Cognitive-behavioral therapy for psychogenic nonepileptic seizures A pilot RCT

被引:287
作者
Goldstein, L. H. [1 ,4 ]
Chalder, T. [2 ]
Chigwedere, C. [4 ]
Khondoker, M. R. [3 ]
Moriarty, J. [4 ]
Toone, B. K. [4 ]
Mellers, J. D. C. [4 ]
机构
[1] Kings Coll London, Dept Psychol, Inst Psychiat, London SE5 8AF, England
[2] Kings Coll London, Dept Psychol Med, Inst Psychiat, London SE5 8AF, England
[3] Kings Coll London, Dept Biostat, Inst Psychiat, London SE5 8AF, England
[4] S London & Maudsley NHS Fdn Trust, Dept Neuropsychiat, London, England
基金
英国医学研究理事会; 英国惠康基金;
关键词
CONSORT STATEMENT; HOSPITAL ANXIETY; SYMPTOMS; SCALE;
D O I
10.1212/WNL.0b013e3181e39658
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To compare cognitive-behavioral therapy (CBT) and standard medical care (SMC) as treatments for psychogenic nonepileptic seizures (PNES). Methods: Our randomized controlled trial (RCT) compared CBT with SMC in an outpatient neuropsychiatric setting. Sixty-six PNES patients were randomized to either CBT (plus SMC) or SMC alone, scheduled to occur over 4 months. PNES diagnosis was established by video-EEG telemetry for most patients. Exclusion criteria included comorbid history of epilepsy, <2 PNES/month, and IQ <70. The primary outcome was seizure frequency at end of treatment and at 6-month follow-up. Secondary outcomes included 3 months of seizure freedom at 6-month follow-up, measures of psychosocial functioning, health service use, and employment. Results: In an intention-to-treat analysis, seizure reduction following CBT was superior at treatment end (group x time interaction p < 0.0001; large to medium effect sizes). At follow-up, the CBT group tended to be more likely to have experienced 3 months of seizure freedom (odds ratio 3.125, p = 0.086). Both groups improved in some health service use measures and on the Work and Social Adjustment Scale. Mood and employment status showed no change. Conclusions: Our findings suggest that cognitive-behavioral therapy is more effective than standard medical care alone in reducing seizure frequency in PNES patients. Classification of evidence: This study provides Class III evidence that CBT in addition to SMC, as compared to SMC alone, significantly reduces seizure frequency in patients with PNES (change in median monthly seizure frequency: baseline to 6 months follow-up, CBT group, 12 to 1.5; SMC alone group, 8 to 5). Neurology (R) 2010;74:1986-1994
引用
收藏
页码:1986 / 1994
页数:9
相关论文
共 35 条
[1]  
[Anonymous], COCHRANE DATABASE SY, DOI DOI 10.1002/14651858
[2]   Treatments for non-epileptic attack disorder [J].
Baker, G. A. ;
Brooks, J. L. ;
Goodfellow, L. ;
Bodde, N. ;
Aldenkamp, A. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2007, (01)
[3]  
Beecham J., 2001, MEASURING MENTAL HLT
[4]   How many patients with psychogenic nonepileptic seizures also have epilepsy? [J].
Benbadis, SR ;
Agrawal, V ;
Tatum, WO .
NEUROLOGY, 2001, 57 (05) :915-917
[5]  
BJELLAND I, 2002, J PSYCHOSOM RES, V0052
[6]   Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration [J].
Boutron, Isabelle ;
Moher, David ;
Altman, Douglas G. ;
Schulz, Kenneth F. ;
Ravaud, Philippe .
ANNALS OF INTERNAL MEDICINE, 2008, 148 (04) :295-309
[7]  
Bowman ES, 2001, PSYCHIATRIC ISSUES IN EPILEPSY: A PRACTICAL GUIDE TO DIAGNOSIS AND TREATMENT, P355
[8]  
Chalder T, 1996, CLIN PSYCHOL PSYCHOT, V3, P291, DOI 10.1002/(SICI)1099-0879(199612)3:4<291::AID-CPP72>3.0.CO
[9]  
2-H
[10]   A POWER PRIMER [J].
COHEN, J .
PSYCHOLOGICAL BULLETIN, 1992, 112 (01) :155-159