Abstracts

RATIONALE: Children with epilepsy suffer from a variety of psychological problems, including poor self-image and low self-esteem. Drawings are a valuable method to explore self-image in patients with chronic disorders, but this technique has not been utilized extensively in children with epilepsy.
METHODS: Fifty-nine children with epilepsy, who were cognitively able, were asked to, [dsquote]Draw a picture of what it is like to have a seizure.[dsquote] To avoid bias, no further instructions were given. To standardize the methodology, all drawings were made with a no. 2 pencil on a blank sheet of white paper (8.5 x 11 in). Drawings were analyzed jointly by a pediatric epileptologist and an expert in children[ssquote]s art.
RESULTS: The participants (ages 6-18 y, mean 11.6 y) had the following seizure types: benign rolandic seizures (BRE, n=9), absence seizures (ABS, n=5), complex partial seizures with or without secondary generalization (CPS, n=24), generalized tonic-clonic seizures (GTC, n=20), and pseudoseizures (PSEUDO, n=1). Most children with BRE were aware during at least a portion of their seizure (simple partial); their drawings most often depicted unilateral extremity shaking (7/9) and drooling (3/9). The size or shape of the shaking body part was often drawn in a distorted manner. Children with all other seizure types were, by definition, not able to remember their ictal features, so drawings were based on what they were told by a parent or other witness. Auras in children with CPS were depicted by characteristic noises, odors, or other sensory symptoms (6/24), or by fear or confusion (9/24). Children with CPS or GTC typically drew themselves shaking (13/48) or having fallen to the ground (10/48). Children with ABS showed themselves staring (5/5). Features of impaired self-concept and vulnerability were frequently depicted in all diagnostic categories. Examples included distortion of body parts, especially the part involved in the seizure (e.g., small body or head, minimal facial features, brain with abnormal [dsquote]spots[dsquote] or structure). Depictions of helplessness included transport in an ambulance (4/59); one child depicted himself lying in a coffin.
CONCLUSIONS: Self-expression through art is a useful method to understand some of the emotional and psychological challenges facing children with epilepsy. Drawings are a potentially valuable tool to assess self-image in this chronic disorder. There is some correlation of drawing features with seizure type. Depictions of impaired self-concept were seen across syndromic diagnoses.