Psychological approaches to the prevention and inhibition of nocturnal epileptic seizures: A meta-analysis of 70 case studies

The major purpose of this study was to outline and differentiate diagnostic and therapeutic conditions for the usefulness of psychological approaches in controlling nocturnal epileptic seizures. Data on 70 patients (12 'own', 58 from other studies) were evaluated which suggest that at least one psychological approach was primarily responsible for improving nocturnal seizure control. Outcome-related comparisons were made for the behavioural state at seizure onset, seizure types, epilepsy syndromes, types of psychological approaches, age, gender, mental disability, duration of epilepsy, impact of psychological treatment on intake of antiepileptic medication, and additional occurrence of diurnal seizures. Seizure favouring or precipitating factors as well as types of seizures and epilepsies were analysed and compared with regard to therapeutic components and strategies. Respective data of patients with exclusively nocturnal seizures or with transitory shifts of seizure activity to the night were evaluated separately. Psychological approaches were effective in a broad range of indications, whose limitations regarding age, level of intelligence, seizure semiology, or type and duration of epilepsy cannot yet be determined. Therapeutic strategies may depend on the concomitant occurrence of diurnal seizures as well as on the identification, types and number of seizure favouring factors, the type and duration of initial symptoms, the behavioural state at seizure onset, the type of epilepsy, and the level of intelligence. Despite methodological reservations emerging from the designs, number, and comparability of the included studies, there is sufficient evidence that psychological approaches to the control of nocturnal seizures clearly deserve more consideration in research. Also, their carefully prepared and designed use in clinical practice should be encouraged.