Young child and adult decorate Styrofoam head.

Photos provided courtesy of the Epilepsy Foundation Greater Dayton Region from it's Studio E: Epilepsy Art Program. Learn more about this nationwide program that helps people living with epilepsy express themselves and work through how the condition impacts their lives.

Brown SE, Shellab T, Pestana-Knight E. Epilepsy & Behavior 9 (2018): 6-9


This case study's purpose was to compare the similarities and differences between artistic sculptures made by five people living with epilepsy and five people living with psychogenic nonepileptic seizures (PNES). PNES refers to seizures that are not associated with changes in the brain's electrical activity. They are thought to be due to psychological factors. The events are real, but the cause is not the same as epilepsy seizures.

Description of Study

  • The authors refer to previous studies that show a link between epileptic seizures and art.
  • They believe that art can uncover, "insights or emotions that might be difficult to express verbally." Art therapy is a safe, therapeutic environment where participants may express their thoughts and emotions physically.
  • The researchers provided each of the 10 participants with a blank Styrofoam head devoid of facial features, a brown mask, a set of 12 scented markers, pipe cleaners, colored construction paper strips, feathers, and a hot glue gun.

Their instructions:

  • On one side of the mask, they were asked to depict an image and/or use words that portrayed how seizures made them feel.
  • Then, on the other side of the mask, "depict how they believe people who did not know they experience seizures viewed them."
  • When the mask was placed on the head, they were asked to use their other materials (on the same side they portrayed their feelings) to, "depict how their seizure would appear if it was visible."
  • On the side where they depicted how they believe people view them, they were told to use their supplies to represent how they look, like creating their hair and any other adornments or imagery to represent "their 'outer' self."

Summary of Study Findings

  • The two groups both depicted feelings of, "anxiety, low self-esteem, guilt, lack of independence, and a decreased quality of life." Both groups also demonstrated themes of stigma, the need to keep their condition secret from the world, and difficulty speaking during or after a seizure.
  • The authors noted a pattern of differences between groups as well.
  • Participants living with epilepsy:
    Child holds up decorated mask
    • Used a large variety of color
    • Used electrical imagery (lightning bolts, zig zags, etc.)
    • Exaggerated their use of height and space
    • Showed fluctuating emotions
    • Showed a repetition of lines
    • Included a visual representation of the post-seizure stage
    • Used themes of resilience, awareness, and hope
  • The PNES group used bold, dark colors around at least one eye with bold outlining of at least one eye as well. They tended to use black, brown, red, yellow, and orange colors with an encapsulation or looping of materials. Their sculptures often portrayed themes of control and strength.
  • Photos of some of the study participants' sculptures can be found within the full study.

What does this mean?

  • Although the authors acknowledge their study had many limitations, such as a lack of blind testing, a low number of participants, and a lack of structure for the task, they think this approach of expressing experiences through art is comparable to having a conversation. This approach provides different diagnostic knowledge for a physician than the traditional method of getting a medical history and gathering facts.
  • The authors noticed the participants living with PNES focus on the emotional experience of their condition, while participants living with epilepsy describe the physical experience. Both groups try to navigate the psychosocial issues that are often associated with their condition.
  • The researchers don't suggest using art therapy as a standalone diagnostic tool, but rather as an additional method that can provide doctors with more information. This could be especially be helpful for PNES since it is difficult to diagnose.
  • The authors plan to launch a larger, controlled study to better understand the dynamics and influence that artistic expression can have on diagnostics and people with epilepsy and/or PNES.

Article published in Epilepsy & Behavior, December 2017.

Authored By: 
Dara Farhadi MS
Authored Date: 
Reviewed By: 
Joseph I. Sirven MD
Tuesday, June 5, 2018