Randomized Trials of Psychotherapeutic Treatment for Psychogenic Seizures: Scoping Review

Abstract

Background: Psychotherapy improves seizure frequency and psychosocial aspects in psychogenic nonepileptic seizures (PNES). Although randomized controlled trials (RCTs) on different psychotherapies have been conducted for almost two decades now, no review has exclusively assessed RCTs of different psychotherapies. Methods: The objective was to review RCTs of psychotherapy for PNES, to understand the impact of different psychotherapies. Eligibility criteria included full-text articles, English articles, published between years 2000 and 2020, randomized trials of psychotherapy, and the adult population. Databases included PubMed, ProQuest, Google Scholar, ScienceDirect, EBSCO, PsycINFO, Cochrane, and a random google search was conducted. Rayyan software was used to include articles that met our eligibility criteria. The search was carried out independently by two researchers Results: Based on the eligibility criteria, seven studies were found. Amongst them, cognitive behavioral therapy (CBT) was the most researched and seemed more effective when paired with standard medical care (SMC) or sertraline. Comparisons of CBT and brief psychodynamic therapy did not reveal significant differences. Other psychotherapies included motivational interview+psychotherapy, which significantly reduced seizure frequency and improved psychosocial functioning. Paradoxical intention therapy also reduced PNES symptoms; however, it has not been researched in the last 15 years. Group psychoeducation seems to have an impact only on psychosocial functioning and not on seizure frequency. Conclusion: CBT paired with SMC or sertraline and MI along with psychotherapy yields the most effective results for PNES in reducing seizure frequency and improving psychosocial functioning.

Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study

“…Despite this, the evidence for the efficacy of psychotherapy for patients with DS is still limited (Haritsa et al, 2021), with most evidence coming from small and uncontrolled studies (Baslet, 2012;Brooks et al, 2007). Although there is some controlled and adequately powered research regarding cognitive behavioural therapies (CBT) and DS, studies such as the CODES multi-centre RCT (Goldstein et al, 2020) did not yield significant differences between the treatment and the control group for their primary outcome of seizure reduction.…”