BEHAVIOR THEt~APY (1973) 4, 712 - 713

Aversive Conditioning of Self-Induced Seizures ~

LOCAN WRIGHT Children's Hospital of the University oJ Oklahoma

Aversive stimuli (electroshock) were used to condition a 5-yr-old men- tally retarded male to refrain from inducing seizures. Results from two separate 3-4 day treatment periods, as well as a 7-too follow-up, indicated a significant decrease in the number of self-induced seizures. The electro- shock also seemed to exert an adaptive effect upon the subject's behavior in other areas of functioning.

INTRODUCTION

Approximately one percent of the total epileptic population has seizures precipitated by some form a visual stimulation (Sehmidt & Wilder, 1968) and there is clinical evidence that some of these patients intentionally induce seizures in themselves (Sherwood, 1960.; Gastont & Tassinari, 1966). In the investigation reported here the behavior was modified to reduce or eliminate self-induced seizures. Two separate conditioning periods are described, separated by a 5-mo interval, and a 7-mo follow-up.

METHOD

The subject was a 5-yr-old, white mentally retarded male. There was no family history of mental retardation or seizures. Delivery was by facial presentation and there was considerable swelling in the face and head during the immediate postnatal period. The subject's mother described him as being hyperactive, interpersonally unresponsive and developmentally delayed ahnost from birth. Seizure activity, which typically took the form of a traneelike state, was first noticed near the end of the second year of life. The self-induced phenomena became obvious by the fourth birthday. He induced seizures by moving a hand back and forth before his eyes and blinking while looking at a light source. Altbough blinking occurs regularly in every- one, the subject's eye movements were clearly different. Particularly noticeable was momentary "freezing" of all body movements following these flutters. The epilepto- genie nature of these attacks was documented by an EEG. At the time conditioning began, both the patient's mother and a neurologist corroborated the fact that he was experiencing "several hundred" self-induced seizures (trancelike states lasting up to 10 see) per day. A first hospital admission was used to condition the patient to refrain only from inducing seizures by moving his hand back and forth before his

'Requests for reprints should be addressed to Logan Wright, Department of Pediatrics, Children's Hospital of the University of Oklahoma, P. O. Box 26901, Oklahoma City, Oklahoma 73190.

712 Copyright @ 1973 by Academic Press, Inc. All rights of reproduction in any form reserved.

CASE REPORTS 713

eyes. A base rate of 53 "hand before eyes" seizures per hour was obtained by ob- serving the patient for three separate 1-hr periods. He was then fitted with a 90-V battery and potentiometer for adjusting voltage. A milliammeter was used to meas- ure the amount of shock conducted by the subject's skin between two silver elec- trodes 1 in. in diameter and secured 1 in. apart by means of a plaster-of-paris cast. The electrodes were attached to the medial side of the left midthigh, and the sub- ject was seen for conditioning treatment for five, 1-hr daily sessions over a 3-day period. Treatment periods were at 9 AM, 11 AM, 1 VM, 3 PM and 5 VM.

Every time the subject moved Iris hand before his eyes he was administered approximately 0.6 sec of electroshock measuring 3 mamps and approximately 60 V. The aversive conditioning proved to be effective in preventing the patient from putting a hand in front of his eyes. After the third session of the second day, the patient never again placed his hand in front of his eyes so as to induce a seizure.

During a second admission 5 mo later, an attempt was made to condition the subject's tendency to induce seizures by blinking. The same method was employed for establishing the base rate of 407 seizures per hour. The subject was seen for conditioning of eye blinking during three, 1-hr sessions per day (at 9 AM, 1 r ~ and 5 PM) over a 4-day period. During this time the number of seizures induced by eye blinking decreased steadily from a total of 175 on the first day to 112, 73 and 36 on Days 2, 3 and 4, respectively.

A follow-up interview was conducted with the mother seven months after the second conditioning session. She reported that the "holding power" of the condition- ing was extremely good. The patient was observed never again to induce seizures by putting his hand in front of his face. She estimated that the seizures induced by blinking were approximately twice as frequent as they were immediately following conditioning. However, this still represented a decrease of approximately 90% of the base rate obtained initially. Just prior to the follow-up session, the patient was old enough for transfer to a state school. There attempts were made further to control his seizures through medication. The mother reported that this approach was generally unsuccessful. The medication produced drowsiness and lethargy, and had adverse effects on his interpersonal behavior and the frequency of seizures.

RESULTS

Clinical ly the exper imenters were impressed wi th the genera l ly bene-

ficial effects of the aversive cond i t ion ing p rog ram on the subject 's self- i n d u c e d seizures and his ad jus tmen t in other areas. He d isp layed greater

alertness, a h igher level of cogni t ive func t ion ing , improved in terpersonal contacts, and greater a t ten t iveness to the env i ronment . There was no

ev idence of an increase in nega t ive affect, wi thdrawal or other behaviors

which one migh t fear as the resul t of electroshock.

REFERENCES

GASTONT, H., & TASSINARI, C. A. Triggering mechanisms in epilepsy. The electro- clinical point of view. Epilepsia, 1966, 7~ 85-138.

SCr~IDT, R. D., & WrLDEn, B. J. Epilepsy. Philadelphia: F. A. Davis, 1968. SnEnwoon, S. L. Self-induced epilepsy. A collection of self-induced epilepsy cases

compared with some other photo-convulsive cases. Archives of Neurology, 1962, 6, 63-77.