- Email: [email protected]
33. Psychological treatments for epilepsy
Abstracts / Epilepsy & Behavior 17 (2010) 579–620
of phase synchrony, cross-correlation or computing the directed transfer function. The study was supported by MŠMT CˇR Research Program No. MSM0021622404. doi:10.1016/j.yebeh.2010.01.057
The interaction of mind and epileptic activity in epilepsy 33. Psychological treatments for epilepsy Gus A. Baker
In the absence of seizure control with optimal antiepileptic drug therapy, there is an increasing interest in alternative or complementary therapies. Relaxation therapy, cognitive behavior therapy, biofeedback, acupuncture and educational interventions have been used alone or in combination in the treatment of epilepsy, in an attempt to reduce the seizure frequency and improve the quality of life. While there is an increasing awareness from anecdotal evidence that such therapeutic options may benefit people with epilepsy, a number of systematic reviews have highlighted that methodological deficiencies and the limited number of individuals studied prevents the establishment of reliable evidence to support the use of these treatments [see Cochrane reviews]. Further well designed and well conducted trials with adequate statistical power are needed to provide evidence that is rigorous enough to support their use in daily clinical practice. In this presentation the author will draw upon previous research in epilepsy [cognitive behavioral treatment and psychoeducational programme] and other chronic conditions to consider what psychological treatments may be relevant to people with epilepsy and how evidence might be gathered to support their use. In addition the author will describe a number of recent initiatives and discuss their contribution to this field of endeavor. doi:10.1016/j.yebeh.2010.01.058
34. The influence of a modulation of peripheral sympathetic activity on epilepsy Yoko Nagai, University of Essex, Psychology, Colchester, UK
The galvanic skin response (GSR) is an accessible and sensitive index of sympathetic nervous activity, reflecting centrally-induced changes in peripheral autonomic arousal. The functional relationship between peripheral autonomic arousal and central cortical excitation has been intensively characterized using GSR and electroencephalography (slow cortical potential), respectively. Peripheral sympathetic activity was negatively correlated with the amplitude of slow cortical potential suggesting there is an inverse relationship between peripheral and cortical arousal. Biofeedback is a non-invasive behavioral treatment enabling a patient to gain volitional control over states of bodily arousal, which in turn impact on central systems governing cortical excitability and sensorimotor control. The therapeutic application of biofeedback has become increasingly popular over the last fifty years. Typically, biofeedback treatment is offered to patients whose seizures fail to respond robustly to medications or used as an adjunct to pharmacotherapy. We have conducted a program of research on the application of GSR
589
biofeedback to the control of epilepsy. Clinical studies of patients with treatment-resistant seizures were complemented by a set of EEG and functional imaging investigations to detail neural mechanisms underlying an observed therapeutic effect. Active (compared to sham) biofeedback training elicited a significant reduction in seizure frequency, where the degree of seizure reduction correlated with improved biofeedback task performance, following training. Parallel electrophysiological and neuroimaging studies in controls and patients demonstrated GSR biofeedback-induced modulation of circuits controlling cortical excitability. Both phasic and tonic interactions were apparent between peripheral autonomic activity and indices of cerebral arousal. Together, these studies highlight the efficacy and validity of biofeedback treatment for epilepsy. doi:10.1016/j.yebeh.2010.01.059
35. Understanding others’ mental states and epilepsy A.R. Giovagnoli 1, A. Riva 1, F. Villani 2, L. D’Incerti 3, G. Avanzini 2, 1 Neuropsychology Unit, Carlo Besta Neurological Institute, Milano, Italy, 2 Epilepsy Center, Carlo Besta Neurological Institute, Milano, Italy, 3 Neuroradiology Unit, Carlo Besta Neurological Institute, Milano, Italy
Objective: Theory of mind (ToM), the ability to understand mental states, is essential for the maintenance of social relationships. This study assessed ToM in epilepsy patients aiming to characterize their cognitive functioning. In particular, we evaluated the ability to understand epistemic and emotional states and intentionality in patients with temporal (TLE) and frontal lobe epilepsy (FLE). Methods: One hundred and thirty-eight patients with TLE (n = 109) or FLE (n = 29) and 69 healthy subjects were assessed using the Faux Pas task (FPT) that evaluates the ability to attribute others’ mental states in 20 stories. Each story provides one recognition score (the number of FP correctly recognized or rejected), four comprehension scores of the story contents, and one control score. All subjects also underwent testing for reasoning, language, visual perception, and attention, memory, executive, and praxis functions. Results: With respect to healthy subjects, both TLE and FLE patients were significantly impaired on the FPT, showing poor recognition of gaffes and altered comprehension of intentions, emotions, and behavior appropriateness. With respect to TLE patients, FLE patients were also significantly impaired in recognizing gaffes. In the epilepsy patients, factor analysis distinguished two ToM factors distinct from the other cognitive domains, and a regression analysis showed that ToM was predicted by schooling and the type of epilepsy. Conclusions: These findings suggest that focal epilepsy involving either frontal or temporal lobe regions may impair the understanding of others’ mental states. Such impairment seems independent from language, perception, memory, and executive deficits and mainly reflects frontal lobe dysfunctions. doi:10.1016/j.yebeh.2010.01.060
36. Cognitive modulation of the electrophysiological nonlinear dynamics within the hippocampus K. Lehnertz 1,2,3, C. Helmstaedter 1, 1 Department of Epileptology, University of Bonn, Bonn, Germany, 2 Helmholtz-Institute for Radiation and Nuclear Physics, University of Bonn, Bonn, Germany, 3 Interdisciplinary Center for Complex Systems, University of Bonn, Bonn, Germany
Objective: To investigate whether nonlinear aspects of the electroencephalogram (EEG) recorded invasively from the mesial tempo-
