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High-frequency monitoring of psychological variables has been recommended to monitor and manage psychotherapeutic processes. However, high-frequency monitoring might be regarded as burdensome for participating patients. This feasibility study applied the concept of high-frequency treatment monitoring in patients with seizures and psychiatric comorbidities in an outpatient neurology service. The treatment monitoring entailed the development of a personalized process questionnaire, daily online monitoring, and regular reflection of the current time series graphs. Participants' feedback on user-friendliness and usefulness of this treatment monitoring was evaluated quantitatively and qualitatively. Participants' compliance rates (CRs) of daily self-assessments after 6 months were correlated with their quantitative feedback on user-friendliness and usefulness and the number of scheduled treatment sessions during this time period. Twenty patients, 15 women/5 men, median age 48 years (range: 23-73 years), were recruited. The median number of scheduled sessions was 11 sessions (range: 6-22). Participants reported a high overall satisfaction with the user-friendliness and usefulness of treatment monitoring. No notable correlations could be found between CRs and quantitative feedback nor between CRs and the number of scheduled treatment sessions. Personalized high-frequency monitoring of psychological variables seems to be feasible to monitor and manage process-oriented psychotherapeutic care in patients with seizures and psychiatric comorbidities. The results support the user-friendliness and usefulness of high-frequency monitoring and suggest that high-frequency monitoring may be suitable for monitoring of low-frequent treatment sessions and patients with attendance issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social–cultural–spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psychological and social factors to aid the delivery of patient-centered clinical care in neurology.

ZusammenfassungVon Kriegszitterern zu Teenies mit TikTok-Tics – funktionelle Bewegungsstörungen galten lange als motorischer Ausdruck seelischer Turbulenzen. Tatsächlich werden psychodynamische Modelle jedoch zunehmend durch neurophysiologische Erkenntnisse ergänzt, sodass die Kombination von Psychotherapie mit spezialisierter Physiotherapie an Bedeutung gewinnt. Bislang existiert allerdings kein störungsspezifisches Ergebnismaß, welches patientenrelevante Aspekte dieser vielfältigen Störung adäquat abbildet. Ein erster derartiger Fragebogen wurde entwickelt und in einem mehrstufigen Entwicklungsprozess inhaltlich validiert. Relevanz und Verständlichkeit der Items wurden zuerst durch ein Expertengremium und anschließend durch betroffene Patienten evaluiert und entsprechend angepasst. Der so konstruierte Fragebogen erlaubt erstmals eine inhaltlich valide Quantifizierung der subjektiven Beschwerden und Auswirkungen funktioneller Bewegungsstörungen. Als Nächstes erfolgt eine multizentrische teststatistische Validierung.

Clinical interest in using psychological interventions for people with epilepsy (PWE) aiming at decreasing mental health difficulties, improving health-related quality of life (HRQOL) and seizure-related outcomes, continues to grow. This article summarizes the 2020 update of the 2017 Cochrane Review and meta-analysis of psychological interventions for PWE, highlighting the reasons for major methodological modifications such as the recategorization of interventions and expanded risk of bias assessment. A 2020 literature search yielded 36 RCTs (n=3526) investigating psychological treatments for PWE with a validated HRQOL measure as an outcome. Twenty-seven trials were skills-based psychological interventions, whilst nine studies were education-only interventions. Among skills-based psychological interventions, 11 studies (n=643) used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories convertible to QOLIE-31 as an outcome measure and were pooled for meta-analysis. Significant mean changes were observed for the QOLIE-31 total score (mean improvement of 5.23 points; p< 0.001) and in six out of seven subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication and cognitive functioning). The mean changes in the QOLIE-31 total score and the overall QoL subscale exceeded the threshold of minimally important change (MIC), indicating clinically meaningful post-intervention improvement. These results provide moderate evidence that psychological treatments for adults and adolescents with epilepsy enhance HRQOL. In addition to the summary of the Cochrane review, we provide a detailed characterization of the interventions and patient populations of the meta-analyzed studies.

ObjectiveTo determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.MethodsWe performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.ResultsAmong 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.ConclusionsMisdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.

Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017.To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes.For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies.We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy.We used standard methodological procedures expected by Cochrane.We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL.Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty.Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.배경: 간질이 간질을 가진 개인과 그 가족의 건강 관련 삶의 질(HRQOL)에 상당한 영향을 미칠 수 있다는 점을 고려할 때, 이 집단의 심리적 및 발작 관련 결과 제고를 목적으로 하는 근거 기반 심리치료에 대한 임상적 관심이 증가하고 있다. 이것은 2017년 이슈 10에 게재된 오리지널 코크란 리뷰의 업데이트 버전이다. 목적: 간질을 가진 사람들의 심리 치료법이 HRQOL 결과에 미치는 영향을 평가한다. 검색 전략: 이 업데이트를 위해 언어 제한 없이 2019년 8월 12일에 다음 데이터베이스를 검색했다. CRS 웹(Cochrane Register of Studies, CRS Web)은 간질, Cochrane Central Register of Controlled Trials(중앙), MEDLINE(Ovid, 1946년 ~ 2019년 8월) 및 PycINFO(EBSCO 호스트, 1887년)를 포함한 코크란 검토 그룹의 전문 레지스터에서 무작위 또는 준 무작위 관리 시험을 포함한다.inicalTrials.gov 및 세계보건기구(WHO) 국제임상시험 등록 플랫폼(ICTRP). 포함된 연구와 관련 리뷰의 참고자료를 선별하고, 미발표 연구를 위해 해당 분야의 연구자에게 연락했다. 선정 기준: 이 검토를 위해 무작위 대조 시험(RCT)과 준 RCT를 고려했다. HRQOL이 주된 결과였다. '정신적 치료'의 운영적 정의를 위해, HRQOL, 발작 빈도 및 중증도를 개선하기 위해 고안된 광범위한 기술 기반의 심리 치료와 교육 전용 중재, 그리고 간질을 앓고 있는 성인과 어린이들을 위한 정신과 행동 건강 이상 등을 포함시켰다. 이러한 심리 치료는 평상시와 같은 치료법(TAU), 능동적인 통제집단(사회지원집단 등), 또는 항우울제 약리치료법과 비교되었다. 자료 수집 및 분석: 코크란이 기대하는 표준 방법론적 절차를 사용했다. 주요 결과: 총 3526명의 참가자와 함께 36개의 완성된 RCT를 포함했다. 이들 연구 중 27개 연구팀이 기술 기반의 심리 중재를 조사했다. 나머지 9개 연구는 교육 전용 중재였다. 아동·청소년의 중재를 조사한 연구도 6건, 청소년·성인의 중재를 조사한 연구도 3건, 성인의 중재를 조사한 연구도 남아 있었다. 만족스러운 임상 및 방법론적 동질성을 바탕으로 간질 31(QOLIE‐31) 또는 QOLIE‐31로 전환된 다른 QOLIE 재고(QOLIE‐89 또는 QOLIE‐31‐P)를 사용한 11개 연구(643명 참여자)의 데이터를 취합했다. QOLIE‐31 총점과 6개 항목별 판매(감정 웰빙, 에너지 및 피로, 전체 QoL, 발작 우려, 약물 효과, 인지 기능)에 대한 평균적인 변화를 발견했다. QOLIE‐31 총점(5.23점, 95% CI 3.02~7.44점, P0.001점), 전체 QoL 점수(5.95점, 95% CI 3.05~8.85점, P0.001)의 평균 변동은 최소 중요 변화 한계치(MIC: 총점)를 초과했다. 4.73점, QoL 점수: 5.22점))는 HRQOL의 임상적으로 의미 있는 사후 중재 개선을 나타낸다. 포함된 일부 연구에서 편향의 심각한 위험 때문에 메타분석이 제공하는 근거의 확실성을 하향조정했다. 결과적으로, 이러한 결과는 간질을 가진 성인에 대한 심리치료가 전반적인 HRQOL을 향상시킬 수 있다는 중간 정도의 확실성 근거를 제공했다. 연구진 결론: 실무에 대한 의미: 기술 기반의 심리적 중재는 간질을 가진 성인과 청소년의 HRQOL을 개선한다. 간질이 있는 성인과 청소년을 위한 기술기반 심리치료의 부수적 사용은 환자 중심의 관리에 통합될 때 HRQOL에서 추가적인 혜택을 제공할 수 있다. 그 근거가 어느 정도 확실하다고 판단한다. 연구에 대한 시사점: 수사관들은 그들의 중재에 대한 보고의 질을 향상시키기 위해 연방 수사국 지침을 엄격히 준수해야 한다. 재현성을 확보하기 위해서는 중재 프로토콜에 대한 철저한 설명이 필요하다. 간질 환자 심리치료의 효과를 조사할 때, 간질재고(QOLIE‐31, QOLIE‐31‐P, QOLIE‐89)와 같은 표준화된 HRQOL 재고를 사용하면 비교가능성이 높아질 것이다. 불행히도 간질과 지적장애를 가진 사람들을 포함한 소아 RCT와 RCT에는 심각한 격차가 있다. 마지막으로, RCT 연구 설계의 전반적인 품질을 높이기 위해서는 할당 은폐 및 블라인드 결과 평가를 통한 적절한 무작위화가 추진되어야 한다. 적극적인 참여가 필요한 연구에서는 소모가 높은 경우가 많으므로 치료의향 분석을 실시해야 한다. 치료 충실도와 치료 능력도 평가해야 한다. '비뚤림의 위험' 평가와 관련된 이러한 중요한 차원은 항상 보고되어야 한다.پیشینه: با توجه به تاثیر عمده بیماری صرع بر کیفیت زندگی مرتبط با سلامت (health‐related quality of life; HRQOL) افراد مبتلا به صرع و خانواده‌های آنها، علاقه بالینی به درمان‌های روانشناختی مبتنی بر شواهد، با هدف بهبود پیامد‌های روانشناختی و مرتبط با تشنج، برای این گروه، رو به افزایش است. این یک نسخه به‌روز‌ شده از مرور اصلی کاکرین است که در شماره 10، سال 2017 منتشر شده است. اهداف: ارزیابی تاثیر درمان‌های روانشناختی افراد مبتلا به صرع بر پیامد‌های HRQOL. روش‌های جست‌وجو: در 12 آگوست 2019، برای آخرین نسخه به‌روز، بانک‌های اطلاعاتی زیر را بدون اعمال محدودیت‌های زبانی جست‌وجو کردیم: پایگاه ثبت مطالعات کاکرین (CRS Web)، شامل مطالعات تصادفی‌سازی یا شبه‐تصادفی‌سازی شده و کنترل شده از پایگاه ثبت تخصصی گروه مرور کاکرین از جمله بیماری صرع، پایگاه ثبت مرکزی کارآزمایی‌های کنترل‌ شده کاکرین (CENTRAL)؛ MEDLINE؛ (Ovid؛ 1946 تا 09 آگوست 2019)؛ PsycINFO؛ (EBSCOhost؛ 1887 به بعد)؛ و از PubMed؛ Embase؛ ClinicalTrials.gov؛ و پلت‌فرم بین‌المللی پایگاه ثبت کارآزمایی‌های بالینی (ICTRP) سازمان جهانی بهداشت. منابع مربوط به مطالعات وارد شده و مرور‌های مرتبط را غربال کردیم و برای شناسایی مطالعات منتشر نشده با محققان این حوزه تماس گرفتیم. معیارهای انتخاب: کارآزمایی‌های تصادفی‌سازی و کنترل شده (randomised controlled trials; RCTs) و شبه‐RCTها را برای ورود به این مرور در نظر گرفتیم. پیامد اصلی HRQOL بود. برای تعریف عملی «درمان‌های روانشناختی»، طیف گسترده‌ای از درمان‌های مبتنی بر مهارت و مداخلات صرفا آموزشی طراحی شده برای بهبود HRQoL، فراوانی و شدت تشنج (seizure) و نیز اختلالات روانپزشکی و سلامت رفتاری برای بزرگسالان و کودکان مبتلا به صرع را در نظر گرفتیم. این درمان‌های روانشناختی، با درمان به‌طور معمول (treatment as usual; TAU)، و گروه کنترل فعال (مانند گروه حمایت اجتماعی)، یا دارو‌درمانی ضد‐افسردگی مقایسه شدند. گردآوری و تجزیه‌وتحلیل داده‌ها: از روش‌های استاندارد روش‌شناسی مورد انتظار کاکرین استفاده کردیم. نتایج اصلی: 36 RCT کامل شده، با مجموع 3526 شرکت‌کننده را وارد کردیم. از بین این مطالعات، 27 مطالعه مداخلات روانشناختی مبتنی بر مهارت را بررسی کردند. نه مطالعه باقیمانده فقط مداخلات مربوط به آموزش بودند. شش مطالعه، مداخلات مربوط به كودكان و نوجوانان، سه مطالعه مداخلات مربوط به نوجوانان و بزرگسالان و مطالعات دیگر مداخلات مربوط به بزرگسالان را مورد بررسی قرار دادند. بر مبنای همگنی روش‌شناسی و بالینی، داده‌های 11 مطالعه (643 شرکت‌کننده) را که از کیفیت زندگی در صرع ‐31 (QOLIE‐31) یا سایر پرسش‌نامه‌های QOLIE (مانند QOLIE‐89 یا QOLIE‐31‐P) قابل تبدیل به QOLIE‐31 استفاده کرده‌ بودند، تجمیع کردیم. میانگین تغییرات قابل توجهی را برای نمره کل QOLIE‐31 و شش مقیاس (بهزیستی (well‐being) عاطفی، انرژی و خستگی، QoL کلی، نگرانی تشنج، تاثیرات دارویی و عملکرد شناختی) یافتیم. میانگین تغییرات نمره کل QOLIE‐31 (میانگین بهبود 5.23 نمره؛ 95% CI؛ 3.02 تا 7.44؛ P0.001) و QoL کلی (میانگین بهبود 5.95 نمره؛ 95% CI؛ 3.05 تا 8.85؛ P0.001) بیش از آستانه حداقل تغییرات مهم بود: (MIC: نمره کل: 4.73 امتیاز؛ نمره QoL: 5.22 امتیاز)، که نشان دهنده یک بهبود معنا‌دار بالینی در HRQOL بود. قطعیت شواهد ارائه شده در متاآنالیز (meta‐analysis) را به دلیل خطر جدی سوگیری (bias) در برخی مطالعات وارد شده، پائین درنظر گرفتیم. در‌نتیجه، این نتایج شواهدی با قطعیت متوسط ارائه کردند که نشان می‌داد درمان‌های روانشناختی برای بزرگسالان مبتلا به صرع ممکن است HRQOL کلی را در افراد مبتلا به صرع افزایش دهد. نتیجه‌گیری‌های نویسندگان: کاربردهای عملی: مداخلات روانشناختی مبتنی بر مهارت، HRQOL را در بزرگسالان و نوجوانان مبتلا به صرع بهبود می‌بخشد. استفاده کمکی از درمان‌های روانشناختی برای بزرگسالان و نوجوانان مبتلا به صرع ممکن است مزایای بیش‌تری برای HRQOL در افرادی فراهم‌ آورد که مدیریت بیمار‐محور را در نظر می‌گیرند. شواهد را دارای قطعیت متوسط قضاوت کردیم. کاربردهای تحقیقاتی: محققان باید دقیقا از دستورالعمل‌های CONSORT برای بهبود کیفیت گزارش‌های مربوط به مداخلات پیروی کنند. توصیف کامل پروتکل مداخله برای اطمینان از تکرار‌پذیری ضروری است. هنگام بررسی اثربخشی درمان‌های روانشناختی برای افراد مبتلا به صرع، استفاده از پرسش‌نامه استاندارد شده HRQOL؛ از جمله پرسش‌نامه کیفیت زندگی در صرع (QOLIE‐31؛ QOLIE‐31‐P و QOLIE‐89) قابلیت مقایسه را افزایش می‌دهد. متاسفانه یک شکاف جدی در RCTهای مربوط به کودکان و RCTهای افراد مبتلا به صرع و ناتوانی‌های فکری وجود دارد. در نهایت، به منظور افزایش کیفیت کلی طرح‌های مطالعاتی، در زمان انجام RCTها باید تصادفی‌سازی مناسب با پنهان‌سازی تخصیص و ارزیابی کورسازی شده پیامد پیگیری شوند. به دلیل این‌که در اغلب پژوهش‌هایی که نیاز به مشارکت فعال شرکت‌کننده دارند، ریزش نمونه (attrition) بالاست، یک آنالیز قصد درمان (intention‐to‐treat) باید انجام شود. تعهد به درمان و کفایت درمان نیز باید ارزیابی شود. این ابعاد مهم، که به ارزیابی «خطر سوگیری (bias)» مربوط می‌شوند، باید همیشه گزارش شوند.Étant donné l'impact significatif que l'épilepsie peut avoir sur la qualité de vie liée à la santé (QVLS) des personnes épileptiques et de leurs familles, il existe un intérêt clinique croissant pour les traitements psychologiques basés sur des données probantes visant à améliorer les critères de jugement psychologiques et liés aux crises pour ce groupe. Ceci est une version mise à jour de la revue Cochrane originale publiée dans le numéro 10, 2017.Évaluer l'impact des traitements psychologiques pour les personnes épileptiques sur la QVLS. STRATÉGIE DE RECHERCHE DOCUMENTAIRE: Pour cette mise à jour, nous avons effectué des recherches dans les bases de données suivantes et sans restrictions de langues jusqu’au 12 août 2019: Le Registre Cochrane des études (CRS Web), qui comprend des essais contrôlés randomisés ou quasi randomisés provenant des registres spécialisés des groupes de revues Cochrane, dont celui sur l’épilepsie, le registre Cochrane des essais contrôlés (CENTRAL), MEDLINE (Ovid, de 1946 au 9 août 2019) et PsycINFO (EBSCOhost, à partir de 1887), ainsi que PubMed, Embase, ClinicalTrials.gov et le Système d'enregistrement international des essais cliniques (ICTRP) de l'OMS. Nous avons examiné les références des études incluses et des revues pertinentes, et nous avons contacté des chercheurs dans le domaine pour des études non publiées. CRITÈRES DE SÉLECTION: Nous avons pris en compte les essais contrôlés randomisés (ECR) et les quasi‐ECR pour cette revue. La QVLS en a été le principal critère de jugement. Pour la définition opérationnelle de « traitement psychologiques », nous avons inclus un large éventail de traitements psychologiques basés sur les compétences, et d'interventions éducatives conçues pour améliorer la QVLS, la fréquence et la gravité des crises, ainsi que les comorbidités psychiatriques et comportementales pour les adultes et les enfants épileptiques. Ces traitements psychologiques ont été comparés au traitement habituel (TH), à un groupe témoin actif (tel qu'un groupe de soutien social) ou à une pharmacothérapie antidépressive. RECUEIL ET ANALYSE DES DONNÉES: Nous avons suivi les