People with psychogenic nonepileptic seizures (PNES) who complete psychotherapy are more likely to improve than patients who do not, new research shows.

“Patients who complete psychotherapy have fewer psychogenic seizures, better quality of life, and fewer visits to the emergency department,” Dr. Benjamin Tolchin of the Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine in New Haven, CT, told Reuters Health by email. “Neurologists and behavioral health providers need to collaborate to help patients with PNES to initiate and complete psychotherapy.”


PNES are paroxysmal events involving involuntary movements or alterations of consciousness caused by psychological factors. They are relatively common, disabling, and tough to diagnose correctly because they can look and feel very much like epileptic seizures, Dr. Tolchin explained. “Even the person having the seizures and trained neurologists observing the seizures can easily confuse the two.”

The best way to differentiate PNES from epileptic seizures is capturing the seizure events on video-electroencephalogram (video-EEG). “Once the diagnosis of PNES is made, the evidence suggests that psychotherapy, and specifically cognitive behavioral therapy, is an effective treatment, while the anti-seizure medications used to treat epileptic seizures are not effective in treating PNES,” said Dr. Tolchin.

The new study, online January 4 in Neurology, provides more evidence that psychotherapy works, when patients adhere to it.

Dr. Tolchin and colleagues at Brigham and Women’s Hospital in Boston, MA, studied 105 patients diagnosed with documented PNES by board-certified epileptologists via video-EEG who were referred to psychotherapy. Eighty-seven patients (94%) were adherent to psychotherapy, defined as attending at least eight sessions within a 16-week period starting at the time of referral.

Adherent patients were more likely to achieve a 50% reduction in weekly seizure frequency than their non-adherent peers (84% vs 61%, P=0.021), see improvement in quality of life (P=0.044), and make fewer trips to the emergency department (P=0.040), “with medium effect sizes,” the researchers report in their paper.

The association between adherence to psychotherapy and a 50% reduction in PNES frequency persisted after controlling for potential confounders in a multivariate model, they say.

“There are many obstacles to completing psychotherapy,” said Dr. Tolchin, “including stigma, a shortage of behavioral health providers, and patient non-adherence. This study suggests that people of self-identified minority status or a history of childhood abuse are at increased risk of not completing psychotherapy.”

The researchers note that the study was done at a single center with a special interest in PNES, and with treatment resources that may not be available in other settings, which may limit the generalizability of the findings. “Our results should ideally be replicated in a multi-center study spanning different treatment environments,” they say.

“Internal validity of the study is also limited by heterogenous psychotherapy, variable follow-up time, and by subjective measurements of PNES frequency, which allows recall bias. Our study is further limited by a lack of data on the types of therapy performed by outpatient therapists, and the use of psychotropic and anti-seizure medications during the course of psychotherapy,” they add.

SOURCE By Megan Brooks for Reuters Health News