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Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT.

L H Goldstein1, T Chalder, C Chigwedere

  • 1Department of Psychology, King's College London, Institute of Psychiatry, London, UK. laura.goldstein@kcl.ac.uk

Neurology
|June 16, 2010
PubMed
Summary
This summary is machine-generated.

Cognitive-behavioral therapy (CBT) significantly reduces psychogenic nonepileptic seizure (PNES) frequency compared to standard medical care alone. This finding offers a more effective treatment option for PNES patients.

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Published on: August 15, 2017

Area of Science:

  • Neurology
  • Psychiatry
  • Clinical Psychology

Background:

  • Psychogenic nonepileptic seizures (PNES) are characterized by episodic neurological symptoms without an epileptic origin.
  • Standard medical care (SMC) for PNES often focuses on symptom management, with limited evidence for specific psychotherapeutic interventions.
  • Cognitive-behavioral therapy (CBT) targets psychological factors contributing to PNES, offering a potential alternative or adjunct to SMC.

Purpose of the Study:

  • To compare the efficacy of cognitive-behavioral therapy (CBT) combined with standard medical care (SMC) against SMC alone for treating psychogenic nonepileptic seizures (PNES).
  • To evaluate the impact of CBT on seizure frequency and other relevant clinical outcomes in PNES patients.

Main Methods:

  • A randomized controlled trial (RCT) involving 66 PNES patients was conducted in an outpatient neuropsychiatric setting.
  • Participants were randomized to receive either CBT plus SMC or SMC alone over a 4-month period.
  • The primary outcome measure was seizure frequency, assessed at the end of treatment and at a 6-month follow-up, with diagnosis confirmed by video-EEG telemetry for most patients.

Main Results:

  • Cognitive-behavioral therapy (CBT) demonstrated superior seizure reduction compared to standard medical care (SMC) alone at the end of treatment (p < 0.0001).
  • The CBT group showed a trend towards higher rates of sustained seizure freedom (3 months) at 6-month follow-up (OR 3.125, p = 0.086).
  • While both groups showed some improvements in health service use and psychosocial functioning (Work and Social Adjustment Scale), mood and employment status did not significantly change.

Conclusions:

  • Cognitive-behavioral therapy (CBT) is more effective than standard medical care (SMC) alone in reducing seizure frequency for patients diagnosed with psychogenic nonepileptic seizures (PNES).
  • The study provides Class III evidence supporting the addition of CBT to SMC for managing PNES.
  • Further research may explore long-term effects and specific mechanisms of CBT in PNES treatment.