Evaluation of a Behaviour Analysis and Treatment of Progressive Myoclonus Epilepsy, Type Unverricht-Lundborg: a Case Study Rikard K. Wicksell 1 and JoAnne Dahl Olerud 2 1 Karolinska Hospital, Sweden; 2 Department of Education and Psychology, University of Ga ¨vle, Sweden Abstract. This case study evaluates the clinical effectiveness of a psychological treatment within a behaviour medicine approach to epilepsy of a subject with progressive myoclonic epilepsy. The pattern of seizure behaviour was identified in the behaviour analysis. Self-management skills were taught to the client and in vivo exposure was subsequently used in a desensitization process. The main findings in this study were that the debilitating effects of the myclonic jerks can be reduced and functioning level improved when fear of seizures is reduced. These results indicate that psychological treatment can increase the level of functioning in clients with progressive myoclonic epilepsy. Key words: behaviour analysis; self- management; seizure control; psychological treatment; classical and operant conditioning. Received December 15, 2001; Accepted October 30, 2002 Correspondence address: Rikard K. Wicksell, Pain Treatment Service, Astrid Lindgren Children’s Hospital, Karolinska Hospital, SE-171 76 Stockholm, Sweden. Tel: 46 (0) 8517 79917. Fax: 46 (0) 8 517 77 265. E-mail: Rikard.Wicksell@ks.se Myoclonic epilepsy in young people is usually considered difficult to treat with anti-epileptic drugs (Koskiniemi, 1998). Very few cases with this type of epilepsy are reported to have been treated using psychological interventions. The results from a recent study of Martinovic (2001) indicate that the use of behavioural therapy treatment principles may contribute to not only a decrease in seizure frequency, but also a decrease in related fear and other incapacitating responses. Epilepsy as a phenomenon is traditionally conceived of as the symptom of an organic predisposition and occurring at a neurotransmitter level (Johanson & Kihlgren, 2000; Dahl, 1999). Even though extensively researched, in as many as 70% of the cases of epilepsy, the aetiology of the symptoms remains unknown (Ross, 1994). The question of why the client does not experience seizures all the time, but instead in rather predictable situations, has brought about an extension of the analysis to also include external factors (Fenwick, 1994; Dahl, 1999). This broader perspective has come to show useful in establishing a pattern of seizure occurrence within the client’s everyday life (Dahl, 1999; Spector, Goldstein, Cull, & Fenwick, 1994; Goldstein, 1990). The organic predisposition unquestionably sets the stage for seizure occurrence, but stimuli in the person’s external or internal environment may facilitate or inhibit the spread of pathological neuronal activity (Dahl, 1999). Goldstein (1990) points out the interaction between psychosocial problems and medical symptomatology, and emphasizes the importance of taking this into consideration while deciding on diagnosis and treatment. Behaviour medicine interventions take the organic predisposition into account but are primarily focused on the external stimuli facilitating or exaggerating the epileptic activity. In addition to an understanding of pathology, the behavioural medicine model of epilepsy includes an understanding of the classical and operant conditioning of the seizure symptom. In the Cognitive Behaviour Therapy Vol 32, No 1, pp. 38–46, 2003 # 2003 Taylor & Francis ISSN 1650-6073 DOI: 10.1080/16506070310003657