Objective Depression affects about 16% of the U.S. population over a lifetime. People with chronic diseases have especially high rates of co-morbid depression; 32% to 48% of people with epilepsy experience depression. This study evaluated the efficacy of a mindfulness-based cognitive therapy (MBCT) intervention for preventing major depressive disorder (MDD) episodes in people with epilepsy. Method Participants (n = 128) were adults from Georgia, Michigan, Texas, and Washington with epilepsy and mild/moderate depressive symptoms. The eight-session, weekly Project UPLIFT intervention, based on MBCT, was group-delivered via Web or telephone. Using a randomized, controlled, cross-over design, participants were assigned to Project UPLIFT or a treatment-as-usual (TAU) waitlist and assessed at baseline, and after intervening in the intervention group (~10 weeks) and in the TAU group (~20 weeks). Assessments included valid self-report measures of depression and MDD, knowledge/skills, and satisfaction with life. Results The incidence of MDD episodes (new or relapse) from baseline to interim assessment was significantly lower in the intervention condition (0.0%) than in TAU (10.7%). Depressive symptoms decreased significantly more in the intervention condition than in TAU; Web- and telephone did not differ. Change in knowledge/skills mediated the effect, which persisted over the 10 weeks of follow-up. Knowledge/skills and life satisfaction increased significantly more in the intervention condition than in TAU. Conclusions Distance delivery of group MBCT can prevent episodes of MDD, reduce symptoms of depression, and increase life satisfaction in people with epilepsy. This intervention is easily modified for persons with other chronic diseases and other disparity populations.

Summary:Purpose: To determine whether differences in clinical manifestations of psychogenic nonepileptic events are associated with differences in outcome and whether the length of illness before diagnosis correlates with outcome.Methods: We reviewed ictal videotapes and EEGs in 85 patients diagnosed with exclusively nonepileptic psychogenic seizures during inpatient CCTV-EEG monitoring at the University of Michigan between June 1994 and December 1996. They were classified into groups of similar ictal behaviors. Fifty-seven of these patients were available to respond to a follow-up telephone survey about their condition 2 4 years after discharge. We examined demographics, baseline EEG abnormalities, and outcome of treatment interventions. We also evaluated whether interventions were more likely to succeed if patients were diagnosed early in the course of the illness.Results: We found that the largest groups consisted of patients with motionless unresponsiveness ("catatonic," n = 19) and asynchronous motor movements with impaired responsiveness ("thrashing," n = 19). Infrequent signs included tremor, automatisms, subjective events with amnesia, and intermittent behaviors. There was a higher incidence of baseline EEG abnormalities in the thrashing group (31%) than in the catatonic group (0%). There was a higher incidence of complete remission of spells in the catatonic group (53%) than in the thrashing group (21%). Patients who had a more recent onset of seizures [most often within 1 year) were much more Likely to have remission of spells after diagnosis. Conclusions: Classification of nonepileptic seizures is useful in predicting outcome and may be valuable in further investigation of this complex set of disorders. Key Words: Nonepileptic events-Outcome-Personality testing-Pseudoseizures.Carefully refined classification systems for both seizures and epilepsy syndromes have substantially improved the diagnosis and management of patients with epilepsy (1,2). These tools provide a level of detail that suggests separate etiologies and possibly even separate mechanisms of pathogenesis. A new set of revisions in these systems incorporating new knowledge is being developed (3). Observing patients with psychogenic nonepileptic spells, distinct patterns also seem to emerge. These spells are as disabling as epilepsy and tend to be even more refractory to several modes of treatment. The largest outcome study to date (4) documented a 60% refractory rate. On the basis of our observations that patients with minor motor manifestations seemed to fare better than others, we undertook this study to begin to identify potentially separate syndromes with distinguishable etiologies and natural histories.For several years, clinicians studying psychogenic nonepileptic events have discerned differences in predispositions and MMPT profiles that they believed warranted division of their groups into ''convulsive'' or %on-convulsive" patterns (3, or major versus minor motor episodes. Most patients have relatively stereotyped episodes, althou...

This pilot study provided critical information related to study design and feasibility for planning a comprehensive trial to test the hypothesis that treating obstructive sleep apnea in patients with epilepsy improves seizure control.

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Cognitive testing was repeated at intervals ranging from 1 to 8 years in 47 adult patients with temporal lobe epilepsy (TLE). Each patient underwent standardized batteries, including the Wechsler Adult Intelligence Scale, Revised (WAIS-R), and Wechsler Memory Scale (WMS). Both surgically treated and nonsurgical patients were examined. The nonsurgical group underwent serial testing for clinical indications, usually for complaints of memory dysfunction. Longitudinal testing could not verify any mean deterioration of intellect or memory in this group; variance over time was similar to test-retest norms in healthy controls. WAIS-R scores before and after resection in the surgical group were similar to our serial WAIS-R data in nonsurgical patients. When we divided surgical patients according to side of epileptogenesis, we noted the expected differences in verbal and visual memory. Right-sided surgery patients improved significantly in Full-Scale IQ (FSIQ) and tended to improve in logical memory on postoperative testing. Patients undergoing left resections had no retest improvement and tended to show decrease in several measures of verbal memory. Our findings should stimulate continued investigation into the natural history of lateralized memory and intellectual function in epilepsy, particularly to clarify long-term cognitive outcome in nonsurgical patients.