Cognitive behavioral therapy–informed psychotherapy was associated with significant seizure reduction and improved comorbid symptoms and global functioning in patients with psychogenic nonepileptic seizures in a multicenter, pilot, randomized clinical trial.
In 38 patients with psychogenic nonepileptic seizures (PNES) who were randomized to receive treatment with flexible-dose sertraline hydrochloride only, cognitive behavioral therapy–informed psychotherapy (CBT-IP) only, CBT-IP along with sertraline, or treatment as usual, CBT-IP-only was associated with a 51.4% reduction in total monthly seizures and significant improvement in depression, anxiety, quality of life, and global functioning measures. Combined CBT-IP and sertraline was associated with a 59.3% reduction in total monthly seizures and with significant improvement in global functioning, Dr. W. Curt LaFrance Jr. of Brown University, Providence, R.I., and his colleagues reported July 2 in JAMA Psychiatry on behalf of the NES Treatment Trial Consortium.
Dr. W. Curt LaFrance Jr.
The patients were treated at three academic medical centers with mental health clinicians specially trained to treat outpatients with PNES, which is the most common type of conversion disorder, and which is as disabling as epilepsy. They were followed for 16 weeks. No significant seizure reduction was seen in those treated with sertraline only or with usual care, the investigators reported (JAMA Psychiatry 2014 July 2 [doi: 10.1001/jamapsychiatry.2014.817]).
The findings of this study, which address only the effect of treatment in the phase of gaining control of seizures, support the use of this type of manualized psychotherapy for patients with PNES, they concluded, noting that the durability of treatment will be assessed in future studies.
This study was supported by the American Epilepsy Society and the Research Infrastructure Award from the Epilepsy Foundation. Dr. LaFrance reported receiving research support from government institutes and epilepsy organizations and foundations, serving on the editorial boards of Epilepsia and Epilepsy & Behavior, and providing medicolegal expert testimony. Several coauthors reported receiving research support from, serving on an advisory board of, or receiving honoraria from several pharmaceutical companies.