Psychiatric aspects of self-induced epileptic seizures.
OBJECTIVE
To review the literature on self-induced epileptic seizures and apply psychiatric knowledge to define possible causes and treatment recommendations.


METHODS
A review of MEDLINE literature on self-induced epileptic seizures was conducted, followed by cross-referencing with the relevant neurologic, psychiatric and paediatric books and journals.


RESULTS
The reported prevalence of self-induction varies depending on the setting. In most instances, self-inducers are people affected by photosensitive primary generalized epilepsy, in whom self-induction is by intermittent photic stimulation or, more rarely, pattern stimulation or eye closure. Self-induced seizures are most commonly absences with spike-wave, though eyelid myoclonia and generalized myoclonic jerks occur. Earlier studies indicate that the majority of self-inducers were of subnormal intelligence but more recent ones indicate that as a group they could not be considered mentally retarded. Monitoring in a well-lit environment is indicated in any therapy-resistant photosensitive patient to determine whether or not self-induction occurs. Self-induced epilepsy is notoriously resistant to therapy and reasons for this resistance are discussed. An explanatory model for the initiation and maintenance of self-induction behaviour is also included.


CONCLUSIONS
It is difficult to determine from published papers just what level of clinical difficulty self-induction of seizures actually posed to the patients and clinicians. In some cases there is contradictory evidence as to the degree of willfulness or self-induction. Self-induced epileptic seizures may be an important aspect of poor seizure control in a subgroup of epilepsy sufferers. These seizures might be modifiable by psychiatric intervention or behavioural modification.
Ng
Beng-Yeong
BY
Department of General Psychiatry, Woodbridge Hospital and Institute of Mental Health, 10 Buangkuk View, Singapore, 539749. Beng_Yeong_NG@imh.com.sg
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D004829:Epilepsy, Generalized / Q000188:drug therapy / Q000523:psychology*; D020195:Epilepsy, Reflex / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology; D012803:Sick Role; D017211:Treatment Failure
D000927:Anticonvulsants