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Psychological interventions for psychogenic non-epileptic seizures: a meta-analysis (February 2017)

Introduction from Dr Markus Reuber, editor-in-chief of Seizure

Seizure 45 has published Psychological interventions for psychogenic non-epileptic seizures: a meta-analysis

From its foundation 25 years ago, Seizure has not just been a journal about epilepsy but a journal about seizure disorders. Psychogenic Nonepileptic Seizures (PNES) are one of the three most common causes of transient loss of consciousness [1]. They typically present to the same health care professionals who also deal with epilepsy. However, PNES are relatively neglected in many undergraduate and postgraduate training programs. Even experts in the management of seizures often have a much better understanding of epilepsy than PNES. And even if they are knowledgeable about the diagnostic process and how PNES can be distinguished from epilepsy, they are often very uncertain about how to treat PNES.

To be fair to the wider health care community, there are still many questions about the best treatment of PNES disorders that those who have specialized specifically in this area have to answer conclusively. Unfortunately, one of these questions is whether the treatment modality which is widely considered the intervention of choice – individual psychotherapy – is definitely effective.

The authors of my Editor’s Choice article from the current volume of Seizure, Carlson & Nicholson Perry, conclude that the combined evidence from 13 psychotherapy studies describing treatment outcomes in a total of 228 patients is that this psychological treatments may well work for PNES: almost one half of all patients were seizure free upon completion of a psychological intervention. An additional meta-analysis based on ten studies describing outcomes in a total of 137 patients with PNES revealed that four out of five who complete psychological treatment experienced a PNES frequency reduction of at least 50% [2]. This is promising and seems better than the “natural history” of PNES, when patients have not received any treatment specifically targeting their seizures [3].

Fortunately, a more definitive answer to the question whether one particularly widely available form of psychotherapy works for PNES should be available within the next two years when the “Cognitive Behavioural Therapy vs Standardised Medical Care to treat Dissociative Seizures” (CODES) trial reports its findings. To date, well over 500 patients have been recruited to this trial across the United Kingdom. If the new standards for PNES research set by this study are replicated we should soon have more definitive answers to many of the unresolved questions about PNES disorders.

(1) LaFrance Jr., W. C.; Baker, G.A.; Duncan, R.; Goldstein, L.H.; Reuber, M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach. A report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 2013;54(11),2005-18.

(2) Carlson, P., Nicholson Perry, K.; Psychological interventions for psychogenic non-epileptic seizures: A meta-analysis. Seizure 2017; 45, 142-150.

(3) Reuber, M., Pukrop, R., Bauer, J., Helmstaedter, C., Tessendorf, N., Elger, C. E. Outcome in psychogenic nonepileptic seizures: 1 to 10 year follow-up in 164 patients. Annals of Neurology 2003;53,305-11.

Event Date: 
Monday 14 July 2014 - 12:18

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Comments

My support worker as typed before and got so many contradicting answers. I am not sure what is what now with my situation. Firstly for 8 years Iwas diagnosed at the hospital with tonic seizures, I was having average 18 a day 3 at night. After 8 years they told me I gad non epileptic which I was over the moon thinking I can get back into education and seminars, I was taken off my tablets but my epilepsy got worse of which I asked my GP after 4 months when will this increase stop he said he would make appointment for the hospital the neurology got me in for a scan which said my brain was clear and said things will settle in time. That was on the Tuesday of the Thursday of the same week was seeing a professor which I had a scan again and many tests with memory which I had a V IQ . By this time I was told I had two mild strokes scars on the brain with damage on different parts of brain sensory which came a blow. My lip reader said he can't have he only had a scan 2days ago and the professor explained you have also now living with Ataxia which as taken your vision compleatly mute where brain on right side was damaged. I'm complete deaf and now part paralysed. He has put Geoff on epilepsy medication which it as reduced it rapidly after a few weeks. Is this classified non or epilepsy because I need to know on my pip records form

Submitted by Geoff Bosworth (not verified) on

Hi Geoff,

Thanks for your message. I’m sorry to hear that your confused by the information you’ve been given.

When somebody has epilepsy, something is disrupting the electrical activity in the brain. Electrical activity  is happening in our brain all the time, as the cells send messages to each other. A seizure happens when there is a sudden burst of intense activity in the brain. This causes  a temporary disruption in the way the brain normally work. And this leads to an epileptic seizure.

Non-epileptic seizures are not caused by a disruption to the electrical activity in the brain. They happen for psychological reasons rather than physical ones. These reasons could include thoughts, feelings and present or past experiences.

It can be difficult to tell the difference between epileptic seizures and non-epileptic seizures. You can’t usually tell just by looking at the person having a seizure. But there are tests that can be done to help a doctor decide whether a seizure is an epileptic seizure or non-epileptic seizure. These tests look at the electrical activity in the brain while a seizure is taking place. Usually if someone is having a non-epileptic seizure there will be no abnormal activity going on in the brain while the seizure is happening. We have some more information about diagnosing non-epileptic seizures (https://www.epilepsy.org.uk/info/diagnosis/dissociative-seizures-non-epileptic-attack-disorder-nead)  on our website. It is also worth knowing that sometimes people can be diagnosed with epileptic and non-epileptic seizures. both types of seizures.

We’re not medically trained so we can’t make a diagnosis and say whether or not your seizures are epileptic seizures. You would need to ask your doctor about this.

Regards 

Jess

Epilepsy Action Helpline Team

Submitted by rich on