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Helped Stanford/Packard Physicians Pinpoint Cause of Children's Seizures
Thu, 14 Feb 2008 22:08:23 GMT
Author : CA-SUMC
Category : PressRelease
STANFORD, Calif. - (Business Wire) It was no way for an 11-year-old to live. For
a month the boy had endured daily episodes of uncontrollable jerking and foaming
at the mouth, and his physicians at Lucile Packard Children’s Hospital at
Stanford were concerned that the boy had epilepsy. Before starting the boy on a
lifetime of anti-seizure medications, though, they turned to an unconventional
diagnostic tool: hypnosis.
“Children are highly suggestible and they have great imaginations,” said
Packard Children’s child psychiatrist Richard Shaw, MD. “We’ve found that if we
suggest that they are going to have one of their events while they are in a
hypnotic trance, they will usually have one.”
But wait. Aren’t physicians supposed to try to STOP seizures rather than
searching for new ways to cause them? In a word, yes. But in order to treat
seizures effectively, doctors must learn which parts of the brain are causing
the trouble. Many children who seem to be having epileptic seizures are actually
having an involuntary physical reaction to psychological stress in their lives.
These events require a vastly different treatment than do true epileptic
The only way to pinpoint the true cause is to monitor the child’s brain activity
during an event. Connecting a panel of electrodes to a child’s scalp is
relatively easy and painless. Conducting a “seizure watch” of indefinite length
is another matter.
“It’s very difficult for parents to spend three or four days in the hospital
hoping their child has a seizure,” said Packard Children’s chief of pediatric
neurology, Donald Olson, MD. “It puts them in a very uncomfortable place
emotionally.” Furthermore, some hospitalized children, removed from the very
stressors that may be causing the events, never have a seizurelike event.
Hypnosis can speed the process considerably, say Shaw and Olson. Together with
former medical student Neva Howard, they tested the procedure on nine children
between the ages of 8 to 16 whose seizurelike events included twitching, loss of
consciousness, shaking, jerking and falling. Their results were published online
in January in Epilepsy & Behavior. The physicians needed to know whether these
were true epileptic events, which are best treated by medication, or
non-epileptic events caused by psychological stress or other neurological
“We can’t always distinguish epileptic from non-epileptic events visually, or
through descriptions by family or friends,” said Olson, an associate professor
of neurology, of neurosurgery and of pediatrics at the Stanford University
School of Medicine. “But regardless of the cause, these are disabling,
life-altering events that need to be treated.”
The authors believe that, although hypnosis may not work for every child, the
technique is an important tool that can speed proper diagnosis and treatment for
children suffering from seizurelike events.
To hypnotize the subjects, Shaw, an associate professor of psychiatry and
behavioral sciences and of pediatrics at the School of Medicine, first used a
combination of deep breathing and progressive muscle relaxation to induce a
state of relaxation and deep focused attention in the subjects. He then used a
combination of imagery and suggestion to induce one of their typical seizurelike
events. Children typically visualize being at one of their favorite places—for
one teen, it was on a beach in the Bahamas. After a hypnotic trance was
established, Shaw would then direct the child to recall the feelings or events
that usually precede a typical seizure. Electrodes on the child’s scalp recorded
their brain activity during the session.
In eight out of nine cases, Shaw could successfully trigger a seizurelike event
with this procedure. After an appropriate monitoring interval, Shaw then
directed the hypnotized child to “return” to his or her favorite place and the
episode would stop. Using this technique, the physicians found that all eight of
the subjects were experiencing non-epileptic events.
“We had a number of clues that these particular children might not have
epilepsy,” said Olson, “but hypnosis helped us confirm our suspicions.”
Physicians begin to suspect causes other than epilepsy if an individual has a
variety of episodes, if the person’s cognition is unaffected despite frequent
seizures or if the person has a pre-existing psychiatric diagnosis.
Were the kids in the study relieved to find they didn’t have epilepsy? “Yes and
no,” said Shaw. “It’s important to explain very clearly that although these
events are psychologically based, they are completely out of a child’s control.”
He and Olson compare the events, which are a type of condition called conversion
disorder, to other well-known ways that stress and emotions affect other bodily
functions, such as migraines, ulcers and blushing.
Stanford is part of an ongoing multicenter study of these non-epileptic events
to better understand their causes and possible treatments. For now, Shaw often
couples psychotherapy with self-hypnosis lessons to teach children how to avoid
“When they’re feeling out of control, this is a tool they can use. They know
that they were able to ‘turn off’ an event during the initial hypnosis, and that
gives them confidence to try it themselves,” said Shaw.
In general, people are growing more comfortable with the idea of hypnosis in a
medical setting, said Olson. “The first reaction of many people may be to equate
hypnosis with some sort of black magic. But once we explain the reasons and
benefits, they’re very accepting.”