Outcomes of patients with functional/dissociative seizures after neurobehavioral therapy

Neurobehavioral therapy (NBT) is a multi-modal treatment that combines elements of interpersonal, dialectical, and cognitive behavioral therapy. This study aims to describe the efficacy and patient-centered outcomes of manualized NBT for patients with functional/dissociative seizures (FDS).

We conducted a retrospective chart review of 43 patients who received NBT for FDS. Patients completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Quality of Life in Epilepsy (QOLIE) questionnaires at the first and last sessions and a treatment outcome response grid at the final session assessing changes in social functioning, depression, anxiety, and sleep quality. FDS event frequency was ascertained at the end of treatment from self-reported seizure logs.

The frequency of FDS events decreased significantly from baseline to post-treatment (p < 0.01). There was also significant improvement in BDI (p < 0.01), BAI (p = 0.01), QOL (p < 0.01), and the QOLIE seizure worry subscale (p < 0.01). The most common psychiatric comorbidities were anxiety (94.0%), depression (62.0%), and post-traumatic stress disorder (32.0%). 90.0% of patients with depression reported improvement in depression, while 73.3% of those with anxiety reported improvement in anxiety. Among those who experienced impaired social functioning as a comorbid symptom, 89.5% reported improved functioning upon completion of NBT.

The results of this study suggest that manualized NBT effectively reduces seizure frequency and improves symptom comorbidities and quality of life for patients with FDS. This study supports the value of psychotherapy as a primary or adjunct treatment modality for patients with FDS.