The present study, a qualitative case series report with a quantitative component, explores the relation between changes in family interaction patterns and therapy outcome at 9-month follow-up in a child-and familyoriented psychosocial treatment program developed to treat pediatric primary headache. Changes in the family interaction patterns of 38 children and adolescents diagnosed according to International Headache Society criteria were examined via qualitative methods. Therapy outcome was assessed on an 11-point numeric rating scale measuring the reduction of subjectively experienced global headache burden. At follow-up, 1 subgroup of families showed positive change, and a 2nd subgroup displayed either unchanged or worsened headache-associated interaction patterns. Participants from families with a positive change in headache-associated interaction patterns showed a 64% reduction (p ϭ .00) of global headache burden; participants with unchanged or worsened family interaction patterns showed only a 17% reduction. The findings are illustrated by case histories and discussed in the context of dynamic systems theory.
SUMMARY The “hemiconvulsive seizures” here described concern all epileptic convulsions – tonic or clonic – interesting only one side of the body. The “Jacksonian epilepsy” is one of the aspects of this type of epilepsy, the others being: “Hemi grand mal”: typical grand mal seizures, but strictly localized to one side of the body and, electroencephalographically, to the contralateral hemisphere. “Hemiclonic seizures”: clonic phenomena often beginning with an “oculoclonic crisis”, spreading to the whole ipsilateral half of the body. On the EEG are observed, on the contralateral hemisphere, 2–3 c/s slow waves and 8–10 waves predominating in the posterior region. The hemiclonic seizures occur in two main groups of epileptics: Those with neurological, radiological and/or electroencephalographical signs of focalization (among whom are found some with “H.H.E. syndrome”). Those without any sign of cerebral focalization, but suffering from petit mal or grand mal. The authors discuss the differences between the two latter types of non‐jacksonian hemiconvulsive seizures (hemi grand mal and hemiclonic seizures) and the “Jacksonian seizures”, both from a pathophysiological and from a therapeutical point of view. RÉSUMÉ Les crises hémiconvulsives décrites dans ce travail englobent toutes les convulsions toniques ou cloniques intéressant seulement un côté du corps. L'épilepsie Jacksonienne représente un des aspects de ce type d'épilepsie; les autres aspects décrits par les auteurs sont: L'hémi grand‐mal: crises présentant toutes les caractéristiques du grand mal, mais strictement localisées cliniquement à un hémicorps et électroencéphalographiquement à l'hémisphère contralatéral. Les crises hémicloniques: les manifestations cloniques commencent souvent par une “crise oculoclonique” et s‘étendent ensuite à tout l'hémicorps homolatéral. Le tracé EEG montre, sur l'hémisphère controlatéral, des ondes lentes à 2–3 c/s associées à des ondes plus rapides (8–10 c/s) prédominant dans la région postérieure. Malades où peuvent être mis en évidence des signes de focalisation neurologique, radiologique et/ou électroencéphalographique (un certain nombre de ceux‐ci présen‐tent un syndrome H.H.E.: Hémiconvulsion‐Hémiplégie‐Epilepsie). Malades chez qui aucun signe de focalisation cérébrale ne peut être relevé, mais sujets à des crises généralisées petit mal ou grand mal. Les auteurs discutent les différences entre ces deux types de crises hémiconvulsives non Jacksoniennes (hémi grand‐mal et crises hémicloniques) et les crises Jacksoniennes, tant du point de vue physiopathogénique que thérapeutique.
These data provide empirical evidence about when to include family in treatment of pediatric headache: when rigid family interaction patterns associated with headache complicate a symptom change.
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