defined and it has no generally accepted terminology. In the model used in this article, psychogenic seizures can be classified according to the conscious and unconscious control. Differential diagnostics is difficult and an interdisciplinary cooperation is required. The therapy is problematical; especially the treatment of patients with combined seizures that could be therefore considered as pharmaco-resistant. In such cases it is necessary to combine antiepileptic medication with psychotherapeutic techniques. The psychotherapeutic techniques used in the presented case are, among others, following: Rogers's psychotherapy, techniques of self-regulation and relaxation, and Leuner's imaginative technique. Significant seizure reduction was achieved after two years of the joint effort of the neurologist and psychologist treating a 34-year-old woman who suffered from combined seizures. She was temporary regarded as pharmaco-resistant with a prominent anxiety disorder verging to social phobia. After four years of treatment, she has had no seizures for the recent eight months, she had no problems in the social communication either and she has been also without the characteristic anxiety features.