Treatment of Psychogenic Not-Epileptic Seizures

Psychogenic Non-Epileptic Seizures (PNES), also known equally dissociative or functional seizures or Functional Non-Epileptic Attacks (FNEA), are episodes of sensory or involuntary motor symptoms that tin can be difficult to distinguish from epileptic attacks. A substantial part of all patients under investigation for seizures are thought to take PNES, and anti-epileptic drugs do not alleviate symptoms for these patients. Although the crusade of PNES is largely unknown, psychological factors are idea to contribute.

Question

What systematic reviews or scientific studies are in that location on handling of Psycogenic Not-epileptic Seizures?

Identified literature

I systematic review with low run a risk of bias [ane] and twelve main studies were identified [ii-xiii]. The chief studies were not assessed for risk of bias.

Table one. Systematic reviews with low/medium risk of bias
Included studies Population/Intervention Issue and Results
Martlew et al, 2014 [1]
Psychological and behavioural treatments for adults with nonepileptic set on disorder (Review)
Included studies:
  • iv RCTs
  • 8 before and after not-controlled studies
 Population: Adults with any blazon of non-organic, not-epileptic seizures, with or without learning disabilities (n=343).

Intervention: Behavioural or psychological interventions.

Interventions in included studies: cognitive behavioural therapy (n=iii), hypnotherapy (n=2), paradoxical intention therapy (due north=1), psychotherapy (n=five), mixed interventions (n=1).

 Cerebral behavioural therapy vs standard medical care:

1 RCT (north=66)

Significant decrease in seizures in the CBT intervention group compared to the standard medical intendance grouping.

Cognitive behavioural therapy, before and after measurement:

1 RCT (due north=66), two not-controlled studies (n=37)

All three studies reported significant seizure reduction post-treatment compared to pre-treatment.

Psychotherapy, before and after measurement:

5 not-controlled studies (due north=53)

In three of the five studies the majority of participants experienced a decrease in seizure frequency at the finish of the treatment.

Mixed intervention, before and after measurement:
1 non-controlled written report

The majority of participants were effect-costless at the end of the handling.
Authors' conclusion: "There is little reliable evidence to support the use of any treatment, including CBT, in the treatment of non-epileptic seizures. Further randomised controlled trials of CBT and other interventions are needed."
Tabular array 2. Primary studies
Publication Study type Population Handling
Senf-Beckenbach et al
2022 [10]		 Pilot RCT Developed outpatients with PNES Trunk-focused grouping therapy
Goldstein et al
2021 [6]
Studien är även publicerad i Lancet 2020		 RCT (HTA) Adults with dissociative seizures CBT
Stager et al
2021 [eleven]		 RCT (follow up) Children with PNES Retraining and Command Therapy (ReACT)
Fobian et al 2020 [5] RCT Children with PNES Retraining and Command Therapy (ReACT)
Tolchin et al
2019 [13]		 RCT Adults with PNES Motivational interviewing
Baird et al
2017 [2]		 Airplane pilot RCT Adults with PNES CBT informed psychotherapy with or without sertraline or sertraline alone
Hill et al
2017 [7]		 Retrospective observational cohort Adults with PNES Standardized follow-up
Drane et al 2016 [4] RCT Adults with PNES Structured feedback
Hubschmid et al
2015 [eight]		 RCT Adults with conversion disorder with motor or NEA symptoms Interdisciplinary psychotherapeutic intervention
Chen et al
2014 [3]		 RCT Adults with PNES Grouping psychoeducation
LaFrance et al
2014 [nine]		 Pilot RCT Adults with PNES CBT informed psychotherapy with or without sertraline or sertraline alone
Thompson et al2012 [12] Airplane pilot RCT Adults with PNES Brief educational intervention

