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document
Cognitive-behavioral therapy for psychogenic nonepileptic seizures : a pilot RCT . 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 ) .
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Intervention_Psychological
Cognitive-behavioral therapy
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Intervention_Psychological
cognitive-behavioral therapy
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Intervention_Psychological
CBT
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Intervention_Pharmacological
standard medical care ( SMC )
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Intervention_Psychological
CBT
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Intervention_Pharmacological
SMC
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Intervention_Educational
CBT
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Intervention_Pharmacological
SMC
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Intervention_Pharmacological
SMC
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Intervention_Educational
CBT
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Intervention_Educational
CBT
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Intervention_Psychological
cognitive-behavioral therapy
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Intervention_Educational
CBT
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Intervention_Pharmacological
SMC
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Intervention_Pharmacological
SMC
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Outcome_Physical
seizure frequency
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Outcome_Physical
3 months of seizure freedom at 6-month follow-up
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Outcome_Mental
measures of psychosocial functioning
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Outcome_Other
health service use
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Outcome_Other
employment
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Outcome_Physical
seizure reduction following CBT
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Outcome_Physical
seizure freedom
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Outcome_Other
health service use measures
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Outcome_Other
Work and Social Adjustment Scale
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Outcome_Mental
Mood
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Outcome_Other
employment status
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Participant_Condition
psychogenic nonepileptic seizures
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Participant_Condition
psychogenic nonepileptic seizures ( PNES
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Participant_Sample-size
Sixty-six
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Participant_Condition
PNES
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Participant_Condition
PNES