procédures méthodologiques standard définies par Cochrane. RÉSULTATS PRINCIPAUX: Nous avons inclus 36 ECR terminés, avec un total de 3 526 participants. Parmi ces études, 27 portaient sur des interventions psychologiques basées sur les compétences. Les neuf autres études étaient des interventions à caractère éducatif uniquement. Six études ont porté sur les interventions auprès des enfants et des adolescents, trois sur les interventions auprès des adolescents et des adultes, et les autres sur les interventions auprès des adultes. Sur la base d'une homogénéité clinique et méthodologique satisfaisante, nous avons mis en commun les données de 11 études (643 participants) qui ont utilisé le questionnaire sur la qualité de vie en cas d'épilepsie (QOLIE‐31) ou d'autres questionnaires QOLIE (tels que QOLIE‐89 ou QOLIE‐31‐P) convertibles en QOLIE‐31. Nous avons constaté des changements moyens significatifs pour le score total de QOLIE‐31 et pour six sous‐échelles (bien‐être émotionnel, énergie et fatigue, qualité de vie globale, inquiétudes liées aux crises, effets des médicaments et fonctionnement cognitif). Les changements moyens du score total de QOLIE‐31 (amélioration moyenne de 5,23 points, IC à 95 %, de 3,02 à 7,44 ; P0,001), et du score global de QV (amélioration moyenne de 5,95 points, IC à 95 %, de 3,05 à 8,85 ; P0,001) ont dépassé le seuil de changement important minimal (MIC) (MIC : score total : 4,73 points ; score de la qualité de vie: 5,22 points), ce qui indique une amélioration cliniquement significative de la qualité de vie liée à la santé après l'intervention. Nous avons déclassé le niveau de confiance des données probantes fournies par la méta‐analyse en raison de risques sérieux de biais dans certaines des études incluses. Par conséquent, la valeur probante de ces résultats était modérée à propos de l’amélioration de la qualité de vie globale chez les adultes épileptiques par les traitements psychologiques.Implications pour la pratique: Les interventions psychologiques basées sur les compétences améliorent la qualité de vie des adultes et des adolescents épileptiques. L'utilisation complémentaire de traitements psychologiques basés sur les compétences chez les adultes et les adolescents épileptiques pourrait apporter des avantages supplémentaires en matière de qualité de vie liée à la santé lorsque ceux‐ci sont intégrés dans une gestion centrée sur le patient. Nous estimons que le niveau de confiance des données probantes est modéré. Implications pour la recherche: Les enquêteurs doivent se conformer strictement aux recommandations CONSORT afin d'améliorer la qualité des rapports sur leurs interventions. Une description complète des protocoles d'intervention est nécessaire pour assurer la reproductibilité. Lors de l'examen de l'efficacité des traitements psychologiques pour les personnes souffrant d'épilepsie, l'utilisation de questionnaires standardisés sur la qualité de vie, tels que les questionnaires sur la qualité de vie dans l'épilepsie (QOLIE‐31, QOLIE‐31‐P et QOLIE‐89), permettrait d'accroître la comparabilité. Malheureusement, il existe une lacune importante dans les ECR pédiatriques et les ECR incluant les personnes souffrant d'épilepsie et de handicap intellectuel. Enfin, afin d'améliorer la qualité globale des plans d'étude des ECR, il convient de poursuivre une randomisation adéquate avec assignation secrète et évaluation des critères de jugement en aveugle. Comme le taux d'attrition est souvent élevé dans les recherches qui nécessitent une participation active, il convient de procéder à une analyse des intentions de traitement. La fidélité au traitement et la compétence en matière de traitement doivent également être évaluées. Ces dimensions importantes, qui sont liées à l'évaluation du « risque de biais », devraient toujours être signalées.Debido al impacto significativo que podría tener la epilepsia sobre la calidad de vida relacionada con la salud (CdVRS) en los individuos con epilepsia y sus familias, hay un creciente interés clínico en los tratamientos psicológicos basados en evidencia, dirigidos a mejorar los desenlaces psicológicos y relacionados con las crisis para este grupo de personas. Esta es una versión actualizada de la revisión Cochrane original publicada en el número 10, 2017.Evaluar los efectos de los tratamientos psicológicos para los pacientes con epilepsia en los resultados de la CdVRS. MÉTODOS DE BÚSQUEDA: Para esta actualización, se realizaron búsquedas en las siguientes bases de datos el 12 de agosto de 2019 sin restricciones de idioma: La Cochrane Register of Studies (CRS Web),que incluye ensayos controlados aleatorizados o cuasialeatorizados del registro especializado de los Grupos Cochrane de Revisión de Epilepsia, Cochrane Central de Ensayos Controlados (CENTRAL), MEDLINE (Ovid, 1946 a 9 de agosto de 2019), y PsycINFO (EBSCOhost, 1887 en adelante), y de PubMed, EMBASE, ClinicalTrials.gov y la plataforma de registros internacionales de ensayos clínicos (ICTRP) de la Organización Mundial de la Salud. Se examinaron las referencias de los estudios incluidos y las revisiones pertinentes, y se estableció contacto con los investigadores del tema para obtener estudios no publicados. CRITERIOS DE SELECCIÓN: Se consideraron los ensayos controlados aleatorizados (ECA) y los ensayos controlados cuasialeatorizados para esta revisión. La CdVRS fue el desenlace principal. Para la definición operativa de “tratamientos psicológicos”, se incluyó un rango amplio de tratamientos psicológicos basados en habilidades e intervenciones solo educativas diseñadas para mejorar la CdVRS, la frecuencia y la gravedad de las crisis, y las comorbilidades psiquiátricas y conductuales para los adultos y los niños con epilepsia. Estos tratamientos psicológicos se compararon con el tratamiento habitual (TH), un grupo de control activo (como el grupo de apoyo social) o la farmacoterapia antidepresiva. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Se utilizaron los procedimientos metodológicos estándares previstos por Cochrane.Se incluyeron 36 ECA completos con 3526 participantes. De estos, 27 estudios investigaron intervenciones psicológicas basadas en habilidades. Los nueve estudios restantes fueron intervenciones solo educativas. Seis estudios investigaron intervenciones para niños y adolescentes, tres estudios investigaron intervenciones para adolescentes y adultos, y los restantes investigaron intervenciones en adultos. De acuerdo con una homogeneidad clínica y metodológica satisfactoria, se agruparon los datos de 11 estudios (643 participantes) que utilizaron la escala para medir la calidad de vida en la epilepsia Quality of Life in Epilepsy‐31 (QOLIE‐31) u otros listados QOLIE (como el QOLIE‐89 o el QOLIE‐31‐P) convertibles a QOLIE‐31. Se encontraron cambios medios significativos para la puntuación total de la QOLIE‐31 y seis subescalas (bienestar emocional, energía y fatiga, CdV general, preocupación sobre la crisis, efectos de la medicación y función cognitiva). Los cambios medios en la puntuación total de la QOLIE‐31 (mejora media de 5,23 puntos, IC del 95%: 3,02 a 7,44; P0,001), y la puntuación global de la CdV (mejora media de 5,95 puntos, IC del 95%: 3,05 a 8,85; P0,001) superaron el umbral de cambio mínimo importante (CMI: puntuación total: 4,73 puntos; puntuación de CdV: 5,22 puntos), lo que indica una mejoría posintervención clínicamente significativa en la CdVRS. La certeza de la evidencia aportada por el metanálisis se redujo debido a riesgos graves de sesgo en algunos de los estudios incluidos. En consecuencia, estos resultados aportaron evidencia de certeza moderada de que los tratamientos psicológicos para los adultos con epilepsia pueden mejorar la CdVRS general.Implicaciones para la práctica: Las intervenciones psicológicas basadas en habilidades mejoran la CdVRS en adultos y adolescentes con epilepsia. El uso adyuvante de terapias psicológicas basadas en habilidades para los adultos y adolescentes con epilepsia podría proporcionar beneficios adicionales a la CdVRS cuando se incorporan a un tratamiento centrado en el paciente. Se consideró que la evidencia era de certeza moderada. Implicaciones para la investigación: Los investigadores deben adherirse estrictamente a las guías CONSORT para mejorar la calidad del informe sobre las intervenciones. Una descripción minuciosa de los protocolos de intervención es necesaria para asegurar la reproducibilidad. Cuando se examina la efectividad de los tratamientos psicológicos para los pacientes con epilepsia, el uso de listados estandarizados de CdVRS (QOLIE‐31, QOLIE‐31‐P, y QOLIE‐89) aumentaría la comparabilidad. Por desgracia, existe una laguna crítica en los ECA pediátricos y ECA que incluyen a personas con epilepsia y discapacidades intelectuales. Finalmente, para aumentar la calidad general de los diseños de estudio de ECA, debe aplicarse una asignación al azar adecuada con ocultación de la asignación y una evaluación de resultados cegada. Debido a que la deserción a menudo es alta en la investigación que requiere la participación activa, debe realizarse un análisis de intención de tratar. También deben evaluarse la fidelidad al tratamiento y la competencia del tratamiento. Estas importantes dimensiones, relacionadas con la evaluación del "riesgo de sesgo", deben ser siempre comunicadas.

