Abstracts

Rationale:
It is estimated that more than 20% of video-EEG monitoring admissions result in a diagnosis of psychogenic non-epileptic seizures (PNES). Many psychiatric comorbidities affecting the epilepsy population are heightened in PNES, with estimates that more than half of PNES patients suffer from depression. Prior research has shown that both mindfulness (MBCT) and cognitive behavioral therapy (CBT) can reduce seizures and general psychopathology in PNES, but common barriers to treatment include inaccessibility of treatment and provider shortage. Project UPLIFT was developed by the Managing Epilepsy Well Network as a self-management intervention to improve mood in people with epilepsy. It is a CBT/MBCT-based, time-limited intervention that is distance-delivered to groups of patients over the phone. The purpose of this study was to adapt the UPLIFT program for patients with PNES.
Method:
The original UPLIFT program includes 8 weekly sessions delivered by a trained facilitator and a co-facilitator who is often someone with epilepsy. Each session involves didactic teaching, a group exercise, skill-building, and group discussion to reinforce the material. Participants are assigned homework that serves as the basis of the check-in during the next session. This study, which was designed as proof-of-concept for the delivery of the UPLIFT intervention for patients with PNES, differed from the original as it did not include a facilitator with non-epileptic seizures. The original UPLIFT materials were modified to be appropriate for people with PNES by removing any reference to epilepsy, and instead focusing on participants’ seizures.  Primary study outcomes were feasibility and acceptability, as measured by recruitment, program delivery, adverse events, retention, and satisfaction. Secondary study endpoints included psychopathology and PNES symptomology, measured by self-report and questionnaires at three time points: pre-and-post-treatment, and 1-month follow-up.  Results 8 participants were enrolled to participate in the pilot group, and 2 withdrew prior to the first UPLIFT session. All 6 participants who attended Session 1 completed the final Session 8, and all 6 participants completed all surveys including the 1-month follow-up. The overall attendance rate was 98%, with one participant missing one session. The program was delivered effectively over the phone to the group, and there were no study-related adverse events. Participants had positive feedback for the program. The average amount that participants felt they benefited was 8/10 (range: 6.7-10). Several participants reported that UPLIFT helped them cope with stressful life events and allowed them meet others with PNES. Suggestions to improve the program included more interaction and opportunities to participate.  Initial results support program efficacy, which should be studied in a future randomized-controlled trial. No participants reported increased seizure frequency from baseline to 1-month follow-up, and four participants had a reduction in seizures at follow-up. Five of the six participants had a reduction in baseline PHQ-9 score at 1-month follow-up, and the average change in score was -3.33. UPLIFT is an evidence-based treatment for depression in people with epilepsy, and these results support its adaptation for people with PNES as well.
Conclusion:
Project UPLIFT can be adapted for the PNES population. Initial results support its efficacy in seizure control and managing psychopathology. The intervention’s use of MBCT and CBT, its group format, and distance-delivery make it an accessible and cost-effective self-management program that is well-suited for people with PNES.
Funding:
:Department of Neurology at Dartmouth-Hitchcock Medical Center.