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Abstract

Objective: To compare cognitive-behavioral therapy (CBT) and standard medical care (SMC) as treatments for psychogenic nonepileptic seizures (PNES).
Methods: Our randomized controlled trial (RCT) compared CBT with SMC in an outpatient neuropsychiatric setting. Sixty-six PNES patients were randomized to either CBT (plus SMC) or SMC alone, scheduled to occur over 4 months. PNES diagnosis was established by video-EEG telemetry for most patients. Exclusion criteria included comorbid history of epilepsy, <2 PNES/month, and IQ <70. The primary outcome was seizure frequency at end of treatment and at 6-month follow-up. Secondary outcomes included 3 months of seizure freedom at 6-month follow-up, measures of psychosocial functioning, health service use, and employment.
Results: In an intention-to-treat analysis, seizure reduction following CBT was superior at treatment end (group × time interaction p < 0.0001; large to medium effect sizes). At follow-up, the CBT group tended to be more likely to have experienced 3 months of seizure freedom (odds ratio 3.125, p = 0.086). Both groups improved in some health service use measures and on the Work and Social Adjustment Scale. Mood and employment status showed no change.
Conclusions: Our findings suggest that cognitive-behavioral therapy is more effective than standard medical care alone in reducing seizure frequency in PNES patients.
Classification of evidence: This study provides Class III evidence that CBT in addition to SMC, as compared to SMC alone, significantly reduces seizure frequency in patients with PNES (change in median monthly seizure frequency: baseline to 6 months follow-up, CBT group, 12 to 1.5; SMC alone group, 8 to 5).

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Published In

Neurology®
Volume 74Number 24June 15, 2010
Pages: 1986-1994
PubMed: 20548043

Publication History

Published online: June 14, 2010
Published in print: June 15, 2010

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Authors

Affiliations & Disclosures

L.H. Goldstein, PhD
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
T. Chalder, PhD
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
C. Chigwedere, MSc
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
M.R. Khondoker, PhD
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
J. Moriarty, MD
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
B.K. Toone, MPhil
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.
J.D.C. Mellers, MRCPsych
From the Departments of Psychology (L.H.G.), Psychological Medicine (T.C.), and Biostatistics (M.R.K.), King's College London, Institute of Psychiatry, London; and Neuropsychiatry Department (L.H.G., C.C., J.M., B.K.T., J.D.C.M.), South London & Maudsley NHS Foundation Trust, London, UK.

Notes

Address correspondence and reprint requests to Prof Goldstein, Department of Psychology, PO77, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK [email protected]

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