Summary Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers’ current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27‐item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents’ patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

BACKGROUND Anxiety disorders remain undiagnosed in routine clinical practice in up to two thirds of affected patients with epilepsy despite their significant impact on medical and psychosocial outcomes. The study objective was to translate and validate the German 8-item "brief Epilepsy Anxiety Survey Instrument" (brEASI) to facilitate effective screening for the presence of anxiety disorders in German-speaking patients. METHODS After expert translation into German, the brEASI was completed by consecutive adult inpatients with epilepsy hospitalized for seizures at an academic reference epilepsy center. Patients also completed the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Generalized Anxiety Disorder scale (GAD-7) for external validity, and underwent a standardized interview (Mini-DIPS-OA) as a gold standard to determine the presence of an ICD-10 anxiety disorder (generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social phobia). Receiver operating characteristics (ROC) were calculated to determine the diagnostic accuracy of the brEASI, including the associated area under the curve (AUC) statistics to determine the potential of the brEASI to identify ICD-10 anxiety disorders diagnosed by interview. For comparative purposes, these analyses were also conducted for the GAD-7. RESULTS Of 80 recruited adult inpatients with epilepsy, 18 (23 %) were found to have a current anxiety disorder through standardized interview. In this study, both brEASI and GAD-7 showed a better diagnostic performance at a cutoff of >5 than at the previously reported cutoff values of >6 and >9, respectively. The AUC of the German brEASI was outstanding (AUC = 0.90, 95 % confidence interval (CI) = 0.82-0.96) for detecting all anxiety disorders and excellent for detecting non-GAD disorders (AUC = 0.85, CI = 0.76-0.92) at a cutoff of >5. At this optimal cutoff of >5 the brEASI demonstrated better sensitivity and specificity (89 % and 84 %) for identifying anxiety disorders than the GAD-7 (83 % and 74 %). The final German version of the brEASI is free to download at https://www.v-neuro.de/veroeffentlichungen/. CONCLUSION The German version of the brEASI represents a valid and reliable epilepsy-specific anxiety screening instrument. A positive screening result should be followed by further diagnostic procedures. Appropriate therapeutic steps should be initiated if the presence of an anxiety disorder or other psychiatric disorders is confirmed.

