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Moro P, Lattanzi S, Beier CP, Di Bonaventura C, Cerulli Irelli E. Cognitive behavioral therapy in adults with functional seizures: A systematic review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 159:109981. [PMID: 39181107 DOI: 10.1016/j.yebeh.2024.109981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Randomized controlled clinical trials (RCTs) investigating cognitive-behavioral therapy (CBT) among adults with functional seizures (FS) have become increasingly available, prompting the opportunity to critically appraise the efficacy and safety of CBT in this population. METHODS We conducted a systematic review and meta-analysis including RCTs comparing CBT in addition to standardized medical treatment (SMT) versus SMT alone for adults with FS. The primary outcome was seizure freedom at the end of treatment. Secondary outcomes included measures of quality of life, anxiety and depression assessed via standardized clinical questionnaires. RESULTS Three RCTs were included comprising 228 participants treated with CBT and 222 with SMT. The intervention was significantly associated with seizure freedom (Odds Ratio [OR] 1.98; 95 % confidence interval [CI] 1.14, 3.46; p = 0.02; I2 = 0 %), reductions in anxiety (standardized mean difference [SMD] -0.21; 95 % CI -0.41, -0.003; p = 0.047; I2 = 0 %) and improvements in quality of life (SMD 0.34; 95 % CI 0.12, 0.57; p = 0.003; I2 = 0 %) at the end of treatment. Conversely, no significant differences between groups were observed in depression symptoms (SMD -0.19; 95 % CI -0.39, 0.02; p = 0.08; I2 = 0 %). There was no statistically significant increase in the risk of suicidal ideation and self-harm with CBT (OR 2.11; 95 % CI 0.81, 5.48; p = 0.13; I2 = 0 %) nor were there differences in terms of discontinuation rates during follow-up (OR 0.92; 95 % CI 0.49, 1.72; p = 0.79; I2 = 7 %). CONCLUSIONS There is high-quality evidence supporting the efficacy and safety of CBT in treating FS. Future research should investigate whether combining CBT with other therapeutic methods could potentially enhance treatment efficacy.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Gaskell C, Power N, Novakova B, Simmonds-Buckley M, Kerr WT, Reuber M, Kellett S, Rawlings GH. A meta-analytic evaluation of the effectiveness and durability of psychotherapy for adults presenting with functional dissociative seizures. Seizure 2024; 119:98-109. [PMID: 38824867 DOI: 10.1016/j.seizure.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes. METHODS This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes. RESULTS Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis. CONCLUSIONS The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
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Affiliation(s)
- Chris Gaskell
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Department of Neuropsychology, North Staffordshire Combined NHS Foundation Trust, Stoke-on-Trent, UK.
| | - Niall Power
- South West Yorkshire Partnership NHS Foundation Trust, UK
| | - Barbora Novakova
- Health and Wellbeing Service, NHS Sheffield Talking Therapies, Sheffield Health and Social Care NHS Foundation Trust, UK
| | - Melanie Simmonds-Buckley
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Wesley T Kerr
- Departments of Neurology & Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, S10 2JF Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Gregg H Rawlings
- Clinical and Applied Psychology Unit, University of Sheffield, UK
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Kanemoto K, Tadokoro Y, Motooka H, Kawasaki J, Horinouchi T, Tsuji T, Fukuchi T, Tomohiro O. Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases-Results at 1-year follow-up examinations. Epilepsia Open 2023; 8:134-145. [PMID: 36509699 PMCID: PMC9978061 DOI: 10.1002/epi4.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The primary purpose of this prospective multicenter study was to examine clinical and demographic feature differences according to the diagnostic level of psychogenic nonepileptic seizures (PNES) and then clarify whether prognosis may also differ accordingly. METHODS Two hundred forty-two consecutive patients strongly suspected of having PNES attacks were invited to participate, of whom 52 did not consent or contact was lost. At the 1-year follow-up examination, PNES diagnosis was reconsidered in nine patients. In 96 patients, the diagnostic level remained the same (P-group), with that in 43 considered to be clinically established (CE-group) and in 42 documented (D-group). The Qolie-10 and NDDI-E questionnaires were examined at both the study entry and the follow-up examination. RESULTS Multiple regression analysis of quality of life (QoL) score (n = 173; R2 = 0.374; F = 7.349; P < 0.001) revealed NDDI-E score (t = -6.402; P < 0.001), age of PNES onset (t = -3.026; P = 0.003), and ethnic minority status (t = 3.068; P = 0.003) as significant contributors. At entry, the P-group showed the lowest PNES attack frequency (P < 0.000), the lowest rate of antiseizure, antidepressant, and antipsychotic medication (P < 0.000; P = 0.031; P = 0.013, respectively), and the lowest proportion of psychosis (P = 0.046). At follow-up, PNES attack frequency (P < 0.000), number of admittances to emergency room (P < 0.000), and scores for QoL (P < 0.000) as well as depression (P = 0.004) were found to be significantly improved together with other collateral indicators, such as rate of antiseizure medication prescription (P = 0.001) and psychiatric symptoms (P = 0.03). Multiple regression analysis of a sample limited to patients with intellectual disability (ID) (n = 44; R2 = 0.366; F = 4.493; P = 0.002) revealed continued psychotherapy at follow-up (t = 2.610, P = 0.013) and successful reduction in antiseizure medication (t = 2.868; P = 0.007) as positively related with improved QoL. SIGNIFICANCE Clinical and the socio-psychological constellation of possible, clinically established, and documented PNES were found to differ greatly. Unexpectedly, significant effects of the continuous psychotherapeutic intervention were confirmed in PNES patients with ID.
