Abstracts

Rationale: The purpose of this study was to investigate the effects of pre- and post-surgical hypnotic intervention on the anxiety, pain, and nausea suffered by epilepsy surgery patients undergoing intracranial EEG monitoring. Discussions with post-surgical patients identified a need for additional techniques to control these discomforts. Hypnosis was theorized as one modality that could favorably influence patients’ experiences of surgery and intracranial EEG recording. Methods: : Seventy-seven patients who were candidates for intracranial EEG and epilepsy surgery were invited to participate in the study. Forty patients accepted, and were randomly assigned to receive usual care or usual care plus hypnosis. Thirty-three patients completed the study. Usual care included informal pre- and post-surgical teaching by nursing staff about how to control anxiety, pain and nausea. Patients in the treatment group met with a clinical hypnotherapist for a one-hour session of hypnosis. In addition to producing a deeply relaxed state, this intervention included positive suggestions for managing symptoms. Patients were then given audiotapes with a standardized hypnosis script, and instructed to listen to the tape at least once per day, or more often, for five days prior to surgery. Patients in both groups completed an anxiety scale daily for 5 days prior to surgery. The treatment group were also encouraged, if awake, to listen to the tape during electrode implantation surgery. Following the surgical procedure, patients in the treatment group listened to a postoperative tape for five days, one or more times per day, while undergoing intracranial EEG monitoring. Patients in both groups completed an anxiety scale daily for five days. Nursing staff assessed all patients every four hours for ratings of pain and nausea, using a standardized scale. The levels of anxiety, use of pain-killers and anti-emetics, and extent of weight-loss, were compared between the two groups. Results: Seventeen patients were randomized to the treatment group and sixteen to the control group. The groups were similar with regard to gender, epilepsy type, and the types of intracranial electrodes that were used. There was a statistically significant difference in pain-medication use on post-surgical Days 1 and 2 (p=.013 and p=.024 respectively), with the treatment group needing less. There was also a statistically significant difference in anxiety between the two groups on the day prior to surgery (p=.022), with the treatment group being less anxious. No statistically significant differences in weight loss, or use of anti-emetics, were noted, though trends favored the hypnotic intervention. Patients in the treatment group reported that hypnosis was helpful, and would recommend it to others. Conclusions: Hypnosis is helpful in the management of anxiety, pain, and possibly nausea, in epilepsy surgery patients undergoing intracranial EEG monitoring.