Patients with psychogenic nonepileptic seizures (PNES) who adhere to psychotherapy experience reductions in the frequency of PNES, improvements in quality of life, and decrease in emergency department visits, according to a new study published in Neurology.
Consecutive patients with PNES who were referred to psychotherapy were prospectively recruited (n=105). Patients received psychotherapy either at Brigham and Women’s Hospital or with a local psychotherapist. Researchers were able to collect 12- to 24-month follow-up data from 93 participants. Responder rate, defined as the proportion of patients who achieved a ≥50% reduction in weekly PNES frequency, made up the primary outcome. Adherence to psychotherapy was defined as patients who attended ≥8 sessions within a 16-week period beginning at referral.
Patients who were adherent to psychotherapy had a greater reduction in seizure frequency compared with nonadherent participants (84% vs 61%, respectively; P =.021). In addition, adherence to psychotherapy was associated with greater improvement in quality of life (P =.044) and reductions in emergency department visits (P =.040).
In the multivariable model, responder rate was associated with psychotherapy adherence (odds ratio [OR] 3.46; P =.038) and weekly seizure frequency (OR 1.12; P =.047). Patient variables associated with nonadherence to psychotherapy included self-identified minority status (OR 7.47; P =.019) and having a history of childhood abuse (OR 3.30; P =.023).
Limitations of the study include its lack of assessment for causal associations between responder rate and psychotherapy adherence, the small patient cohort, and the lack of data on outpatient therapies.
“Neurologists and behavioral health care providers should collaborate to develop and test new interventions to improve PNES patients’ adherence to efficacious psychotherapies,” the researchers concluded.
Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes with psychogenic nonepileptic seizures. Neurology. 2019;92(7):e675-e679.