References

  1. Martlew J, Pulman J, Marson AG. Psychological and behavioural treatments for adults with non-epileptic attack disorder. Cochrane Database Syst Rev. 2014(2):CD006370. Available from: https://doi.org/10.1002/14651858.CD006370.pub2.
  2. Baird GL, Harlow LL, Machan JT, LaFrance WC, Jr. Cluster reduction in patients in a airplane pilot handling trial for psychogenic nonepileptic seizures. Epilepsy Behav. 2017;73:273-9. Available from: https://doi.org/10.1016/j.yebeh.2017.04.015.
  3. Chen DK, Maheshwari A, Franks R, Trolley GC, Robinson JS, Hrachovy RA. Brief grouping psychoeducation for psychogenic nonepileptic seizures: a neurologist-initiated program in an epilepsy middle. Epilepsia. 2014;55(1):156-66. Bachelor from: https://doi.org/10.1111/epi.12481.
  4. Drane DL, LaRoche SM, Ganesh GA, Teagarden D, Loring DW. A standardized diagnostic arroyo and ongoing feedback improves outcome in psychogenic nonepileptic seizures. Epilepsy Behav. 2016;54:34-9. Bachelor from: https://doi.org/x.1016/j.yebeh.2015.10.026.
  5. Fobian AD, Long DM, Szaflarski JP. Retraining and control therapy for pediatric psychogenic non-epileptic seizures. Ann Clin Transl Neurol. 2020;seven(8):1410-9. Available from: https://doi.org/10.1002/acn3.51138.
  6. Goldstein LH, Robinson EJ, Pilecka I, Perdue I, Mosweu I, Read J, et al. Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative not-epileptic seizures: the CODES RCT. Health Technol Assess. 2021;25(43):ane-144. Bachelor from: https://doi.org/10.3310/hta25430.
  7. Hill CE, Schwartz H, Dahodwala Northward, Litt B, Davis KA. Postdiagnosis neurological intendance for patients with psychogenic nonepileptic spells (PNES). Epilepsy Behav. 2017;74:64-8. Bachelor from: https://doi.org/10.1016/j.yebeh.2017.06.029.
  8. Hubschmid Thou, Aybek South, Maccaferri GE, Chocron O, Gholamrezaee MM, Rossetti AO, et al. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks. Gen Hosp Psychiatry. 2015;37(5):448-55. Bachelor from: https://doi.org/x.1016/j.genhosppsych.2015.05.007.
  9. LaFrance WC, Jr., Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71(9):997-1005. Available from: https://doi.org/10.1001/jamapsychiatry.2014.817.
  10. Senf-Beckenbach P, Hoheisel Grand, Devine J, Frank A, Obermann 50, Rose M, et al. Evaluation of a new torso-focused grouping therapy versus a guided cocky-help grouping program for adults with psychogenic non-epileptic seizures (PNES): a pilot randomized controlled feasibility study. J Neurol. 2022;269(1):427-36. Available from: https://doi.org/10.1007/s00415-021-10652-0.
  11. Stager Fifty, Szaflarski JP, Fobian Advertizing. I-year follow-upward of treatment outcomes and patient opinions of Retraining and Control Therapy (ReACT) for pediatric functional seizures. Epilepsy Behav Rep. 2021;16:100503. Available from: https://doi.org/10.1016/j.ebr.2021.100503.
  12. Thompson North, Connelly L, Peltzer J, Nowack WJ, Hamera Eastward, Hunter EE. Psychogenic nonepileptic seizures: a pilot study of a brief educational intervention. Perspect Psychiatr Care. 2013;49(ii):78-83. Bachelor from: https://doi.org/10.1111/j.1744-6163.2012.00353.x.
  13. Tolchin B, Baslet G, Suzuki J, Martino Due south, Blumenfeld H, Hirsch LJ, et al. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia. 2019;60(5):986-95. Available from: https://doi.org/x.1111/epi.14728.

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Literature searc

Medline via OvidSP eleven January 2022
Title: Treatment for Psychogenic non-epileptic seizures
The last search result, usually found at the finish of the documentation, forms the list of abstracts.

