CBTip Demonstrates Pronounced Results in Psychogenic Nonepileptic Seizures


Half of the patients who were on a flexible, longer-term Cognitive Behavioral Therapy-informed psychotherapy treatment schedule demonstrated improvements in seizure frequency by more than 50%.

Becky Tilahun, PhD

Becky Tilahun, PhD

Results from a retrospective study found significant improvements in seizure frequency, anxiety, and depression in patients with psychogenic nonepileptic seizures (PNES) when treated with Cognitive Behavioral Therapy-informed psychotherapy (CBTip) for more than a 12-week period. These results were presented at the American Epilepsy Society (AES) Annual Meeting, December 3-7, 2021 by Becky Tilahun, PhD, clinical psychologist, Cleveland Clinic.

This 2-part analysis included 160 patients who were treated with at least 7 sessions of CBTip for a 12-week period. The first analysis looked at change in outcomes in pretreatment and 90-day patient reported outcome (PRO) scores, whereas the second analysis looked at those in a flexible treatment schedule by comparing pretreatment scores with 90-day to 1-year post initial visit scores.

"One of the good things about this type of intervention is that CBTip is specifically designed for patients with nonepileptic seizures,” Tilihun told NeurologyLive®. "We know that many patients with PNES or other similar symptoms are known to not be very adherent and tend to drop out of treatment early when it’s a more general CBT. Whereas this specific type of intervention addresses seizure triggers, pre-seizure auras, and is tailored to the type of symptoms and struggles that they have."

Patient reported assessments on depression, anxiety, and quality of life, were recorded monthly prior to each visit using Patient-Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Quality of Life in Epilepsy-10 (QOLIE-10). Using single-predictor linear regression models, investigators found no significant change in outcomes based on number of visits (7-11 visits or more).

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After computing t-tests and Mann-Whitey U tests, there was no significant change in seizure frequency, with a post treatment mean of 1.3 (standard deviation [SD], 1.1) seizures per day compared to 0.3 (SD, 0.1) at pretreatment. Additionally, CBTip showed no significant change in outcomes such as depression (pretreatment PHQ-9 scores: 12.2 [SD, 5.9]; post treatment: 11.3 [SD, 7.3]; P = .455), anxiety (pretreatment GAD-7 scores: 12.3 [SD, 5.3]; post treatment: 10.1 [SD, 6.4]; P = .149), and quality of life (pre-treatment QOLIE-10 scores: 25.5 [SD, 9.2]; post treatment: 22.0 [SD, 8.5]; P = .090).

In the second analysis, Tilahun and colleagues identified a significant improvement in seizure frequency (pretreatment seizures per day: 0.5 [SD, 0.9]; post treatment: 0.2 [0.4]; P = .449), depression (pretreatment PHQ-9 scores: 13.3 [SD, 6.5]; post treatment: 9.9 [SD, 7.5] and anxiety symptoms (pretreatment GAD-7 score: 12.0 [SD, 5.8]; post treatment: 9.2 [SD, 6.2]). Only 10 patients had data from seizures per day in 6 months, and 5 (50%) improved by 50% or more in the number of seizures per day.

"Our suspicion is that even the patients in the 12-week sample may have shown some improvement if we had a larger sample size. We were also wondering if the longer duration was more beneficial since that’s where we saw the benefits, or if it’s just the sample size,” Tilahun added. “The conclusion that we drew is that we need more research to prove if that’s the case. Maybe longer, more intense care is needed or is it just because patients came infrequently and didn’t come weekly? We are curious to see what are the specific factors that helped these patients improve."

Looking forward, Tilahun mentioned she wants to evaluate this type of approach in a virtual setting. "There’s a scarcity of providers for functional neurological disorders, so one of the ways you’re going to do [treat] this is to try different approaches,” she continued. "With more research, these interventions will be more approachable and accessible for patients as opposed to just saying ‘well you don’t respond to one type of approach, there is no other option for you."

For more coverage of AES 2021, click here.

Tilahun B, Thompson N, Sankary L, Laryea F, Trunick C. Outcomes in the treatment of psychogenic non-epileptic seizures (PNES) with CBTip: improvement in seizure frequency, mood, and quality of life. Presented at AES Annual Meeting; December 3-7, 2021. Abstract 3.256
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