Abstracts

Rationale: Psychogenic nonepileptic seizures (PNES) are seizures without a neurological abnormality and are believed to be precipitated by psychological distress. Psychological counseling has been found to be an effective intervention for PNES management and to address the underlying psychiatric symptoms. Yet, many PNES patients remain untreated and symptomatic. The current study evaluates the outcomes of PNES patients treated with Cognitive Behavioral Therapy-informed psychotherapy (CBTip), in the 12-week regimen as well as in a flexible treatment schedule to test whether those who attended the treatment in a longer duration also responded to treatment.

Methods: We retrospectively extracted archival data on patients seen in an outpatient PNES Clinic within an Epilepsy Center from January 2015 to December 2020. Of those, 160 patients met our inclusive and exclusive criteria and had at least 7 sessions. Patient reported outcomes (PROs) that were completed by patients on a monthly basis as part of pre-visit assessments including seizure frequency, depression (PHQ-9), anxiety (GAD-7), and quality of life (QOLIE-10) were extracted for these patients. We conducted two separate analyses to examine treatment outcomes. In the first analyses, we looked at change in outcomes in pre-treatment and 90-day PRO scores. In the second analysis, we examined change by comparing pre-treatment scores with >90-day to 1-year post initial visit scores. The PROs that matched the patients' first and last visit dates were much smaller than the original number because patients tended to fail to complete the PROs.

Results: The single-predictor linear regression showed there was no significant change in outcomes based on number of visits (7-11 or more). We computed t-tests and Mann-Whitney U tests to examine for significance in mean and median change scores in outcome variables. In the first analysis in which we compared pre-treatment scores with 90 day scores, there was no significant change in seizure frequency, depression, anxiety, and quality of life variables (Table 1). In the second analysis, when we compared pre-treatment scores with 90-day-to-one-year post-initial visit scores for the patients who had 7 or more visits, there was significant improvement in seizure frequency, depression, and anxiety symptoms as shown in Table 2. For seizure frequency, 10 patients had data for seizures per day in 6 months and 5 participants (50%) improved by 50% or more in the number of seizures per day. Similar to the first analysis, there was no improvement in quality of life.

Conclusions: The current study examined outcomes of PNES patients who attended a CBTip program for a minimum of 7 visits within 90 days and no significant change was observed in treatment outcomes. However, those who attended the treatment for a minimum of 7 visits taking longer than 12-weeks and up to one year showed significant improvement in seizure frequency, anxiety and depression. The study showed that CBTip is effective for seizure control, depression, and anxiety even in patients who may take longer than the prescribed 12-week period to complete at least 7 visits.

Funding: Please list any funding that was received in support of this abstract.: No funding was received for this abstract or the research project.