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DISCUSSION
Analysis of the results indicates that the clinical therapy model developed in this pilot study was successful in producing favorable changes in seizure frequency, psychological tests and emotional functioning. Furthermore, these improvements were maintained in the five subjects during the 12-month period following the therapy program. It is beyond the scope of this study to isolate variables in the therapy model responsible for the positive changes. Further study using control groups might isolate the more important components. Our work with partial complex epilepsy leads us to propose that to some extent the seizures may be within the realm of voluntary control. Our study indicates that individuals with partial complex epilepsy are sometimes able to diminish the frequency of daytime partial-complex seizures.
The standard medical approach has been to use pathological phenomena described by patients in a diagnostic way. The usual approach to treatment of complex-partial epilepsy is to take careful history, outline aberrancies such as frequent deja vu, dissociation, floating sensations, disturbed memory, and then pronounce the diagnosis of complex-partial epilepsy and the treatment as anticonvulsant medication.
Our counseling method is designed to allow the aberrant phenomena to tell us something of the individual's capacity to control seizures. Often, the perceptual aberrancies described by individuals with complex-partial epilepsy present more of a problem in their daily activities than their actual seizures. When individuals gain control over their thought processes, they can effect positive changes in interpersonal relationships, jobs and school performance.
Our counseling includes: 1) self awareness; 2) awareness of parapsychological phenomena as normal and not to be feared; 3) identification of subtle internal changes that precede seizures; 4) identification of factors in their daily lives that trigger seizures; 5) recognition of their ability to change the "feeling state" of the brain by using relaxation techniques and reinforcing these techniques with weekly EEG biofeedback training.
Because the results we obtained in this pilot project were uniformly good, some investigators might raise the question as to whether we were working with people who had pseudo-seizures as opposed to those with organic seizures. We think the summaries and case histories outline clinical histories compatible with actual seizures. In addition, focal temporal slowing in the 24 Hz and the 5-6 Hz range had been documented in past EEGs in all of our five subjects. Two of our subjects had exhibited focal spikes over temporal region in the EEGs at some time in their clinical seizure history. One of our patients had bilateral temporal spikes at the beginning of our project, with improvements of her EEG during the course of therapy.
At the beginning of our study, the five subjects were on from one to four anticonvulsant medications. These medications may contribute, to increased problems with memory function, flow of thought and body awareness (Matthews & Harley [13] and Hutt et al. [14]). It is possible that anticonvulsants "re-set' the central nervous system and make it difficult for patients to perceive subtle internal changes that indicate the onset of a seizure. Our study leads us to speculate that prescription of anticonvulsants should be directed at minimally influencing a patient's level of alertness and ability to perceive subtle internal mechanisms that can herald increased seizure frequency. Within this context, the full potential of a behaviorally oriented approach in rehabilitation of individuals with complex partial epilepsy will be understood only when it is instituted early after the initial diagnosis and, when possible, before the institution of anticonvulsant medication. | 
