That night at the concert, we had a bitter disagreement. I wanted a Tom Petty T-shirt. Sam said he would buy me one. At the last minute, he changed his mind. I felt betrayed. I came home in a rage.

My mother later told me that the minute I came home she knew something was seriously wrong. I was shaking with anger, and my eyes looked crazed. That night I must have known something was wrong, too. At four in the morning I crawled into my mother's bed. Thirty minutes later I began to convulse. My eyes rolled to the back of my head, I began to shake, to drool. I urinated all over her bed. My mother called 911. Paramedics strapped me to a gurney and rushed me to nearby John Muir Hospital, where I was placed in the intensive care unit.

Doctors at the hospital diagnosed me as having epilepsy. They put me on Tegretol, a dosage of 400 milligrams a day. The effect was immediate. I had been a straight-A student up to that point, a nerd of sorts with a penchant for algebra. Once the Tegretol kicked in, computing equations became impossible. It was like my brain had been dunked into sludge. I felt my thoughts growing slower, my abilities slipping away. I slogged through my homework, hoping that somehow these side effects would fade.

 
  
 

A picture of me, left, with Sam's son, Jesse.  This photo was taken in 1991, the year of my first seizure.

 

   

 

 

They didn't. Soon my textbooks became useless, the numbers inside them now just incomprehensible scratches of ink. I couldn't read, couldn't write, was too woozy to participate in gym class. I felt like a zombie.

A month after my first dose, I fell down a flight of stairs. It was at a friend's party, and thirty to forty people watched as I fell. I wasn't hurt. But as I lay on my back, my brain was so foggy from the medication, I couldn't process what had just happened. My mom had to pull me out of school, at least until my confusion subsided. It took a few days.

Lying in bed that week, I thought about what my medication was supposed to do, and what it was doing to me. Tegretol had stopped my seizures, but the havoc it wreaked on my brain was worse than the seizures themselves. I wondered if there was a better way.

 

 

                                                                  

 

 

Most neurologists agree that certain factors can trigger seizures: lack of sleep, forgetting to eat and suddenly stopping medication. But the medical community isn't of one mind on whether a fourth factor - stress, specifically psychological stress - can trigger an attack.

Donna Andrews and neurologist Joel Reiter believe stress can cause seizures. And the epilepsy treatment they have designed is based on that belief.

Andrews' theory is that rage, panic and worry can create dangerously erratic neural firings in everybody, not just epileptics. In people without epilepsy, these erratic firings don't cause seizures because their seizure threshold, or ability to tolerate irregular bursts of cerebral electricity, is higher. But in epileptic patients with damaged neurons already prone to overfiring, these electrical surges can create seizures.

On her research center's website, Andrews is emphatic about this point. "Seizures," she writes, "are triggered by emotional reactions and stressful situations." Consequently, epileptics who seek treatment at the Andrews-Reiter Research Program are given training in relaxation and deep breathing. Patients are asked to discuss the thoughts and feelings that preceded their recent seizures. If patients can learn to relax and resolve their psychological issues, Andrews explains, their brains will stop producing erratic electrical bursts and begin to produce smooth, low-voltage electrical flows. According to Andrews' theory, epileptics who learn to produce this smooth steady current will stop having seizures because they will no longer produce the electrical bursts that cause them.

  

It's not a belief shared by many neurologists. In fact the vast majority dispute any connection between a patient's psychological state and epileptic attacks. Most dismiss a psychological treatment out of hand.

  

"Taking medication is the way to stop seizures," says Susan Herman, a neurologist at the University of Pennsylvania . "It wouldn't be inappropriate for patients to reduce their level of stress. But I certainly wouldn't tell patients that it would make their lives better. If they sought such a treatment in lieu of traditional medical approaches, it could potentially be harmful."

Herman takes particular exception to Andrews' assertion that she teaches patients to abort seizures that are in progress. Andrews does this by encouraging patients to recognize the first signs of a seizure, such as a vision of strange lights or the sound of an abnormal ringing. These initial symptoms of a coming seizure are called auras, and they are technically small seizures themselves, seizures localized to one portion of the brain. By relaxing and breathing deeply when an aura begins, Andrews says, patients can slow their neural firings and prevent a seizure from spreading throughout the whole brain, rendering the patient unconscious.

"I don't know of any evidence that deep breathing can stop an aura, and I do not recommend it to my patients," Herman says.

  

Andrews' theories do have their defenders. Carl Bazil, a neurologist at Columbia University, believes psychology has such a profound role in triggering seizures that, he says, he has seen agitated patients purposely provoke seizures and relaxed patients successfully stop them. "What we're dealing with here is overactive thought," Bazil says. "The seizures are the same range of electricity that produces thoughts and feelings, only in epileptics, there's an abnormal discharge.