.ab. = Abstruse; .ab,ti. = Abstruse or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH bureaucracy; .sh. = Term from the Medline controlled vocabulary; .ti. = Championship; / = Term from the Medline controlled vocabulary, only does not include terms found below this term in the MeSH hierarchy; * = Focus (if plant in front of a MeSH-term); * or $ = Truncation (if plant at the end of a gratuitous text term); .mp = Text, heading discussion, field of study area node, title; " " = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Search terms Items plant
Population: Psychogenic non-epileptic seizures
1. Psychogenic Nonepileptic Seizures/ 4
2. ((psychogenic or dissoc* or nonorganic or non-organic) adj3 (episod* or seizure* or attack* or effect* or convulsion*)).ab,kf,ti. two 612
three. (functional adj3 (episod* or seizure* or attack* or convulsion*)).ab,kf,ti. 803
iv. (pseudoseizure* or pseudo-seizure* or nonepileptic* or not-epileptic*).ab,kf,ti. 4 257
5. ane OR 2 OR three OR 4 half dozen 057
Intervention: Treatment
6. exp psychotherapy/ or (therap* or treatment* or psychotherap* or CBT or management or care).ab,kf,ti.
Study types: Systematic reviews
7. (Systematic Review or Meta-Assay).pt. or Cochrane Database Syst Rev.ja. or ((systematic adj3 review) or "meta analys*" or metaanalys*).ti,ab.
Limits: XX
eight. From 2013
Combined sets
nine. 5 AND vii 98
10. 5 AND vi AND eight 1 037
Final outcome
11. Systematic reviews on Psychogenic non-epileptic seizures 98
12. Psychogenic non-epileptic seizures treatment studies from 2013 - 1 037
CINAHL via EBSCO 11 January 2022
Title: Treatment of Psychogenic not-epileptic seizures
The final search event, usually found at the end of the documentation, forms the list of abstracts.
AB = Abstract; AU = Author; DE = Term from the thesaurus; MH= Exact Bailiwick Heading from CINAHL Subject area Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; " " = Citation Marks; searches for an exact phrase; N = Nearly Operator (North) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Inside Operator (Westward) finds the words if they are within ten words of 1 another, in the gild in which y'all entered them.
Search terms Items found
Population: Psychogenic non-epileptic seizures
one. TI ( ((psychogenic OR dissoc* OR nonorganic OR not-organic) N3 (episod* OR seizure* OR set on* OR effect* OR convulsion*)) ) OR SU ( ((psychogenic OR dissoc* OR nonorganic OR non-organic) N3 (episod* OR seizure* OR attack* OR event* OR earthquake*))) OR AB ( ((psychogenic OR dissoc* OR nonorganic OR not-organic) N3 (episod* OR seizure* OR set on* OR event* OR earthquake*)) ) 566
ii. TI ( functional N3 (episod* OR seizure* or attack* OR convulsion*) ) OR SU ( functional N3 (episod* OR seizure* or attack* OR convulsion*) ) OR AB ( functional N3 (episod* OR seizure* or attack* OR convulsion*) ) 267
iii. TI ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) OR SU ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) OR AB ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) 811
four. i OR two OR 3 1 233
Intervention: Treatment
5. TI ( therap* OR treatment* OR psychotherap* OR CBT OR management OR intendance ) OR SU ( therap* OR treatment* OR psychotherap* OR CBT OR direction OR care ) OR AB ( therap* OR treatment* OR psychotherap* OR CBT OR management OR care )
Study types: Systematic reviews
6. TI ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR AB ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR PT ( (systematic N3 review) OR "meta analys*" OR metaanalys* )
Limits: 20
7. From 2013
eight. Limit to academic journals
Combined sets:
8. four AND half dozen 31
9. 4 AND 5 644
ten. 10 AND 7 AND 8 483
Final result
11. Systematic reviews on Psychogenic non-epileptic seizures 31
12. Psychogenic non-epileptic seizures treatment studies from 2013 - 483
Multi-database searching: PsycINFO, Psychology and behavioral sciences collection via EBSCO eleven January 2022 Title: Treatment of psychogenic non-epileptic seizures
The last search event, usually plant at the finish of the documentation, forms the list of abstracts.

