توسعه یک مدل علت و مداخله بالینی برای افراد مبتلا به صرع پیچیده جزئی
Abstract: Complex partial epilepsy is typically described as a stable and chronic neurological condition. Despite considerable progress in the understanding of pathophysiology, pharmacotherapy, and the surgical removal of epileptogenic tissue, the etiology for this particular form of epilepsy remains unknown in up to 70 percent of cases. Moreover, about 50 percent of existing treatment modalities fail to offer significant relief. Current treatments merely address the initiation or propagation of seizures, not the underlying etiology. Based on a synthesis of research findings from the behavioral and neurosciences, a bio-psychosocial model of the etiology of complex partial epilepsy is proposed. The model illustrates a causal relationship between the exposure to chronic stress and trauma and the onset of complex partial epilepsy. Based on the model, the author hypothesizes that (1) the onset of complex partial epilepsy is a learned bio-behavioral response to a progressively over-excited nervous system owing to a prolonged stress response, and (2) a seizure is a self-regulatory mechanism reestablishing the allostatic balance in the over-excited brain. Based on the theoretical model proposed, a psychotherapeutic intervention was developed addressing the underlying mechanisms of nervous system hyper-excitability. This intervention is based on the hypotheses that (1) by working directly with psychobiological symptoms of chronic stress and trauma, the over-excited nervous system down-regulates and complex partial epilepsy is thus less likely to manifest, and (2) the self-regulatory mechanism of a seizure is reconfigured wherein the nervous system becomes less likely to produce seizures. The principles of the intervention, derived from the proposed model, are illustrated through a detailed description and analysis of the dynamics involved in three comprehensive case studies undertaken by the author. Also given are specific recommendations for future research derived from the model, the supporting literature review, and the collected case study data.