  

"I believe people can alter their seizures," Bazil says, "either bring them on or stop them. And if we can see how patients stop them, then we can teach others to do it. If stress really is a part of epilepsy, then reducing stress might really improve things. You certainly can't take the stress out of people's life, but you can teach their body to react to it in a different way."

Andrews' psychological approach to epilepsy was born out of personal experience. Thirty-eight years ago, at the age of 18, she contracted a life-threatening case of viral encephalitis, which inflamed her brain and left her in a coma for a month. When she regained consciousness, her mental faculties had been devastated. She had profound memory loss and could barely talk or think coherently. She also had developed severe epileptic seizures, brain-scattering cerebral fits that struck her up to ten times a day. Doctors placed her on medication, but the medication did nothing to quell the seizures.

  

After a year of persistent seizures, Andrews began to despair. "I was trying to think of a way to kill myself. I felt like I was a terrible burden to my parents and I didn't want to live," she says. "Then, all of a sudden, a light went on in my head. The doctors had told me that the damage in my brain was there all the time. Then I thought, 'If the damage is there all the time, why aren't I having seizures all the time?' I started asking myself a million questions, like what I was thinking before each seizure, what brought them on."

  

Andrews says she started to see a link between moments of severe frustration and anger and her epileptic attacks. She began dealing with those emotions, she says, and working on resolving them. Within three years Andrews stopped having seizures. Three years after that she came off her epilepsy medication. She hasn't had a seizure in 34 years.

  

In 1980 Andrews teamed with Joel Reiter, a neurologist trained at Harvard and the University of California-San Francisco. Over 23 years, they have treated thousands of patients with both the traditional pharmaceutical approach and Andrews' alternative psychological approach. The combination has proved highly successful, resulting in far more seizure-free patients than witnessed in other clinical trials in which patients are treated with medication alone. Andrews and Reiter have chronicled this success in a book, "Taking Control of Your Epilepsy," and in four peer-reviewed studies, three of which appeared in the medical journal Seizure. Despite such mainstream exposure, Andrews and Reiter remain fringe figures in the neurological community. Few know of them and even fewer know the results of their studies.

 

 

                                                                    

 

 

I was expecting Donna Andrews to be an imposing figure, but Andrews - like her epilepsy facility itself - was not quite what I had in mind. She was short, round and a little wrinkly, but warm and buoyant, with the engaging wheeze of a happy ex-smoker. When my mother and I arrived at her Santa Rosa research center, she rushed out and hugged me, then escorted us to a nearby house, where we would stay for the five days of my treatment.

At 9 the next morning Andrews came to the house and sat down on the carpet. With a skeptical expression, I joined her. We talked about each of my major seizures and a few of my recent auras. She asked me to tell the story of each, not just what happened directly before the seizures but in the days leading up to them. I told her, and I remember thinking how strange it was that in all the years I had been seeing neurologists, never once did any of them ask about the circumstances preceding my seizures. Frequently I was asked whether I had taken my medicine, whether I was eating well and had gotten enough sleep. But the story of each seizure never came up.

Now describing the circumstances of each episode, I started seeing connections, links between my anger and my seizures that suddenly seemed obvious. Not only had I been angry before each seizure, but each time, rather than releasing that anger - yelling at Sam or my tyrannical boss - I stifled it instead. I started to wonder whether my seizures were triggered by that rage imploding inside me. Andrews said my rage did appear to be a factor. She told me that emotions like anger and frustration can trigger seizures in epileptics with damaged neurons. And that by learning techniques to deal with those emotions, I could prevent those seizures.

Then she had me lie down on the carpet and led me through a relaxation exercise. I was taught deep, diaphragmatic breathing and was asked to close my eyes and imagine myself traveling through a host of relaxing settings: a forest, a beach, a river. Later that day Andrews gave me a relaxation tape that followed a similar journey and instructed me to listen to it when I felt anger welling inside me again.

She also gave me her workbook, "Taking Control of Your Epilepsy," which she co-wrote with Reiter. Following the workbook, she and I went over alternate ways to handle my feelings, things to do instead of bottling them up. We talked about the difference between passive, aggressive and assertive communication. She encouraged me to be less passive and more assertive.

Perhaps the most immediately helpful technique was learning to stop the sensory oddities that preceded my seizures, like flashing lights. Andrews explained that these auras were the first signs of a major seizure. If I could recognize the lights, I could do something to cut them off - breathe deeply, relax, anything to resolve the underlying tension. By relaxing, she said, I could decrease the electrical activity in my brain and prevent my damaged neurons from firing erratically. Quelling those neurons would stop the flashing lights, preventing the onset of a major seizure.