AB = Abstruse; AU = Author; DE = Term from the thesaurus; MH= Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; " " = Citation Marks; searches for an exact phrase; N = Almost Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the gild in which they appear.; W = Within Operator (W) finds the words if they are inside x words of 1 another, in the order in which y'all entered them.
Search terms Items found
Population: Psychogenic not-epileptic seizures
i. TI ( ((psychogenic OR dissoc* OR nonorganic OR non-organic) N3 (episod* OR seizure* OR assail* OR event* OR earthquake*)) ) OR SU ( ((psychogenic OR dissoc* OR nonorganic OR non-organic) N3 (episod* OR seizure* OR assail* OR event* OR convulsion*))) OR AB ( ((psychogenic OR dissoc* OR nonorganic OR non-organic) N3 (episod* OR seizure* OR set on* OR event* OR convulsion*)) ) 2 054
two. TI ( functional N3 (episod* OR seizure* or set on* OR earthquake*) ) OR SU ( functional N3 (episod* OR seizure* or attack* OR convulsion*) ) OR AB ( functional N3 (episod* OR seizure* or assail* OR convulsion*) ) 739
3. TI ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) OR SU ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) OR AB ( pseudoseizure* OR pseudo-seizure* OR non-epileptic* OR nonepileptic* ) ii 561
4. one OR ii OR iii 4 101
Intervention: Treatment
5. TI ( therap* OR treatment* OR psychotherap* OR CBT OR direction OR care ) OR SU ( therap* OR handling* OR psychotherap* OR CBT OR management OR care ) OR AB ( therap* OR handling* OR psychotherap* OR CBT OR management OR care )
Study types: Systematic reviews
6. TI ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR AB ( (systematic N3 review) OR "meta analys*" OR metaanalys* ) OR PT ( (systematic N3 review) OR "meta analys*" OR metaanalys* )
Limits: XX
7. From 2013 -
eight. Limit to academic journals
Combined sets:
ix. 4 AND half-dozen 68
x. 4 AND 5 one 746
11. 10 AND 7 AND 8 903
Terminal result
12. Systematic reviews on Psychogenic not-epileptic seizures 68
13. Psychogenic non-epileptic seizures treatment studies from 2013 - 903
Scopus via Elsevier eleven Jan 2022
Title: Treatment of psychogenic non-epileptic seizures
The last search effect, commonly plant at the terminate of the documentation, forms the list of abstracts.

Championship-ABS-KEY = Championship or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The get-go term in the search must precede the second by a specified number of terms (n).; W/n = "Inside". The terms in the search must exist within a specified number of terms (n) in any order.; * = Truncation; " " = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document blazon commodity; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Search terms Items found
Population: Psychogenic non-epileptic seizures
one. TITLE-ABS-KEY ( ( ( psychogenic OR dissoc* OR nonorganic OR non-organic ) W/2 ( episod* OR seizure* OR attack* OR event* OR earthquake* ) ) ) three 679
2. Title-ABS-KEY ( ( functional Due west/two ( episod* OR seizure* OR attack* OR convulsion* ) ) ) 1 066
3. TITLE-ABS-KEY ( ( pseudoseizure* OR pseudo-seizure* OR not-epileptic* OR nonepileptic* ) ) 5 544
four. ane OR ii OR 3 viii 081
Intervention: Handling
5. Championship-ABS-KEY ( ( therap* OR handling* OR psychotherap* OR cbt OR management OR care ) )
Study types: Systematic reviews
half dozen. Title-ABS-Primal ( ( systematic W/2 review ) OR "meta analys*" OR metaanalys* ) OR ( SRCTITLE ( cochrane ) AND DOCTYPE ( re ) )
Limits:
7. From 2013 -
viii. Document type: Periodical article
Combined sets
ix. 4 AND 6 156
10. 4 AND v 3 505
xi. 10 AND 7 AND 8 1 423
Last result
12. Systematic reviews on Psychogenic non-epileptic seizures 156
thirteen. Psychogenic non-epileptic seizures treatment studies from 2013 - one 423

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