Three children, ages 12-15, with frequent refractory seizures were treated by behavioral intervention techniques in the Depts of Medical Rehabilitation and Clinical Neurophysiology, Orebro Medical Center Hospital, Orebro, and Dept of Clinical Psychology, University of Uppsala, Sweden. Seizure types described as myoclonic in pt 1, Jacksonian (pt 2), and minor motor (pt 3) were associated with mental deterioration. Behavioral countermeasures, consisting of tensing of muscle groups and screaming “stop”! (pt 1), massaging the affected limb (pt 2), and fixing eye movements on an object (pt 3), resulted in an immediate reduction in both the seizures and paroxysmal EEG activity in all three cases. Other behavioral strategies, including biofeedback training in awareness of early seizure signals, applied relaxation, and positive reinforcement, were without beneficial effect. The authors propose that countermeasures in the level and speed of arousal may be the mechanism of the treatment intervention. [1]

COMMENT. Countermeasures involving sensory stimulation for the treatment of Jacksonian seizures have been advocated for centuries, dating back to the time of Galen and Aretaeus. Brown-Sequard (1872) proposed an encircling blister and Gowers (1901) found that forcing the closed fingers to open or preventing a leg from flexing would break up a motor march [2]. The value of these methods in the treatment of other seizure types should be explored further.