Cognitive-behavioral therapy for psychogenic nonepileptic seizures
A pilot RCT
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).
Get full access to this article
View all available purchase options and get full access to this article.
Supplementary Material
REFERENCES
1.
World Health Organisation. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. Geneva: World Health Organization; 1992.
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994.
3.
Benbadis SR, Agrawal V, Tatum WO. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 2001;57:915–917.
4.
Mellers JDC. The approach to patients with ‘non-epileptic seizures.’ Postgrad Med J 2005;81:498–504.
5.
Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 2008;12:622–635.
6.
Baker GA, Brooks JL, Goodfellow L, Bodde N, Aldenkamp A. Treatments for non-epileptic attack disorder. Cochrane Database Syst Rev 2007;1:CD006370.
7.
Deary V, Chalder T, Sharpe M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin Psychol Rev 2007;27:781–797.
8.
Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychother Psychosom 2000;69:205–215.
9.
Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007;69:881–888.
10.
Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008;3:CD001027.
11.
Goldstein LH, Deale AC, Mitchell-O'Malley SJ, Toone BK, Mellers JD. An evaluation of cognitive behavioral therapy as a treatment for dissociative seizures: a pilot study. Cogn Behav Neurol 2004;17:41–49.
12.
LaFrance JW, Miller IW, Ryan CE, et al. Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy Behav 2009;14:591–596.
13.
Rusch MD, Morris GL, Allen L, Lathrop L. Psychological treatment of nonepileptic events. Epilepsy Behav 2001;2:277–283.
14.
Chalder T. Non-epileptic attacks: a cognitive behavioural approach in a single case approach with a four-year follow-up. Clin Psychol Psychother 1996;3:291–297.
15.
Moher D, Schulz KF, Altman DG, CONSORT group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001;134:657–662.
16.
Goldstein LH, LaFrance Jr WC, Chigwedere C, Mellers JDC, Chalder T. Cognitive behavioral treatments. In: Schachter SC, LaFrance Jr WC, eds. Gates and Rowan's Non-Epileptic Seizures, 3rd ed. New York: Cambridge University Press; 2010:281–288.
17.
Godfrey E, Chalder T, Ridsdale L, Seed P, Ogden J. Investigating the ‘active ingredients’ of cognitive behaviour therapy and counselling for patients with chronic fatigue in primary care: developing a new process measure to assess treatment fidelity and predict outcome. Br J Clin Psychol 2007;46:253–272.
18.
Marks IM. Behavioural Psychotherapy: Maudsley Pocket Book of Clinical Management. Bristol, UK: Wright; 1986.
19.
Mundt JC, Marks IM, Shear MK, Greist JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry 2002;180:461–464.
20.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002;52:69–77.
21.
Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 2001;40:429–434.
22.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
23.
Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, ed. Measuring Mental Health Needs. London: Gaskell; 2001.
24.
Cohen J. A power primer. Psychol Bull 1992;112:155–159.
25.
Landau S, Everitt BS. A Handbook of Statistical Analyses using SPSS. Boca Raton, FL: Chapman & Hall/CRC; 2004.
26.
Gates JR. Nonepileptic seizure. Epilepsy Behav 2002;3:28–33.
27.
Goldstein LH, Mellers JD. Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. J Neurol Neurosurg Psychiatry 2006;77:616–621.
28.
Reuber M, Mitchell AJ, Howlett S, Elger CE. Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission? Epilepsia 2005;46:1788–1795.
29.
Reuber M, Pukrop R, Bauer J, Helmstaedter C, Tessendorf N, Elger CE. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003;53:305–311.
30.
Oto M, Espie C, Pelosi A, Selkirk M, Duncan R. The safety of antiepileptic drug withdrawal in patients with non-epileptic seizures. J Neurol Neurosurg Psychiatry 2005;76:1682–1685.
31.
LaFrance J, Rusch MD, Machan JT. What is “treatment as usual” for nonepileptic seizures? Epilepsy Behav 2008;12:388–394.
32.
Bowman ES. Psychopathology and outcome in pseudoseizures. In: Ettinger ABE, Kanner AME, eds. Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2001:355–377.
33.
Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008;148:295–309.
Information & Authors
Information
Published In
Copyright
© 2010.
Publication History
Published online: June 14, 2010
Published in print: June 15, 2010
Notes
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Psychogenic Non-Epileptic Seizures (PNES), Epilepsy - Seizures without Triggers, (2023).https://doi.org/10.5772/intechopen.108418
- Adolescents' Perceptions of Functional Seizure Self-Management Strategies, Facilitators, and Barriers in the School Environment, Journal of Psychosocial Nursing and Mental Health Services, 61, 10, (19-27), (2023).https://doi.org/10.3928/02793695-20230424-04
- Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources?, Frontiers in Psychiatry, 14, (2023).https://doi.org/10.3389/fpsyt.2023.1120981
- Diagnosis and treatment of somatoform disorders, Neurology Clinical Practice, 2, 2, (94-102), (2023)./doi/10.1212/CPJ.0b013e31825a6183
- Functional Neurologic Disorders, Neurology Clinical Practice, 11, 2, (e152-e156), (2023)./doi/10.1212/CPJ.0000000000000949
- Views on Using Psychoactive Substances to Self-Manage Functional Neurological Disorder: Online Patient Survey Results, The Journal of Neuropsychiatry and Clinical Neurosciences, 35, 1, (77-85), (2023).https://doi.org/10.1176/appi.neuropsych.21080213
- MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND), BMJ Open, 13, 6, (e073727), (2023).https://doi.org/10.1136/bmjopen-2023-073727
- A meta‐analytic review of the effectiveness of psychological treatment of functional/dissociative seizures on non‐seizure outcomes in adults, Epilepsia, 64, 7, (1722-1738), (2023).https://doi.org/10.1111/epi.17626
- Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study, British Journal of Learning Disabilities, 51, 4, (586-596), (2023).https://doi.org/10.1111/bld.12531
- Clinician-rated outcomes of patients with functional neurological disorders treated in an outpatient clinic, Seizure: European Journal of Epilepsy, 107, (21-27), (2023).https://doi.org/10.1016/j.seizure.2023.03.005
- See more
Loading...
View Options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.