Groh C, Tatzer E, Schubert M T, Lischka A
J Neurol. 1987 Feb;234(2):97-9. doi: 10.1007/BF00314110.
Epileptic patients who, after years of being free from symptoms, have relapses during puberty or adolescence (some-times coinciding with a reduction in therapy) pose special therapeutic and diagnostic problems. Because of pubertal lability, the cause of a relapse might seem to be "organic", especially if the EEG also shows a "deterioration", yet psychogenic factors must not be disregarded. On the basis of typical case studies, a characteristic constellation is presented. The achievement of a "well-behaved" child at first dramatically improves and this correlates with the success of antiepileptic therapy. Then individuation and further development cannot adequately take place because the family unit is not functioning properly. At a critical stage of development, the excessive expectations of the parents lead to too much stress on the child, thus destroying the balance within the family system, which has hitherto been maintained only with difficulty. Attempts to improve the situation by changing the medication (increasing the dose or switching to another drug) fail. If, however, it is realized that the symptoms are of psychogenic origin, adequate therapeutic interventions (e.g. adequate schooling or professional training as well as psychotherapy) promise good results.
癫痫患者在多年无症状后，于青春期复发（有时与治疗减量同时发生），会带来特殊的治疗和诊断问题。由于青春期的易变性，复发原因可能看似是“器质性的”，尤其是脑电图也显示“恶化”时，但心理因素绝不能被忽视。基于典型案例研究，呈现了一个特征性的情况组合。起初，一个“表现良好”的孩子的状况显著改善，这与抗癫痫治疗的成功相关。然后，由于家庭单元运作不正常，个体化和进一步发展无法充分进行。在发展的关键阶段，父母过高的期望给孩子带来了过大压力，从而破坏了家庭系统内部的平衡，而这种平衡此前一直维持得很艰难。试图通过改变药物治疗（增加剂量或换用另一种药物）来改善状况的尝试失败了。然而，如果认识到症状源于心理因素，适当的治疗干预（如适当的学校教育或职业培训以及心理治疗）有望取得良好效果。