Eventually, she said, I would learn to sense my brain's electrical tension and quell it even before my aura began. To develop this skill, I was asked to pay attention to the sensations that came before my aura.

I said I would try. But I was highly skeptical. To say I could abort a seizure by relaxing and breathing went against everything I had been taught.

Andrews left me that night with this thought: The damage in my brain existed all the time. Yet I wasn't having seizures all the time. What was happening in my life on days I had seizures that wasn't happening on all the days I was seizure-free? In bed that night I mulled over that thought and reflected on the seizures I'd had. The emotional trigger behind each seizure became clearer and clearer to me. Though my seizures were all baffling at the time, none of them, I now realized, came out of the blue.

In the following days I met with Reiter, who told me to continue taking my normal dosage of medication. Soon after, my mother and I packed up and set off for home. I promised to make daily diary entries of my seizures and auras, along with detailed descriptions of the circumstances. Andrews and I planned to speak on the phone once a week.

In the weeks and then years following my trip to Santa Rosa I came to believe that Andrew's understanding of epilepsy was correct, that defusing my anger and slowing down my cerebral electricity would prevent my seizures. I was soon able to trace a definite progression from high stress to a seizure. First I would feel a pressure in my eyes, then the lighting in the room would look strange, as if there were lights coming from places where in reality there were no lights at all. After that the room would look like a photographic negative of itself, then came the light in the upper-right-hand corner, then the light would pulse or flash, then my right eye would go black. Then the seizure.

Soon I became adept at cutting the sequence off at the first sight of a light in the upper-right-hand corner of my vision. Later, I could abort the sequence at the very beginning, at the first sense of pressure in my eyes. I became so good at this that within two months I was able to stop both my seizures and my auras. Ten months after that, I was able to secure the driver's license that had eluded me for four years.

 

 

                                                                    

 

 

In 1981 Andrews and Reiter submitted their psychological treatment to its first clinical study. The study's scope was limited. Five patients from Reiter's private practice were invited to participate in the experiment. Each of them had a long history of epilepsy and continued to have seizures despite taking a variety of anticonvulsant medications.

  

Before treating the patients, Andrews and Reiter asked each of them to keep detailed records of every seizure they had over four weeks. This established a baseline seizure frequency against which their improvement could be judged. At the end of the four weeks, Andrews began to counsel the patients. She taught them about pre-seizure auras and shared her theory of a psychological trigger for epileptic attacks. Patients were asked to pay attention to the emotions that preceded their seizures and work on resolving those feelings. As part of that effort, patients learned deep, diaphragmatic breathing and other relaxation techniques.

  

All of the patients continued to take their normal dosage of epilepsy medication.

For two years, Andrews and Reiter followed their patients' progress and recorded each of their seizures. Their study showed a marked improvement in the health of all five patients. The seizure frequency of each subject decreased steadily over the two-year follow-up. One patient who was having three seizures a month stopped having seizures altogether and remained seizure-free after her doctor withdrew her medication. A second patient who was having three to six seizures a day also stopped having epileptic attacks and remained seizure-free after his medication was decreased.

  

The success of the pilot study spurred Andrews and Reiter to repeat the project, this time on a larger scale. This second study covered 83 patients. Though the scale was larger, the study's structure was much the same. Each of the patients had chronic seizures uncontrolled by medication. Each was studied for several weeks before entering the experiment to establish a baseline seizure frequency. Once in the program, patients were given training in deep breathing and relaxation and were counseled on how to resolve emotionally difficult situations.

All of the patients continued to take their normal dosage of epilepsy medication.

Andrews and Reiter then charted their patients' progress through several years of follow-up. The results surprised even Andrews.

Of the 83 patients in the study, 69 of them (83 percent) became completely seizure-free in the months following treatment. Among patients who were having fewer than six seizures a month, 90 percent gained complete seizure control.

In 1992 Andrews and Reiter published these results in the epilepsy journal Seizure. The results impressed several neurologists, including Dr. Bazil of Columbia University 's Comprehensive Epilepsy Center, who read the study recently.

"This study is really a breakthrough," Bazil says. "It suggests these psychological treatments have a powerful benefit for patients. And they're almost never done. Neurologists tend to think of psychological stress and seizures as having more of a wishy-washy connection. These studies suggest that's not the case."

Bazil says that before reading the Andrews/Reiter study, he commonly treated patients with medication alone - prescribing anticonvulsants like Depakote, which eliminated seizures in nine percent of patients who took it in clinical trials, and Topamax, which stopped seizures in 13 percent of patients. Today, says Bazil, he is more inclined to suggest psychological counseling in addition to drug therapy.

  

"The reason I didn't do so before was because I was ignorant. I was unaware of this type of treatment. And I imagine there are many neurologists in my situation."

                                                                                                                                    

  

 
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