Background Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. MethodsIn this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544.
SUMMARYPurpose: Psychogenic nonepileptic seizures (PNES) continue to represent a serious diagnostic challenge for neurologists. Video-electroencephalography (EEG) studies have provided detailed knowledge of the spectrum of visible PNES manifestations. However, little is known about how patients or seizure witnesses experience PNES, although many diagnoses in seizure clinics are made on the basis of self-reported information rather than video-EEG observations. This study describes the range of PNES manifestations as they are reported by patients or seizure witnesses. Methods: Three hundred eight candidates for this study were consecutively diagnosed with PNES on the basis of video-EEG recordings of habitual seizures involving impairment of consciousness without epileptic ictal EEG activity at the Royal Hallamshire Hospital in Sheffield and the National Hospital for Neurology in London, United Kingdom. One hundred patients responded to a postal questionnaire and participated in this study. Eighty-four of the questionnaires completed by patients were accompanied by questionnaires completed by seizure witness. The patient questionnaire contained 12 demographic and clinical questions and the 86-item Paroxysmal Event Profile (PEP), asking patients to rate statements about their attacks on a five-point Likert scale (''always,'' ''frequently,'' ''sometimes,'' ''rarely,'' ''never''). The Paroxysmal Event Observer (PEO) questionnaire uses 34-items with the same Likert scale. The PEP questionnaire includes inquiries about symptoms of panic or dissociation as well as symptoms previously found to distinguish between generalized tonic-clonic seizures and syncope or thought to differentiate between epilepsy and PNES. Key findings: The item-by-item analysis revealed the inter-and intraindividual variability of PNES experiences.The majority of patients with PNES reported some phenomena, which have traditionally been attributed to epilepsy (such as seizures from sleep, experiencing a rising sensation in their body, postictal myalgia). Although most PNES were experienced as striking without warning and reported to cause loss or impairment of consciousness, most patients also reported seizure warnings in at least some of the seizures. Despite the clinical heterogeneity apparent from these findings, a correlation matrix showed that symptoms were not randomly distributed. Significant correlations were seen between duration of seizures and seizures from reported sleep (r = )0.28, p = 0.006), seizure-related motor activity and seizures from reported sleep (p = )0.48, p < 0.001), flashbacks and anxiety (p = 0.44, p < 0.001) or dissociation (p = 0.66, p < 0.001), and anxiety and dissociation (r = 0.53, p < 0.001). The comparison of similarly worded items on the PEP and PEO questionnaires showed that witnesses were more often aware of seizure triggers and a relationship between PNES and emotional stress than were patients (p = 0.001/p < 0.001). Significance: These findings based on the self-report of patients with well-characterized PNES ...
Clusters of self-reported TLOC symptoms can be used to direct patients to appropriate investigation and treatment pathways for syncope on the one hand and seizures on the other, although additional information is required for a reliable distinction, especially between epilepsy and PNES.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.