Adjunctive behavioural treatment in adolescents and young adults with juvenile myoclonic epilepsy

This study was designed to assess the effects of behavioural treatment on seizure recurrence, on seizure precipitants, and on associated psychiatric disturbances in 22 adolescents and young adults (age range 16-32 years, male : female ratio 10 : 12) with juvenile myoclonic epilepsy (JME) who showed seizure relapses despite rational AED therapy. The neurological assessment and a systematic search for seizure precipitants preceded to the use of psychiatric interviews and rating scales for anxiety and depression. After a structured counselling aiming at the elimination of seizure precipitants, the patients were assigned to one of two treatment modalities (an antistress programme or an individual cognitive behavioural therapy). Structured counselling was associated with complete seizure control in eight patients. In other 14 subjects with uncontrolled seizures, the psychotherapeutic treatment had two types of effects. First, the patients' fears and other unadapted responses, in the form of anxiety states and/or insomnia were significantly decreased during behavioural treatment. Second, a significantly lower rate of relapses occurred during behavioural treatment than during the baseline period. The results encourage the use of adjunctive behavioural treatment methods in decreasing seizure frequency, seizure precipitants and some types of comorbid psychopathology in patients with JME.