From shell shock tremors to TikTok tics, functional movement disorders have long been assumed to be motor expressions of emotional turmoil. However, psychodynamic explanations are increasingly complemented by neurophysiological findings, meaning that specialized physiotherapy is gaining in importance alongside psychotherapy. Still, there is no disease-specific outcome measure that adequately assesses patient-relevant aspects of this heterogeneous condition. Such a questionnaire was developed and its content was validated in a multistage development process. The relevance and comprehensibility of the items were first evaluated by a panel of experts and then by affected patients, and questions and possible response categories were adjusted accordingly. The resultant revised questionnaire yields good content-related validity and thus allows, for the first time, a quantification of the subjective complaints and implications associated with functional movement disorders. The next step will be a multicenter study to analyze the psychometric properties and factorial structure of this new instrument.Von Kriegszitterern zu Teenies mit TikTok-Tics – funktionelle Bewegungsstörungen galten lange als motorischer Ausdruck seelischer Turbulenzen. Tatsächlich werden psychodynamische Modelle jedoch zunehmend durch neurophysiologische Erkenntnisse ergänzt, sodass die Kombination von Psychotherapie mit spezialisierter Physiotherapie an Bedeutung gewinnt. Bislang existiert allerdings kein störungsspezifisches Ergebnismaß, welches patientenrelevante Aspekte dieser vielfältigen Störung adäquat abbildet. Ein erster derartiger Fragebogen wurde entwickelt und in einem mehrstufigen Entwicklungsprozess inhaltlich validiert. Relevanz und Verständlichkeit der Items wurden zuerst durch ein Expertengremium und anschließend durch betroffene Patienten evaluiert und entsprechend angepasst. Der so konstruierte Fragebogen erlaubt erstmals eine inhaltlich valide Quantifizierung der subjektiven Beschwerden und Auswirkungen funktioneller Bewegungsstörungen. Als Nächstes erfolgt eine multizentrische teststatistische Validierung.

