Cognitive-behavioral therapy appears to help reduce seizures among individuals with psychogenic nonepileptic seizures (PNES), a conversion disorder affecting over 400,000 Americans.
The study, led by W. Curt LaFrance Jr., M.D., M.P.H., director of neuropsychiatry and behavioral neurology at Rhode Island Hospital, is published online in advance of print in JAMA Psychiatry.
“PNES is much more common than people realize, in fact it’s estimated to be as prevalent as multiple sclerosis,” LaFrance said.
Researchers say the study demonstrates that through treatments with the cognitive-behavioral informed-psychotherapy workbook, the number of seizures were reduced, as well as the frequency and severity of co-morbid symptoms.
Importantly, this is the first multi-site, multiple-modality, pilot randomized controlled trial for PNES.
In the study researchers measured the effects of four treatment modalities: Medication only (sertraline); cognitive behavior therapy-informed psychotherapy (CBT-ip) only; CBT-ip plus medication (sertraline); or standard medical care/treatment as usual.
Outcome measures included seizure frequency as the primary measure; and psychosocial and functioning measures, including psychiatric symptoms, social interactions, quality of life, and global functioning, as secondary measures.
Results indicate that patients who received CBT-ip only experienced 51 percent fewer seizures and a significant improvement in the majority of the secondary measures including depression and anxiety.
The combined CBT-ip and medication group showed a 59 percent reduction in seizures and significant improvement in some secondary measures.
The medication-only group showed only a slight improvement in seizures; and the standard medical care/treatment as usual group did not show any significant improvement in primary or secondary measures.
Experts believe the findings demonstrate the importance of receiving talk therapy in additional to medication regimens.
“Too often patients are simply prescribed medications, without getting the much-needed psychotherapy,” LaFrance said.
“In fact, many patients are misdiagnosed, and therefore are prescribed antiepileptic drugs, which can make PNES worse. But we found that this therapy alone can greatly reduce anxiety, depression and seizures — much more so than medication alone, or standard medical care (SMC).
“This therapy is unique in that it takes the best methods from a few major psychotherapies and focuses on the common issues found in patients with seizures. This study shows that what is currently being done for PNES (SMC or supportive therapy) is not enough. We have to change the way we treat PNES, and now we have a method and a workbook that patients and therapists can use to do so.”
He continued, “More research is needed to understand conversion disorders, but this is an important major step to providing more appropriate and effective treatments for PNES.”