Abstracts

Rationale: We sought to examine the long-term impact of a targeted therapy for psychogenic nonepileptic seizures (PNES). PNES are a prevalent and disabling disorder, commonly incorrectly treated with antiepileptic drugs for presumed epilepsy. Despite knowledge of the disorder for centuries, effective treatments did not exist, until recently. Newer studies provide more evidence based treatments for patients with PNES (LaFrance et al, 2009; LaFrance et al, 2014). The long term impact of the treatment from prospective trials are lacking. We report 1 year follow-up results for patients treated with a cognitive based therapy-informed psychotherapy (CBT-ip).Methods: Sample included 21 patients, 81% female, with a mean/median age of 36/32 (22-54 range) years. Patients with video EEG documented PNES level diagnosis (LaFrance et al, 2013) who were treated with a time-limited 12-session seizure therapy workbook reported their PNES frequencies at time points: treatment trial entry, and 4, 8, and 12 month follow-up. Data were analyzed using generalized mixed modeling. Seizure frequency was the primary outcome. Secondary measures were collected, including new symptom development, disability, quality of life (QOL) and social functioning.Results: Out of 21 patients, 57.1% (12/21) had a personality disorder (PD) diagnosis, 67% (14/21) had a history of traumatic brain injury (TBI), and 81% (17/21) had a post-traumatic stress disorder (PTSD) diagnosis. A significant reduction in number of average weekly seizures was observed (p=.0226). Least squares estimates indicate that those without a PD diagnosis reported an average of 8.8 seizures weekly at trial entry and .16 at 12 month follow up, a 98% reduction (p=.0027) while those with a PD diagnosis reported an average of 17.2 seizures weekly at trial entry and 10.3 at 12 month follow up, a 40% decrease, though this reduction was not statistically significant (p=.99). No difference in average weekly seizures was observed between those with and without PD at entry (p=.99); however, at 12 month follow up, those without PD had significantly fewer seizures relative to those with PD (p=.0003). Patients with TBI or with PTSD did better than patients without the diagnoses (p<.0001, and p=.0003, respectively). Patients denied developing new symptoms over time (p=.3605).Conclusions: The CBT-ip initially showed a reduction in PNES frequency at the end of therapy (LaFrance et al, 2009). This seizure reduction was maintained over 1 year after enrollment, demonstrating treatment durability for the intervention. Patients with a PD diagnosis reported no significant seizure reduction; those without a PD diagnosis reported significant reduction in their seizures. Disability status also reduced over a 1 year period. Symptom subsitution, a common occurrence in the somatoform population, did not occur. This study supports the long-term sustained effect of treatment with a seizure therapy workbook.