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Abstract
Objective We conducted a prospective cohort study of patients with psychogenic nonepileptic seizures (PNES) to examine the association between adherence with psychotherapy and outcomes, including significant (≥50%) reduction in PNES frequency, PNES freedom, improvement in quality of life, and reduction in emergency department (ED) utilization.
Methods A total of 105 participants were referred to receive psychotherapy either at Brigham and Women's Hospital or with a local therapist. We called participants at 12–24 months follow-up and obtained detailed follow-up data from 93 participants (89%). Participants were considered adherent with psychotherapy if they attended at least 8 sessions within a 16-week period starting at the time of referral.
Results Adherence with psychotherapy was associated with reduction in seizure frequency (84% in adherent group vs 61% in nonadherent, p = 0.021), improvement in quality of life (p = 0.044), and reduction in ED utilization (p = 0.040), with medium effect sizes; there was no difference in PNES freedom. The association between adherence and ≥50% reduction in PNES frequency persisted when controlling for potential confounders in a multivariate model. Psychotherapy nonadherence was associated with baseline characteristics of self-identified minority status (odds ratio 7.47, p = 0.019) and history of childhood abuse (odds ratio 3.30, p = 0.023).
Conclusions Our study is limited in that it cannot establish a causal relationship between adherence with psychotherapy and outcomes, and the results may not generalize beyond the single quaternary care center study site. Among participants with documented PNES, adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in ED visits.
Glossary
- BWH=
- Brigham and Women's Hospital;
- ED=
- emergency department;
- EMU=
- epilepsy monitoring unit;
- OR=
- odds ratio;
- PNES=
- psychogenic nonepileptic seizures;
- QOLIE-10=
- Quality of Life in Epilepsy–10
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial page 311
- Received January 10, 2018.
- Accepted in final form October 11, 2018.
- © 2019 American Academy of Neurology
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Letters: Rapid online correspondence
- Author response to Dr. Sethi: Psychogenic seizures and comorbid epilepsy
- Psychogenic non-epileptic seizures: Make the diagnosis unequivocally
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