Abstracts

Psychogenic nonepileptic seizures (PNES) are commonly encountered during evaluations for refractory epilepsy. Treatment for this debilitating condition centers on various forms of psychotherapy. Group therapy may be an effective therapeutic strategy, particularly in combination with individual therapy. Outcome in therapeutic trials have focused mainly on measures of event frequency or quality of life, which can be influenced by comorbid physical, psychological, and social factors. Changes in the subjective quality of PNES in response to therapy have received relatively little attention. The authors devised a preliminary, retrospective study to assess the impact of group therapy in combination with individual therapy on subjective measures of PNES including frequency, intensity, duration, and semiology. Questionnaires focusing on subjective measures were completed by 7 of 10 participants in Psychodynamic Group Therapy (PDT) and 4 of 6 in Cognitive Behavioral Group Therapy (CBT). Participants had long-standing history of refractory PNES. Mean duration of participation was 16.7 months in PDT group and 6.4 months in CBT group. Two of 7 PGT respondents stopped having PNES. Of the 9 respondents who continued having PNES, 7 felt their events were less disabling, 6 reported improvement in frequency, 6 reported less intense events, 5 reported shorter events, 5 characterized events as less severe, 2 reported change in semiology, and 2 noted less cognitive impairment during events. Eight of 9 with persistent PNES had multiple event types. Five of these 8 reported a change in relative proportion of event types with decrease of more disabling events. This preliminary study reveals improvement in the subjective experience of PNES within the context of group therapy. Participants who continued to have PNES experienced fewer, less intense, and subjectively less disabling events. This preliminary retrospective study raises the possibility that measures of the subjective experience of PNES may be useful for assessing progress in psychotherapeutic interventions. Further similar analyses using validated tools and prospective designs may be of value.