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Abstract

Epilepsy represents a serious medical and social problem. In the majority of cases, seizures are successfully managed by a variety of anticonvulsant medications, even though these drugs may potentiate significant physical and developmental side effects. A small group of studies to date have offered evidence that behavioral procedures can successfully manage some seizure disorders and are particularly desirable treatment choices when seizure disorders are intractable to drug management or when drug side effects are to be avoided. The present case adds to this small but growing group of studies in that it demonstrates the use of behavioral procedures in the analysis and treatment of high-rate myoclonic seizures. Seizures were evaluated on a hospital ward and in a controlled experimental setting. The data indicated a variable rate of seizures across days and activities and a reduction of seizure frequency in the controlled setting when time-out was made contingent on seizures. A program of ldquocontingent restrdquo was then applied on the hospital ward that demonstrated a reduction in myoclonic seizure frequency and the apparent prevention of several grand mal episodes. An observer calibration procedure showed high correspondence between behaviorally and physiologically recorded seizures. A discussion of issues in behavioral medicine research follows.
This work was supported in part by grant #917 from Maternal and Child Health. The authors wish to thank the nursing staff of the Pediatrie Neurology service (CMSC 6 West), and Jane Akers, Roger Aitcheson, and Dr. Vicki Kowlowitz for their assistance in the conduct of this study. This research is a joint effort of the Department of Behavioral Psychology at the John F. Kennedy Institute and the Behavioral Medicine Program of the Johns Hopkins School of Medicine. For reprints, write ldquoReprint Requests,rdquo Department of Behavioral Psychology, John F. Kennedy Institute, 707 N. Broadway, Baltimore, Maryland 21205.

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