Evocation and inhibition of seizures. Behavioral treatment.

These behavioral studies provide abundant evidence of the close interrelation between seizure activity and behavior. They reaffirm the point already made several times in this chapter: Seizures do not occur in a behavioral vacuum. They also strengthen the theoretical framework which provides for behavioral treatment of patients with epilepsy. With the detailed knowledge that we now have of the epilepsy focus and the way that it is connected to the surrounding cerebral mechanisms, it really is not surprising that seizure control is significantly influenced by altering the outlook and behavior of the patient with epilepsy. Seizures should not be thought of as arising randomly. They occur, in the case of focal seizures, when the pools of group 2 neurons are sufficiently excited for seizure activity to spread. Generalized seizures occur when the level of cortical excitability or of corticoreticular excitation has reached a point at which thalamic recruiting volleys generalize and start to spread. In the case of the focal epilepsies, a detailed clinical history should be taken as to the nature and characteristics of the aura; the history should also include details regarding the form that the seizure generalization or spread may take. This information allows the accurate location of the seizure focus, as well as of the cerebral structures through which the seizure discharge passes. The position of the focus will determine the relationship between the individual and his epilepsy. It will define those aspects of the psychic life or behavior of a patient which will both trigger and inhibit seizure activity. Detailed discussion of this information with the patient will help him to understand that his seizures are not part of a random process but are, instead, intimately related to how he feels, what he is doing, and what he is thinking. A complete treatment of epilepsy is not just the administration of drugs; rather, it also includes (a) teaching the patient about his brain and its functioning and (b) how the patient's feelings, thinking, and behavior can all be used in the control of his epilepsy.