Cognitive behavioral therapy (CBT) can benefit patients with psychogenic nonepileptic seizures (PNES), according to a new study.
PNES is a condition that is marked by seizures resembling epileptic seizures. However, unlike epilepsy, seizures in patients with PNES are not caused by the same brain cell firing that occurs with epilepsy.
Patients who suffer from PNES often exhibit a higher incidence of symptoms such as anxiety and depression than patients with epilepsy, along with a reduced quality of life due to the effect of the seizures themselves.
However, it is recognized that conditions such as anxiety and depression often respond well to CBT.
Keeping that in mind, senior author W. Curt LaFrance, Jr., MD, MPH, director of the division of neuropsychiatry and behavioral neurology at Rhode Island Hospital, developed a CBT for PNES treatment manual.
Modified from a CBT for patients with epilepsy workbook, the treatment manual has been developed over the past five years to address core issues in patients with PNES.
LaFrance, who is also an assistant professor of psychiatry and neurology (research) at the Warren Alpert Medical School of Brown University, worked with colleagues at Rhode Island Hospital's comprehensive epilepsy center to conduct an open, prospective clinical trial assessing the outcomes of outpatients with video-electroencephalogram (EEG)-confirmed PNES who were treated using the CBT for PNES manual.
The researchers outlined a clinical model for management of PNES, where a key component is to identify precursors, precipitants and perpetuating factors of the seizures.
"Based on the tendency of patients with PNES to somatize (to manifest mental pain as pain in one's body), we hypothesized that identifying and modifying cognitive distortions and environmental triggers for PNES would reduce PNES," LaFrance said.
The researchers then identified patients who were referred to the Rhode Island Hospital neuropsychiatry/behavioral neurology clinic after being diagnosed with PNES and at least one typical PNES was captured on video EEG.
Of the 101 patients who were assessed for eligibility, 21 patients met the criteria or agreed to participate. Of those 21, 17 completed the 12-week session of CBT intervention and were included in the analysis.
LaFrance noted that the results of the clinical trial showed the CBT to be effective in terms of reducing the frequency of PNES.
The evaluation of quality of life scores, as well as assessments of depression, anxiety, somatic symptoms and psychosocial functioning also showed statistically significant improvement from baseline to final session.
The study was published in the April 2009 edition of Epilepsy and Behavior.