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Summary:Purpose: To define behaviours and to identify psychological, demographic, and epilepsy-related variables associated with high as opposed to low perceived self-control of seizures.Method: In a semistructured interview, 100 adults with intractable seizures were asked about their seizure precipitants and attempts at self-control of seizures. They also completed four psychological questionnaires. Latent Class Analysis was used to analyse the interview data to create two groups, High Controllers and Low Controllers, who were then compared on demographic, epilepsy, and psychological characteristics.Results: Being able to identify and seeking out low-risk-forseizure situations, avoiding high-risk-for-seizure situations, and making attempts at seizure inhibition were seizure behaviours that discriminated High from Low Controllers. The general probability of being a High Controller was greater than that of being a Low Controller. Perceived high self-control of seizures was associated with low chance-health locus of control. For Low Controllers, current age, age at onset of seizures, and duration of epilepsy history were related to psychological variables. A significantly higher proportion of the Low Controllers than High Controllers were women.Conclusions: Many people with intractable seizures do not accept their epilepsy as a condition over which they have no control. Perceived self-control of seizures, however, involves a complex interaction between epilepsy and psychological factors, with health locus of control an apparently important discriminator between High and Low Controllers.

A preliminary investigation of the efficacy of a group intervention combining a range of psychological approaches and techniques for seizure management in adults with poorly controlled epilepsy. An uncontrolled AB group design was employed. Seven adults with intractable seizures took part in 8, weekly group sessions which included providing information, employed cognitive-behavioural techniques and addressed emotional difficulties. Weekly seizure logs were kept by participants during the intervention and the following 3 months. Five questionnaires were administered before and after the intervention and at 2-months follow-up to provide an indication of psychosocial well-being. Seizure frequency and scores on the questionnaires were used as outcome measures. There was a significant reduction in seizure frequency in the group, which persisted at follow-up. There were no significant changes on any of the questionnaires. The results suggest that a group-based intervention incorporating a range of psychological techniques may be effective for improving seizure control. The link between seizure reduction and psychological and psychosocial well-being needs further investigation.

This paper is an attempt to present and discuss the application of psychodynamic thinking and practice to working with people with epilepsy. The paper provides a general explanation of what epilepsy is, followed by a brief review of the existing psychoanalytic literature in relation to epilepsy. The core of the paper is a detailed case study describing a time‐limited psychodynamic counselling with a patient in an epilepsy outpatient clinic at a large general hospital in the UK. This account aims to highlight some of the issues and themes in working with people with epilepsy, and to add to the limited literature available on psychodynamic work with this client group.