An NIHR-funded and supported study has found that adding cognitive behavioural therapy (CBT) to standardised medical care gives patients with dissociative seizures longer periods of seizure freedom, less bothersome seizures and a greater quality of life.
Findings from the study, led by researchers at King’s College London, are now published in the Lancet Psychiatry.
Dissociative seizures, also called functional and non-epileptic seizures, look similar in appearance to epileptic seizures or fainting but are related to a different type of involuntary blackout that is typically distressing and disabling for patients and their carers. Up to 1 in 5 adults presenting in epilepsy clinics have this hidden condition which is one of several types of Functional Neurological Disorder (FND). Historically patients with dissociative seizures have often been ignored or disbelieved by doctors and research on treatment is limited. They are more likely to be found in women and usually have a poor outcome with a worse quality of life than people with epilepsy alone. People with dissociative seizures have a marked increase in health service use.
In the largest treatment trial to date for dissociative seizures, 368 patients from centres across England, Scotland, and Wales were followed up 6 months and 12 months after treatment courses began.
The researchers found patients treated with dissociative seizure specific CBT alongside standardised medical care reported the highest number of consecutive dissociative seizure-free days in the previous 6 months, along with greater functional status, self-rated and doctor-rated change in global impression scores, and satisfaction with treatment when compared with standardised medical care alone.
Chief Investigator Laura Goldstein, Professor of Clinical Neuropsychology at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London said: “We have delivered the first large-scale multi-centre and multi-professional trial investigating treatments for adults with dissociative seizures. This is especially important as the availability of treatment for people with this disorder has been so variable in the UK and elsewhere.
“While overall there appeared to be a reduction in how often people in both groups of the study were having dissociative seizures at the end of the trial, with no clear difference between the groups, the group who had received our package of dissociative seizure-specific CBT were reporting better functioning across a range of everyday situations.”
In the UK, there is currently no standardised care pathway for people with dissociative seizures. The researchers recommend the incorporation of seizure-specific CBT within specialist care from neurologists and psychiatrists.
Reference: Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., Medford, N., McCrone, P., Murray, J., Richardson, M. P., Pilecka, I., Eastwood, C., Moore, M., Mosweu, I., Perdue, I., Landau, S., Chalder, T., Abe, A.-M., Adab, N., … Yogarajah, M. (2020). Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry, 7(6), 491–505. https://doi.org/10.1016/S2215-0366(20)30128-0
This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.