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Gottschalk, L.A. (1956). The Relationship of Psychologic State and Epileptic Activity—Psychoanalytic Observations on an Epileptic Child. Psychoanal. St. Child, 11:352-380.

(1956). Psychoanalytic Study of the Child, 11:352-380

The Relationship of Psychologic State and Epileptic Activity—Psychoanalytic Observations on an Epileptic Child

Louis A. Gottschalk, M.D.

SUMMARY

The psychoanalytic study and treatment of a ten-year-old epileptic boy are reviewed. Particular emphasis is laid on the sequence of psychologic conflicts and states associated with one type of seizure that was repeatedly observed in the playroom sessions with him. This type of seizure was an atypical, so-called "psychic equivalent" seizure, with motor components. Interseizure electroencephalograms showed a 3 c.p.s. spike-wave pattern. Also, the psychic equivalent seizures were the prodromal manifestation of infrequent but clear-cut grand mal seizures.

The features and psychologic conflicts of a hysterical character, although manifested both during seizure and interseizure periods, were not found sufficient in themselves to account for the epileptiform manifestations of this patient. The presence of a type of paroxysmal cerebral functional disorder, which has elsewhere been found to be associated with decreased seizure threshold, could not alone account for the epileptic behavior, particularly that manifested during the psychic equivalent seizures. Both complex factors (the hysterical character disorder and the paroxysmal cerebral functional disorder) were considered necessary to produce the clinical syndrome.

The therapeutic problems encountered in this patient illustrate the therapeutic value of psychoanalytic psychotherapy in the management of certain types of epileptic individuals.

The case study is also considered to illustrate the value of psychoanalytic study of epilepsy as an important avenue of furthering our understanding of the interplay of the neural and experiential bases of emotional disorder.

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