Abstracts

Rationale: To investigate the effectiveness of Cognitive Behaviour Therapy (CBT) as a treatment for Dissociative (Non-epileptic) Seizures (DS). Methods: A prospective, randomised controlled trial comparing CBT with standard medical care. Sixty-six patients with DS were randomised to receive either CBT with standard medical care or standard medical care alone (33 patients in each group). A diagnosis of DS was established in the majority of patients with videoEEG telemetry and for the remaining patients by ictal EEG or clinical consensus between two physicians. Exclusion criteria included a history of epilepsy, fewer than 2 DS per month, IQ < 70 and current drug or alcohol misuse. The primary outcome measure was seizure frequency at the end of treatment and at six months follow-up. Secondary outcome measures included i) whether or not patients had been seizure free for the three months preceding the six-month follow-up and ii) scores on the Work and Social Adjustment Scale which measures the impact of the disorder in the domains of work, home management, social activities and relationships. Results: The two groups were well matched for seizure frequency, duration of DS and demographic variables. In an intention-to-treat analysis, controlling for pre-randomization seizure frequency, outcome following CBT was superior at treatment end and follow-up, with a significant time by group interaction (p=0.006). Six months after the end of treatment, patients who had received CBT were 3 times more likely to have been seizure-free for the preceding three months (p=0.086). The CBT group reported significantly less impact of their disorder on the Work and Social Adjustment Scale (p=0.017) although both groups showed improvement in these scores over time (p<0.001). Conclusions: Our findings suggest that CBT is more effective than standard medical care alone in the treatment of patients with DS. Further work is required to compare CBT with other psychological treatments controlling for therapist contact. ACKNOWLEDGEMENTS: The study was funded by the Guy's and St Thomas' Charitable Foundation, UK.