Refractory epilepsy: an evaluation of psychological methods in outpatient management

Two groups of adult outpatients (n = 19 and n = 21) with poorly controlled epilepsy and significant psychological disorder, assessed in terms of rating scales, received two psychological treatments in a balanced cross-over design after stable baseline seizure frequency had been established. A third group (n = 19), who had poorly controlled epilepsy but no significant psychological disturbance received one type of psychological treatment after a stable baseline. The treatments were educational and were designed to improve coping skills. Weekly seizure frequency was monitored for 42 weeks, and self-rating measures of anxiety and depression were obtained before treatment and at the end of follow-up. All three groups showed a significant reduction in seizure frequency that was maintained at 6-month follow-up. The two groups with psychological symptoms showed a significant improvement in scores on the self-rating scales. We concluded that routine use of psychological intervention may be helpful in outpatient management of epilepsy.