Abstracts

Rationale: Treatment trials for psychogenic nonepileptic seizures (NES) are few, despite the high prevalence and disabling nature of the disorder. The primary aim of this study is to evaluate the effect of cognitive behavioral therapy (CBT) on reduction of NES. The secondary aim is to identify predictors of treatment response in patients with NES. Methods: We conducted a prospective clinical trial assessing the frequency of NES in patients treated from a CBT for NES manual or with Family Therapy (FT). Male and female subjects, ages 18 to 65, diagnosed with video EEG confirmed NES were treated with either CBT or FT for NES. Subjects were enrolled and monitored during a two week lead in period for their baseline NES and psychosocial symptoms and functioning. At week 2, patients were treated with either CBT or FT, according to the decision of the patient and clinician. CBT was conducted in 12 weekly sessions. Family assessments were conducted in the FT group and follow up sessions were scheduled if indicated. Symptom scales were repeated at study exit. Results: Twenty-one subjects enrolled in CBT and 5 in FT. Of the FT patients, three discontinued, one transferred and one did not require further FT sessions. Of the CBT patients, 17 completed (81% completion rate), three did not schedule their final two appointments, and one discontinued because of arm pain. A 50% seizure reduction was noted in 16 of the 21 participants, and 11 of the 17 completers reported no seizures by their final CBT session. Secondary objective variables included depression, anxiety, somatic symptoms, quality of life scores and psychosocial functioning. (See Table 1.) Mean scores of these scales showed improvement from baseline to final session using paired t-tests (p < 0.05) on intent to treat analysis. Conclusions: In this trial we assessed treatment of NES with CBT and FT. CBT for NES reduced the number of NES and improved psychiatric symptoms, psychosocial functioning, and quality of life. There were not enough FT patients to draw conclusions on FT for NES. This study provides data to be used for submission of a future R01, multi-center randomized control trial for treatments of NES.