Steven Whitman

Multietiological determinants of psychopathology and social competence in children with epilepsy

The purpose of this investigation was to inquire into the multietiological determinants of psychopathology and social competence in children with epilepsy. The relationship between behavioral functioning as assessed by the Child Behavior Checklist and a variety of biological, psychosocial, medication and demographic risk factors was investigated in a sample of 183 children with epilepsy aged 6-16. Several risk factors were found to be related to each behavioral measure. The results are discussed both in terms of their implications for models of psychopathology in epilepsy as well as their relationship to previous findings in the epilepsy/psychopathology field.

Psychosocial predictors of interictal depression

Abstract The purpose of this investigation was to attempt to determine whether some of the psychosocial complications associated with epilepsy are predictive of interictal depression. A wide variety of psychosocial, neuroepilepsy, and medication variables were assessed and related to self-reported depressive symptomatology in a sample of 102 adults with epilepsy. The results of multiple regression analysis revealed that four variables were predictive of increased depression: increased stressful life events, poor adjustment to seizures, financial stress, and female gender. The methodological limitations of this correlational approach and the need for a prospective longitudinal investigation are discussed.

Seizures and civilian head injuries.

Summary: Although several studies have reported on the risk of “early seizures” (seizures occurring within 7 days following a head injury), the reported proportions of patients experiencing these seizures vary from 1.4 to 15%. This wide divergence may be due to problems with methodology such as case selection and definitions of head injury and early seizures. In a series of 702 patients admitted with a head injury to Cook County Hospital (CCH), Chicago, Illinois, 29 (4.1%) had early seizures. This proportion is twice as high as one previously reported in a comparable series. This may reflect an actual difference between the two series or a case selection bias serving to elevate the proportion of patients with early seizures at CCH.

Effects of progressive relaxation on epilepsy: analysis of a series of cases

It is well known that stress and other environmental factors often trigger seizures in people with epilepsy but reviews of the literature show no rigorous studies of behavioral approaches to minimize stress and improve seizure control. The purpose of this study was to overcome this deficiency by studying the effects of progressive relaxation therapy on the frequency of seizures in eight intellectually intact subjects with epilepsy. All 8 experienced at least six seizures in a 3-wk. baseline period. They were then randomly placed into either Group 1, who underwent relaxation therapy during the next 3-wk. interval, or Group 2, who underwent a 3-wk. sham treatment and then a 3-wk. relaxation therapy. All 8 subjects showed decreases from baseline to treatment, indicating a significant beneficial effect of relaxation therapy for reduction of seizures. All 8 gave subjective reports of improved feelings of well-being beyond decreases in the frequency of their seizures. The implications of these results are discussed and suggestions for research are presented.

Sequelae Associated with Head Injuries in Patients Who Were Not Hospitalized: A Follow-up Survey

Data about sequelae associated with head injuries in patients presenting at a suburban hospital but not hospitalized were collected from emergency department medical records and two follow-up telephone interviews. During the study period 669 patients with head injuries were discharged from the emergency department. Of these, 288 were asked to participate in the study, 275 (95%) agreed, and 262 (91%) were eventually contacted. Participants and nonparticipants were compared on six variables and differed significantly only on age--younger patients were more likely to be included. Forty-eight hours after trauma, 52% of the respondents suffered headaches, 14% complained of dizziness, and 13% complained of drowsiness. One week after trauma, the complaints were headaches in 27%, dizziness in 11%, and drowsiness in 9%. Twenty-seven per cent had not resumed normal activity at 48 hours after trauma, and 13% had not at 1 week. Sixty-six per cent of the patients followed the patient instructions regarding head injuries.

Psychopathology and seizure type in children with epilepsy

Previous investigations have reported an increased rate of behavioural disorder in children with epilepsy. The role, if any, played by temporal lobe epilepsy (TLE) in predisposing to psychopathology is unclear. In order to evaluate the relationship between seizure type and psychopathology, 35 children with TLE were compared with 48 children with primary generalized epilepsies (GE) on standardized measures of social competence, aggression and overall behavioural disorder via analyses of covariance. Additionally, Pearson correlations were computed in order to evaluate the relationships between psychopathology and several seizure and subject variables. It was found that the presence of TLE per se bore no relationship to aggression, social competence or overall behavioural disorder. Some specific subject- and seizure-related variables were found to be associated with increased aggression and behavioural dysfunction in children with TLE and the interpretation of these findings are related to the larger epilepsy/psychopathology literature. Finally, an alternative approach for studying the precursors of behavioural disorder in epilepsy is suggested.

Aggression and Epilepsy: Seizure‐Type Comparisons and High‐Risk Variables

Summary: One hundred fifty‐three patients with temporal lobe epilepsy and 79 patients with generalized epilepsy were compared on a measure of aggression (derived from the Minnesota Multiphasic Personality Inventory). Analysis of covariance indicated that seizure type was not related to aggression. Multiple‐regression analyses for each seizure group indicated that in temporal lobe epilepsy the chronologic age was inversely correlated with aggression scores. In the group with generalized epilepsy, chronologic age and myoclonic seizures were inversely correlated with aggression, while akinetic seizures were directly associated with increased aggression.

Progressive relaxation for seizure reduction

Abstract It is widely accepted that stress and other environmental factors often trigger seizures in people with epilepsy. It is thus reasonable to hypothesize that behavioral approaches could minimize stress and improve seizure control, yet there have been very few controlled studies of this hypothesis and none that has involved long-term follow-up. To implement such a study, we involved 12 people with epilepsy in a training program for progressive relaxation therapy (PRT). Baseline seizure frequency of 8 weeks was compared to three 8-week follow-up periods. Median seizure frequency for the group decreased 21% after the first follow-up interval, from 19.5 to 15.5 (p = 0.07) and 54% after the third and final follow-up interval, from 19.5 to 9.0 (p = 0.02). This study also tried to answer two methodological questions. First, is it possible to abbreviate the most common protocol for PRT so that only three training sessions are required instead of 107 Second, is it possible that comparative newcomers to this field can become effective trainers? Both of these questions were answered in the affirmative by this study, although it is acknowledged that much more work needs to be done in these areas.

The architecture of research in the epilepsy/psychopathology field

In order to examine how research about the relationship between epilepsy and psychopathology has proceeded, the literature that has appeared since 1966 was reviewed and 78 relevant studies were located. The variables employed in these studies (510 in all) were tabulated to determine if they examined biological variables, social variables or medication variables as etiology of psychopathology in people with epilepsy. The results indicate an overwhelming tendency to omit social variables when searching for etiological factors. It is concluded that such an omission is of theoretical and practical significance and 3 hypotheses are put forward to account for the current distribution of research efforts. Finally, the implications of such a structure of investigation are considered.

Psychosis and epilepsy: seizure-type comparisons and high-risk variables.

Compared 153 patients with temporal lobe epilepsy (TLE) and 79 patients with generalized epilepsy on the Goldberg Index, an MMPI-derived measure of psychosis. Analysis of covariance indicated that seizure type was not related to psychosis. Multiple regression analyses indicated that, in TLE, being female was correlated positively with Goldberg Index scores. In the group with generalized epilepsy, none of the variables was associated significantly with psychosis scores.