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Affiliation(s)
| | | | | | | | - Toru Horinouchi
- Department of Psychiatry & Neurology, Hokkaido University, Sapporo, Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama University, Wakayama, Japan
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Libbon R, Rothberg B, Baker S, Heru A. Multifamily Group Psychotherapy for Patients With Nonepileptic Seizures and Their Families. Am J Psychother 2023:appipsychotherapy20210060. [PMID: 36794444 DOI: 10.1176/appi.psychotherapy.20210060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Multifamily group (MFG) psychotherapy is widely used for mental and general medical conditions. MFG therapy engages family members in caring for a loved one experiencing illness and helps clarify the impact of illness on family. Use of MFG therapy for patients with nonepileptic seizures (NES) and their families to explore satisfaction with treatment and family functioning is described. METHODS MFG therapy for patients with NES and their participating family members was incorporated into an existing interdisciplinary group-based psychotherapy treatment program. The Family Assessment Device and a novel feedback questionnaire were used to understand the effect of MFG therapy on this population. RESULTS Patients with NES (N=29) and their corresponding family members (N=29) indicated on the feedback questionnaire their satisfaction with having MFG therapy as part of their treatment; satisfaction was also evidenced by a 79% (N=49 of 62) patient participation rate. Patients and family members reported enhanced understanding of the impact of illness on the family and believed MFG therapy would help them communicate about illness and reduce family conflict. Scores on the Family Assessment Device indicated that family members perceived better family functioning than did patients (average scores of 1.84 and 2.99, respectively). CONCLUSIONS The discrepancy in perceived family functioning supports the idea of integrating family members in treatment for patients experiencing NES. The group treatment modality was satisfactory to participants and may prove useful for other kinds of somatic symptom disorders, which are often external manifestations of internal distress. Family members can become treatment allies in psychotherapy when included in treatment.
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Malda Castillo J, Beton E, Coman C, Howell B, Burness C, Martlew J, Russell L, Town J, Abbass A, Perez Algorta G, Valavanis S. Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study. PSYCHOANALYTIC PSYCHOTHERAPY 2022. [DOI: 10.1080/02668734.2021.2018623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Javier Malda Castillo
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Ella Beton
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Conor Coman
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Bethany Howell
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Chrissie Burness
- Functional Neurological Disorder Pathway, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jayne Martlew
- Functional Neurological Disorder Pathway, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Leo Russell
- Functional Neurological Disorder Service, Devon Partnership NHS Trust, Exeter, UK
| | - Joel Town
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Allan Abbass
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | | | - Sophie Valavanis
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
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Tilahun BBS, Thompson NR, Bautista JF, Sankary LR, Stanton S, Punia V. Telepsychology May Improve Treatment Adherence in Patients with Psychogenic Nonepileptic Seizures. Telemed J E Health 2021; 28:1159-1165. [PMID: 34962145 DOI: 10.1089/tmj.2021.0463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Access to mental health care is a significant challenge in patients with psychogenic nonepileptic seizures (PNES). Telepsychology can curb the access barriers and improve adherence but the role of telepsychology in improving adherence has not been well investigated. The current study examines the utility of telepsychology during the COVID-19 pandemic and treatment adherence in PNES patients. Materials and Methods: Patients with PNES admitted to a 12-week counseling program were offered two visit types: telepsychology and in-office. Visit type, visit status, and demographic information were obtained from department database. Follow-up visits in 6 months were used to examine the effect of visit type on visit status. Adherence to treatment was measured by higher attendance of scheduled visits and less cancellation and no-show rates. Results: Two hundred fifty-seven (n) patients who scheduled virtual or telepsychology visits were included in the study. After adjusting for demographic variables, and accounting for repeated measures, telepsychology visits were significantly more likely to be attended (odds ratio [OR] = 2.40, 95% confidence interval [CI] = 1.69-3.41, p < 0.001) and were significantly less likely to be canceled (OR = 0.43, 95% CI = 0.29-0.64, p < 0.001). The regression model showed patients in the telepsychology visit group attended more than three times as many visits as in-office patients (incidence rate ratios = 3.16, 95% CI = 2.13-4.73, p < 0.001). Conclusions: Patients with PNES have logistical and psychological barriers that can impede their ability to attend counseling treatment. Receiving care remotely may have been associated with higher engagement with mental health treatment compared to having to travel to counseling clinics. Considering the symptom-related restrictions patients with PNES have and the barriers presented by the COVID-19 pandemic, telepsychology played a key role for continuation of mental health treatment.
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Affiliation(s)
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Neurological Institute, Center for Outcomes Research and Evaluation, Cleveland, Ohio, USA
| | - Jocelyn F Bautista
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Lauren R Sankary
- Neuro-ethics Program, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan Stanton
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Vineet Punia
- The Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
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