Abstracts

Rationale: Patients with psychogenic nonepileptic seizures (PNES) are often severely disabled, difficult to treat, and are frequently encountered in neurology, psychiatry, and emergency departments. The phenomenology and causes of PNES are well delineated, however, much less is known about effective treatments for PNES. Based on the prior single-center pilot trials suggesting benefit of cognitive behavioral therapy (CBT) for PNES (LaFrance et al, 2009) and a pharmacologic pilot randomized controlled trial (RCT) (LaFrance et al, 2010), this pilot RCT sought to evaluate different treatments for patients with PNES compared to standard medical care (SMC). Methods: 38 patients with video EEG-confirmed lone PNES consented, and 35 completed baseline evaluations and were randomized among three sites to one of four treatment arms: Medication (flexible-dose sertraline) only, CBT only, CBT and Medication combined, or SMC. Seizure frequency, psychosocial and function variables were collected at baseline, and prospectively at week 2, week 8 (midpoint) and week 16 (treatment completion). Within group analyses for each arm were performed on primary (seizure frequency) and secondary outcomes. Results: The CBT arm showed significant seizure reduction (p=0.03), improvement in functioning (p<0.001) and in symptoms scales (p<0.005). The combined arm showed significant improvements in functioning (p<0.01), and seizure improvement approached significance (p=0.06). Medication showed improvement in depression scores (p=0.04) and a trend in improved functioning (p=0.08). SMC showed no significant seizure reduction or improvement in secondary outcomes. Conclusions: This prospective, multi-center, multi-arm, combined treatment pilot RCT for PNES revealed significant seizure reduction and improvements in symptoms and functioning with CBT for PNES. CBT+Medication also demonstrated significant improvements, and medication alone improved depression and approached significance on secondary measures. No improvements occurred in the SMC arm. This study supports the effect of CBT for PNES and demonstrates feasibility for a multi-center fully powered RCT for PNES.