Brief group psychoeducation for psychogenic nonepileptic seizures: A neurologist‐initiated program in an epilepsy center

Abstract

SUMMARYObjective: To evaluate therapeutic efficacy upon augmenting the initial communication to patients regarding the diagnosis of psychogenic nonepileptic seizures (PNES) with a novel, brief group psychoeducation administered by the same team that provided the video-electroencephalography (VEEG) confirmed diagnosis and within 4 weeks of the diagnosis. Methods: Prior to discharge from the epilepsy monitoring unit (EMU), a standardized communication strategy was utilized to explain the diagnosis of PNES to all patients prior to enrollment. Enrolled patients were then randomized to either participation in three successive and monthly group psychoeducational sessions (intervention group), or routine seizure clinic follow-up visits (control group). Both groups completed questionnaires at time of enrollment, and then at approximately 3 months (follow-up 1) and 6 months (follow-up 2) after discharge, assessing for: (1) primary outcomes that include a measure of psychosocial functioning, as well as interval difference in seizure frequency/ intensity; and (2) secondary outcomes that include interval seizure-related emergency room visits or hospitalizations, development of new and medically unexplained symptoms, and results of an internal measure of knowledge and perception outcomes. Results: The majority (73%) of patients from the intervention group commenced on therapy sessions within 4 weeks after learning of the diagnosis. Although we did not observe significant group difference in seizure frequency/intensity, patients from the intervention group showed significant improvement on the Work and Social Adjustment Scale (WSAS) scores at both follow-up 1 (p = 0.013) and follow-up 2 (p = 0.038) after discharge from the EMU. In addition, we observed a trend toward lesser likelihood for seizure-related emergency room visits or hospitalizations for the intervention group (p = 0.184), as well as meaningful insights from an internal measure of intervention outcomes. Significance: These findings suggest that our cost/resource effective, brief group psychoeducational program, when administered early and by the same team who confirmed and communicated the diagnosis of PNES, may contribute to significant functional improvement among participating patients.

A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy

“…The scale assesses impairment in five areas of work and social activities, including work, home management, social leisure activities, private leisure activities, and family and relationships, with higher values indicating greater impairment. The WSAS has been established as a valid, reliable and sensitive measure in a number of different disorders, including depression, anxiety, OCD, phobic disorders, or insomnia and it has proven a sensitive measure in a number of studies of patients with psychogenic non-epileptic seizures [25][26][27][28][29].…”

A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment

“…Improvements in HRQoL measures and the WSAS have previously been observed with brief psychoeducation [23,31] and with more intensive psychotherapy programmes for PNES [19] but not with the explanation of the diagnosis alone [12]. This suggests that more extensive psychological input than he explanation of the diagnosis alone or a short course of psychoeducation may be necessary to improve overall functioning and quality of life in patients with PNES.…”

“…This suggests that the psychoeducation intervention is more effective in reducing seizure frequency than communication of the diagnosis on its own, which was previously only associated with the (short term) cessation of PNES in 16% of patients when the same communication strategy was used as in the current service evaluation [12]. Chen et al [31] previously evaluated a psychoeducation program for PNES which also showed that seizure frequency did not decrease in line with the intervention.…”

“…Additionally Chen et al [31] evaluated a psychoeducation program for PNES and showed that participants receiving the intervention improved on a measure of work and social functioning, and reduced their utilisation of emergency healthcare services.…”

Psychological Interventions for Psychogenic Non-Epileptic Seizures (Pnes)

“…Sin embargo, cuando esta explicación es aceptada puede tener consecuencias significativas en el futuro de las crisis y provocar mejorías. Chen et al (2013), llevaron a cabo un programa en el que, previo a la incorporación de los pacientes, se realizaba una explicación del diagnóstico de las CNEP utilizando una estrategia de comunicación estandarizada. En la misma se enfatizaba sobre los siguientes puntos: los ataques no son epilépticos; tienen una causa psicógena, lo cual no implica que las crisis sean causadas deliberadamente por el paciente; los conflictos internalizados o suprimidos son, la mayoría de las veces, las causas de los episodios; el objetivo de la intervención es lograr el control de los eventos y para ello se utiliza como instrumentos la aceptación y la responsabilidad.…”