Background This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients’ compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. Methods A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system’s model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients’ replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. Results Twenty patients [15 women/5 men, median age 48 years (range 23–73 years)] were recruited. Compliance rates were high (median: 93%, range 31–100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. Conclusion The results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.

Semiology is the backbone of any correct categorization of seizures, as epileptic or not, focal or bilateral, and is fundamental to elucidating how they are anatomically generated in the brain. An anatomical hypothesis derived from seizure history is the precondition for optimally designed ancillary studies. Without understanding seizure semiology, no rational therapy is possible. This article describes the semiological approach using patient history based on full use of patients' self-reports as well as descriptions by witnesses. Auras represent the subjective aspects of seizures and provide important semiological clues as observable signs, sometimes including rather precise direct anatomical information. Methods of extracting, facilitating and analysing self-reports including linguistic conversation analysis are presented in detail. It is highlighted that prodromes, seizure triggers and reflex epileptic mechanisms can provide crucial information for diagnostics and therapy. Special issues considering seizure semiology in children are discussed in a separate section. Other sections are dedicated to the two most important issues of differential diagnosis: how to distinguish (1) focal from "generalized" epilepsies, particularly when focal seizure phenomena appear in a bilateral epilepsy; and (2) epileptic from a series of non-epileptic events.

Epileptic activity is characterized by synchronous neuronal activity. Fig. 1 illustrates neuronal ‘behaviour’ at the onset of a focal epileptic seizure: In focal epilepsy, certain epileptogenic neurons occasionally ‘attempt to convince’ interconnected neurons to engage in seizure (i.e., synchronous) activity. If a sufficient amount of neurons ‘behaves’ synchronously, their activity may get recorded by an electroencephalogram (EEG) as epileptiform discharges.