of phase synchrony, cross-correlation or computing the directed transfer function. The study was supported by MŠMT CˇR Research Program No. MSM0021622404. doi:10.1016/j.yebeh.2010.01.057
The interaction of mind and epileptic activity in epilepsy 33. Psychological treatments for epilepsy Gus A. Baker
In the absence of seizure control with optimal antiepileptic drug therapy, there is an increasing interest in alternative or complementary therapies. Relaxation therapy, cognitive behavior therapy, biofeedback, acupuncture and educational interventions have been used alone or in combination in the treatment of epilepsy, in an attempt to reduce the seizure frequency and improve the quality of life. While there is an increasing awareness from anecdotal evidence that such therapeutic options may benefit people with epilepsy, a number of systematic reviews have highlighted that methodological deficiencies and the limited number of individuals studied prevents the establishment of reliable evidence to support the use of these treatments [see Cochrane reviews]. Further well designed and well conducted trials with adequate statistical power are needed to provide evidence that is rigorous enough to support their use in daily clinical practice. In this presentation the author will draw upon previous research in epilepsy [cognitive behavioral treatment and psychoeducational programme] and other chronic conditions to consider what psychological treatments may be relevant to people with epilepsy and how evidence might be gathered to support their use. In addition the author will describe a number of recent initiatives and discuss their contribution to this field of endeavor. doi:10.1016/j.yebeh.2010.01.058
34. The influence of a modulation of peripheral sympathetic activity on epilepsy Yoko Nagai, University of Essex, Psychology, Colchester, UK
The galvanic skin response (GSR) is an accessible and sensitive index of sympathetic nervous activity, reflecting centrally-induced changes in peripheral autonomic arousal. The functional relationship between peripheral autonomic arousal and central cortical excitation has been intensively characterized using GSR and electroencephalography (slow cortical potential), respectively. Peripheral sympathetic activity was negatively correlated with the amplitude of slow cortical potential suggesting there is an inverse relationship between peripheral and cortical arousal. Biofeedback is a non-invasive behavioral treatment enabling a patient to gain volitional control over states of bodily arousal, which in turn impact on central systems governing cortical excitability and sensorimotor control. The therapeutic application of biofeedback has become increasingly popular over the last fifty years. Typically, biofeedback treatment is offered to patients whose seizures fail to respond robustly to medications or used as an adjunct to pharmacotherapy. We have conducted a program of research on the application of GSR
589
biofeedback to the control of epilepsy. Clinical studies of patients with treatment-resistant seizures were complemented by a set of EEG and functional imaging investigations to detail neural mechanisms underlying an observed therapeutic effect. Active (compared to sham) biofeedback training elicited a significant reduction in seizure frequency, where the degree of seizure reduction correlated with improved biofeedback task performance, following training. Parallel electrophysiological and neuroimaging studies in controls and patients demonstrated GSR biofeedback-induced modulation of circuits controlling cortical excitability. Both phasic and tonic interactions were apparent between peripheral autonomic activity and indices of cerebral arousal. Together, these studies highlight the efficacy and validity of biofeedback treatment for epilepsy. doi:10.1016/j.yebeh.2010.01.059
35. Understanding others’ mental states and epilepsy A.R. Giovagnoli 1, A. Riva 1, F. Villani 2, L. D’Incerti 3, G. Avanzini 2, 1 Neuropsychology Unit, Carlo Besta Neurological Institute, Milano, Italy, 2 Epilepsy Center, Carlo Besta Neurological Institute, Milano, Italy, 3 Neuroradiology Unit, Carlo Besta Neurological Institute, Milano, Italy
Objective: Theory of mind (ToM), the ability to understand mental states, is essential for the maintenance of social relationships. This study assessed ToM in epilepsy patients aiming to characterize their cognitive functioning. In particular, we evaluated the ability to understand epistemic and emotional states and intentionality in patients with temporal (TLE) and frontal lobe epilepsy (FLE). Methods: One hundred and thirty-eight patients with TLE (n = 109) or FLE (n = 29) and 69 healthy subjects were assessed using the Faux Pas task (FPT) that evaluates the ability to attribute others’ mental states in 20 stories. Each story provides one recognition score (the number of FP correctly recognized or rejected), four comprehension scores of the story contents, and one control score. All subjects also underwent testing for reasoning, language, visual perception, and attention, memory, executive, and praxis functions. Results: With respect to healthy subjects, both TLE and FLE patients were significantly impaired on the FPT, showing poor recognition of gaffes and altered comprehension of intentions, emotions, and behavior appropriateness. With respect to TLE patients, FLE patients were also significantly impaired in recognizing gaffes. In the epilepsy patients, factor analysis distinguished two ToM factors distinct from the other cognitive domains, and a regression analysis showed that ToM was predicted by schooling and the type of epilepsy. Conclusions: These findings suggest that focal epilepsy involving either frontal or temporal lobe regions may impair the understanding of others’ mental states. Such impairment seems independent from language, perception, memory, and executive deficits and mainly reflects frontal lobe dysfunctions. doi:10.1016/j.yebeh.2010.01.060
36. Cognitive modulation of the electrophysiological nonlinear dynamics within the hippocampus K. Lehnertz 1,2,3, C. Helmstaedter 1, 1 Department of Epileptology, University of Bonn, Bonn, Germany, 2 Helmholtz-Institute for Radiation and Nuclear Physics, University of Bonn, Bonn, Germany, 3 Interdisciplinary Center for Complex Systems, University of Bonn, Bonn, Germany
Objective: To investigate whether nonlinear aspects of the electroencephalogram (EEG) recorded invasively from the mesial tempo-