Trial Examines Treatment for Psychogenic Nonepileptic Seizures

Bottom Line: A clinical trial found a reduction in seizures and improvement in related symptoms, including depression and anxiety, in patients with psychogenic nonepileptic seizures (PNES) who were treated with cognitive behavioral therapy informed psychotherapy (CBT-ip) with and without the medication sertraline.

Authors: W. Curt LaFrance, Jr., M.D., M.P.H., of Brown University, Rhode Island Hospital, Providence, R.I., and colleagues.

Background: PNES is not responsive to standard treatment and can be made worse by antiepileptic medications. Up to 20 percent of civilians and as many as 25 percent of veterans diagnosed as having epilepsy actually have PNES. PNES has psychological underpinnings but much less is known about effective treatments.

How the Study Was Conducted: The authors assigned 38 patients (34 were included in the analysis) to 1 of 4 treatment groups: Medication (flexible dose sertraline hydrochloride) only, CBT-ip only, CBT-ip with medication (sertraline) or treatment as usual (generally tapering antiepileptic medication use and a referral to a psychiatrist or psychologist).

Results:  The psychotherapy (CBT-ip) group had a 51.4 percent reduction in seizure and improvement in other measures, including depression, anxiety, quality of life and global functioning. The CBT-ip with sertraline group had a 59.3 percent reduction in seizures and improvements in other measures including global functioning. The sertraline-only group showed no significant reduction in seizures and the treatment as usual group showed no significant reduction in seizures or improvement in other measures.

Discussion: “This study supports the use of manualized psychotherapy for PNES and successful training of mental health clinicians in the treatment. Future studies could assess larger-scale intervention dissemination.”

(JAMA Psychiatry. Published online July 2, 2014. doi:10.1001/jamapsychiatry.2014.817.