Background Admission to the epilepsy monitoring unit (EMU) for long-term video-electroencephalography (EEG) monitoring (VEEG) constitutes the gold standard for seizure diagnosis and presurgical evaluation. This study applied the concept of a high-frequency systematic monitoring of psychological states and tested patients' compliance in order to evaluate if its integration in the EMU is feasible and if patients benefit from the graphically underpinned discussion of their EMU stay-related cognitions and emotions. Methods The process-monitoring is technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). A convenient sample was enrolled: All eligible patients who were admitted to the EMU of the Department of Neurology, Christian Doppler Medical Center, Salzburg, Austria, between November 6th 2017 and January 26th 2018 were approached and recruited upon consent. After a short resource-oriented interview, each enrolled patient was provided with a tablet. The daily questionnaire included eight standardized and up to three personalized items. Self-assessments were collected every 5 h prior to meal times (6:30 am, 11:30 am, and 4:30 pm) and at 9:30 pm. The detailed visualizations of the patients' replies were discussed with the participants during a feedback session at the end of the EMU stay. Results Twenty-one patients (12 women/9 men, median age 29 years [range 18–74 years]) were consecutively recruited (72% of all eligible patients). Compliance rates were high (median: 82%, range 60%–100%) among the respondents. Mood correlated strongly with hopefulness (r = 0.71) and moderately with energy (r = 0.63) in all patients. When correlating the intraindividual medians of the process questionnaire time series with the pretest total scores, energy correlated moderately and negatively with the Perceived Stress Scale (PSS) (r = − 0.45), while self-efficacy correlated moderately and negatively with the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) total scores in all patients (r = − 0.5). Nine patients (43%) reported that they learned something meaningful about themselves after the feedback discussion of their individual time series. Conclusion The results support the feasibility of high-frequency monitoring of psychological states and processes in routine EMU settings. Repeated daily collections four times per day of psychological surveys allow for the assessment of highly resolved, equidistant time series data, which gives insight into psychological states and processes during EMU admission.

OBJECTIVE Given the significant impact epilepsy can have on health-related quality of life (HRQoL) of individuals with this condition and their families, there is great clinical interest in evidence-based psychological treatments aimed at enhancing well-being in people with epilepsy (PWE). An evaluation of the current evidence is needed to assess the effects of psychological treatments for PWE on HRQoL outcomes to inform future therapeutic recommendations and research designs. METHODS The operational definition of psychological treatments included a broad range of interventions that use psychological or behavioral techniques designed to improve HRQoL, psychiatric comorbidities, and seizure frequency and severity for adults and children with epilepsy. A systematic literature search was conducted in line with Cochrane criteria for randomized controlled trials (RCTs) and quasi-RCTs investigating psychological treatments and using HRQoL outcome measures as primary or secondary outcome measures. Standard methodological procedures required by the Cochrane Collaboration were used for data collection and analysis. RESULTS Twenty-four completed RCTs were included in this review (2439 participants). Based on satisfactory methodological homogeneity, data from 9 studies (468 participants) providing Quality of Life in Epilepsy-31 (QOLIE-31) outcomes were pooled for meta-analyses, showing significant mean changes for QOLIE-31 total score and 6 subscales. The significant mean changes of QOLIE-31 total score (mean improvement of 5.68 points; 95% confidence interval = 3.11-8.24, P

Background There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes. Methods This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models. Results Twenty patients [15 women/5 men, median age 48 years (range: 23–73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6–22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma. Conclusion The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.

Background Generic or even disease-specific quality of life measures are unlikely to be equally responsive to different epilepsy treatment modalities, such as pharmacotherapy, surgery, or psychotherapy. The purpose of the present study was to summarize the development of a patient-reported outcome measure (PROM) designed to be particularly sensitive to change mediated by psychotherapeutic interventions in people with seizures. Methods The development of this instrument involved seven steps: (1) Development of a candidate item set based on the outcome of previous qualitative research, (2) initial quantitative–descriptive study yielding an assessment of content validity by clinical experts, (3) qualitative–descriptive posttherapy cognitive debriefing interviews with patients with epileptic and/or nonepileptic seizures (NES), (4) English translation, (5) elicitation of qualitative feedback from international experts, (6) assessment of internal consistency and correlation with similar previously validated generic and epilepsy-specific measures in a pilot study, and (7) final expert content validity rating. Results (1) The candidate item set comprised 29 stem items; five of which were followed by a follow-up (FU) item that refers to the statement of the stem item. (2) Eight clinical experts assessed content validity. Informed by rating and experts' qualitative comments, 15 items remained unchanged, eleven underwent substantial revisions, three were excluded, and six added. (3) Cognitive debriefing interviews were conducted with 14 patients with epilepsy and/or NES. Based on the interviewees' feedback, 29 of 32 items remained unchanged, two were excluded, one reworded, and four added. (4) The forwards–backwards English translation prompted substantial revision of two items because the verbatim back translation of the corresponding English items was conceptually more convincing than the original German wording. (5) The international experts identified problems with item comprehensibility/clarity of four stem and three FU items that were subsequently reworded. Ten items were added to incorporate their qualitative feedback resulting in a total of 44 items. (6) Thirty-one patients with epilepsy participated in the pilot study. The overall internal consistency of the self- E fficacy, A ssertiveness, S ocial support, self-awareness, and h E lpful thinking in people with seizures (EASE) was very good (α = 0.92). Analysis at item-level revealed problems with inverted and self-evident items. Based on this analysis, three items were eliminated and two items were revised (one FU item was turned into a stem item) resulting in a total of 42 items. (7) The second content validity rating showed final item-content validity indices (I-CVIs) between 0.38 and 1 and an excellent mean CVI of 0.92 at scale level (S-CVI/ave). Fourteen stem items were substantially revised by incorporating the experts' qualitative feedback, three items with low I-CVIs were excluded, and one item was added. The final questionnaire consisted of 40 stem items; eight of which include at least one FU item. Conclusion Based on these results, the EASE is valid in terms of content, internally consistent, clear, and acceptable to patients with seizures. The measure has now been developed to the stage at which the validity and reliability as well as the psychometric properties and factorial structure of the new instrument can be assessed in larger patient groups in a prospective clinical study.

Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.

