A randomized trial of motivational interviewing (MI) to improve treatment adherence and outcomes among patients with psychogenic nonepileptic seizures (PNES)
Abstract number :
3.237
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2017
Submission ID :
349777
Source :
www.aesnet.org
Presentation date :
12/4/2017 12:57:36 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Benjamin Tolchin, Brigham and Women's Hospital - Harvard Medical School; Gaston Baslet, Brigham and Women's Hospital - Harvard Medical School; Joji Suzuki, Brigham and Women's Hospital - Harvard Medical School; and Barbara Dworetzky, Brigham and Women's H
Rationale: Psychotherapy has been shown to decrease seizure frequency and improve quality of life among patients with PNES, but non-adherence with therapy is common and predicts worse seizure frequency, worse quality of life, and more frequent emergency department (ED) visits. MI is a patient-centered counseling style for addressing ambivalence about change and has been shown to be effective in increasing adherence with treatment among patients with epilepsy, schizophrenia, HIV, and other illnesses. We conducted a randomized trial of MI as an intervention to improve adherence with psychotherapy and treatment outcomes among patients with PNES. Methods: We randomized consecutive subjects newly diagnosed with PNES to receive either standard treatment or standard treatment plus a single 30 minute session of motivational interviewing at the end of their first clinic visit following their diagnosis in the epilepsy monitoring unit. Standard treatment consisted of 4 scheduled visits with a neuropsychiatrist plus a recommended course of psychotherapy, typically involving approximately 12 weekly sessions.At the time of diagnosis (baseline) and again at 3 month follow-up, we assessed PNES frequency, quality of life (as measured by the Quality of Life in Epilepsy [QOLIE]-10) and ED utilization.Subjects were considered adherent with psychotherapy if they attended at least 8 sessions over 16 weeks following diagnosis. Results: In total 60 consecutive subjects were randomized (TABLE 1). Compared to subjects receiving standard treatment, subjects receiving MI plus standard treatment were significantly more likely to be adherent with psychotherapy, had a significantly larger percent decrease in their seizure frequency, experienced a significantly larger improvement in quality of life, and trended towards decreased ED utilization (TABLE 2). Conclusions: In this randomized trial of MI vs. standard care, we found MI to be a practical and effective intervention for improving adherence with psychotherapy among historically non-adherent patients with PNES. When used as a supplement to a full course of psychotherapy, MI is effective in reducing seizure frequency and improving quality of life among patients with PNES. Funding: American Academy of Neurology/American Brain Foundation
Cormorbidity