Researchers at Rhode Island Hospital have found that cognitive behavioral therapy (CBT) can reduce the frequency of seizures in patients with psychogenic nonepileptic seizures (PNES), along with improving their overall quality of life.
The study was published in the April 2009 edition of Epilepsy and Behavior .
PNES is a condition that is marked by seizures resembling epileptic seizures. Unlike epilepsy, however, seizures in patients with PNES are not caused by the same brain cell firing that occurs with epilepsy. Estimates indicate that approximately 20 to 30 percent of patients who are seen in epilepsy centers actually suffer from PNES as opposed to epilepsy. Patients who suffer from PNES often exhibit a higher incidence of symptoms such as anxiety and depression than patients with epilepsy, along with a reduced quality of life due to the effect of the seizures themselves. It is recognized, however, that conditions such as anxiety and depression often respond well to CBT. To date, treatment trials for PNES are few, despite the disabling nature of the disorder.
With this in mind, senior author W. Curt LaFrance, Jr., MD, MPH, director of the division of neuropsychiatry and behavioral neurology at Rhode Island Hospital, developed a CBT for PNES treatment manual. Modified from a CBT for patients with epilepsy workbook, the treatment manual has been developed over the past five years to address core issues in patients with PNES. LaFrance, who is also an assistant professor of psychiatry and neurology (research) at the Warren Alpert Medical School of Brown University, worked with colleagues at Rhode Island Hospital's comprehensive epilepsy center to conduct an open, prospective clinical trial assessing the outcomes of outpatients with video-electroencephalogram (EEG)-confirmed PNES who were treated using the CBT for PNES manual.
LaFrance and the researchers have outlined a clinical model for management of PNES, where a key component is to identify precursors, precipitants and perpetuating factors of the seizures. LaFrance says, "Based on the tendency of patients with PNES to somatize (to manifest mental pain as pain in one's body), we hypothesized that identifying and modifying cognitive distortions and environmental triggers for PNES would reduce PNES."