Background Psychological interventions may enhance health-related quality of life in people with epilepsy. The concepts of self-efficacy and mastery may be particularly relevant in the context of epilepsy. To date, the investigation of psychological interventions has not included a qualitative analysis of the effects of such interventions on the interrelation between mastery and general and epilepsy-specific self-efficacy. This qualitative study aimed to explore the relationship between the lived experiences of these concepts in people with epilepsy who participated in a resource-oriented and mindfulness-based psychotherapeutic intervention delivered on a one-to-one basis in an outpatient setting. Methods Semi-structured pre- and postintervention interviews were conducted with people with epilepsy who participated in a six-month resource-oriented and mindfulness-based intervention. The formulation of intervention goals was based on the preintervention interviews. The intervention involved regular one-to-one interactions with the therapist, journal-keeping, and mindfulness-based relaxation. Qualitative content analysis of pre- and posttherapy interviews was conducted to characterize changes in subjective experiences. Results Nine people with epilepsy aged 18–59 years participated in 9 to 22 (median 13) sessions. The following six main themes emerged: (A) Encouragement of individual solutions, (B) Awareness of the link of personal traits with seizure-related worries, (C) How to develop self-efficacy, (D) Shaping everyday life in a way that is good for oneself (general self-efficacy), (E) Coping with seizures (seizure-related self-efficacy), (F) Epilepsy as a means of increasing self-knowledge and control over one's life (sense of mastery). The patients' development of self-efficacy was motivated by their personal initial goals and facilitated by the encouragement to find individual solutions and an increased awareness of the link of personal traits with seizure-related worries. A sense of mastery only emerged through the development of general self-efficacy and as a result of the active self-examination prompted by the challenge of living with epilepsy. Conclusion The qualitative differences observed before and after a psychotherapeutic intervention for individuals with epilepsy increase our understanding of the complex process of psychotherapy-associated change involving self-efficacy and mastery and highlight the contribution that qualitative research approaches can make.

Background: Epilepsy is a serious, common and chronic neurological condition characterized by an increased disposition to suffer occasional seizures. Psychological interventions may enhance the well-being of individuals with epilepsy. So far, no qualitative study has investigated the complex effects of psychotherapeutic interventions in epilepsy. Methods: This study examined the questions as to if and how the participation in a patient-centered 6-month resource-oriented mindfulness-based intervention would enhance an individual's well-being and sense of self-efficacy. Pre- and post-intervention semi-structured interviews were conducted with a total of 9 participants. Qualitative data analysis (Mayring) in an inter-professional group was combined with the evaluation of the Quality of Life in Epilepsy Inventory-31. The case reports follow the CAse REport Guidelines for Anthroposophic Art Therapies (CARE-AAT). To show the diverse nature of individual intervention objectives, we chose the single case study format, contrasting 2 participants with diagnosed focal epilepsy. Results: Pre-intervention deductive and inductive outcome categories revealed high levels of stress regarding personal seizure experience and loss of autonomy, for both participants. Post-intervention interviews consist of increased seizure-related self-efficacy and self-awareness: while minimizing the debilitating impact of the seizures on her life was relevant to Iris, Carl developed a personalized aura interruption technique. Conclusions: These qualitative case analyses suggest that enhanced psychological well-being and even positive medical results may be achieved when epilepsy care focuses on the wishes that are most meaningful to the individual. The possibility of improving the quantitative evaluation of the effects of psychotherapeutic interventions needs to be explored.

The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL.

The aim of this retrospective study is to describe changes of seizure frequency in epilepsy patients who participated in the Andrews/Reiter behavioral intervention for epilepsy. For this uncontrolled retrospective study, data was extracted from patients’ medical journals. Intention-to-treat-analyses were restricted to patients with sufficient documentation supporting a diagnosis of probable or definite epilepsy. Main outcome variable was a comparison of mean seizure frequency at baseline and towards completion of the program. The seizure frequency of 30 (50%%) patients showed a clinically meaningful improvement (>50% reduction of seizures) towards the end of the intervention. Twenty-two (37%) patients became seizure-free at the end of the intervention. In summary, a clinically meaningful reduction in reported seizure frequency was observed in epilepsy patients who received the Andrews/Reiter intervention for epilepsy. Prospective trials are needed to further investigate the program’s efficacy and to study epileptic seizure triggers.

Growing evidence suggests a bidirectional interaction between epileptic seizures and psychological states, fuelling the interest in the development and application of psychobehavioral therapy for people with epilepsy (PWE). The objective of this article is to review the various psychobehavioral therapies in regard to their application, hypothesized mechanisms, and effectiveness. Most psychobehavioral therapy aims at improving psychological well-being and seizure control. Behavioral approaches, cognitive-behavioral therapy (CBT), and mind-body interventions are the most widely applied approaches for PWE. Cognitive-behavioral therapy, mind-body approaches, and multimodel educative interventions have consistently demonstrated positive effects on enhancing well-being. Nevertheless, the effects on seizure control remain inconsistent, partly attributable to small clinical trials and inadequate control groups. Assessor-blinded randomized controlled trials with sufficient power and carefully defined therapeutic components corresponding with objective and subjective outcome measures are recommended for future trial designs.

A recent review of psychobehavioral therapy for epilepsy recommends case reports as a research design to explore specific psychological mediators of psychobehavioral interventions for epilepsy that address the bidirectional relationship between psychological states and seizures. The report was prepared according to the consensus-based CARE guidelines for standardized clinical case reporting.This is a case of a 16-year-old male individual with a diagnosed seizure disorder and learning disability who continued to have daytime and nighttime seizures on a regular basis despite exhausting of available conventional treatment options. A psychological assessment led to the working hypothesis that cognitive dissonance between fear of failure and high expectations of self had led to a “broken” self-image and active avoidance of responsibility that resulted in intense emotional distress which correlated with the occurrence of seizures. This working hypothesis resulted in a treatment plan that employed the acquisition of self-organizational skills and relaxation techniques as the main therapeutic strategy. Motivational strategies were employed to facilitate the regulation of lifestyle-related seizure precipitants. In this case, the acquisition of self-organizational skills and the development of seizure interruption techniques correlated with a clinically significant decrease of seizures. Methodological limitations of the interpretation of the presented data are discussed.