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Behavioural treatments for non-epileptic attack disorder

  • Review
  • Intervention

Authors


Abstract

Background

Psychogenic non-epileptic seizures (NES) have the outward appearance of epilepsy in the absence of physiological or electroencephalographic correlates. Non-epileptic seizures can occur in isolation or in combination with epileptic seizures. The development and maintenance of non-epileptic seizures has been well documented and there is a growing literature on the treatment of NES which includes non-psychological (including anti-anxiety and antidepressant pharmacological treatment) and psychological therapies (including cognitive behavioural therapy (CBT), hypnotherapy and paradoxical therapy). Various treatment methodologies have been tried with variable success. The purpose of this Cochrane review was to establish the evidence base for the treatment of NES.

Objectives

To assess whether treatments for NES result in a reduction in frequency of seizures and/or improvement in quality of life, and whether any treatment is significantly more effective than others.

Search methods

We searched the Cochrane Epilepsy Group's Specialised Register (September 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to July 2005), and PsycINFO (1806 to July 2005). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies

Selection criteria

Randomised or quasi-randomised studies were included that assessed one or more types of psychological or non-psychological interventions for the treatment of NES. Studies of childhood NES were excluded from our review.

Data collection and analysis

Three review authors independently assessed the trials for inclusion and extracted data. Outcomes included reduction in seizure frequency and improvements in quality of life.

Main results

Three small studies met our inclusion criteria and were of poor methodological quality. Two assessed hypnosis and the other paradoxical therapy. There were no detailed reports of improved seizure frequency or quality of life outcomes, and these trials provide no reliable evidence of a beneficial effect of these interventions.

Authors' conclusions

In view of the methodological limitations and the small number of studies, we have no reliable evidence to support the use of any treatment including hypnosis or paradoxical injunction therapy in the treatment of NES. Randomised studies of these and other interventions are needed.

摘要

背景

心因性非癲癇發作發作的行為治療

心因性非癲癇發作(nonepileptic seizures ,NES)具有癲癇的外部表現,但是缺乏生理學或腦波圖上相關變化。非癲癇性發作可以單獨或伴隨癲癇一起出現。關於非癲癇性發作的產生和持續發作已有大量文獻記載,目前有越來越多關於NES治療的文獻,包括非心理性療法 (包括抗焦慮和抗抑鬱藥的藥理治療)和心理療法(包括認知行為療法 (behavioural therapy,CBT), 催眠療法和矛盾療法)。 各種治療方法均得到不同程度的成功。本次Cochrane 文獻回顧的目的是建立非癲癇性發作治療的證據基礎。

目標

評估是否經由治療可以減少NES發作頻率以及改善生活品質;以及是否有某一種治療比其他治療明顯有效。

搜尋策略

我們搜尋Cochrane Epilepsy Group's Specialised Registe(2005年9月以及Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane 圖書館,2005年第3期), MEDLINE(1966年2005年7月), PsycINFO (1806年2005年7月)等資料庫。沒有設定任何語言限制。我們檢查了所檢索出來的研究的參考文獻清單,從中獲取相關研究的補充報告。

選擇標準

我們選擇了包括隨機或半隨機的研究,評估使用一種或多種類型的心理或非心理性方法來治療NES的效果。我們在回顧中排除了針對兒童非癲癇性發作的研究。

資料收集與分析

我們有3位評論作者獨立評估了各個試驗的收錄及所擷取之資料。結果面向的評估包括發作頻率的降低以及生活品質的改善。

主要結論

有3個小規模研究符合我們的收錄標準,而其研究方法品質較差。其中2個研究評估了催眠療法,另外一個研究評估了矛盾療法。它們都沒有詳細的報告出降低發作頻率或改善生活品質等結果,因此上述試驗不能對此類方法的療效提供可靠證據。

作者結論

從方法學限制和研究數量較少的觀點來看,我們沒有可信的證據支持任何一種治療方法包括催眠療法或矛盾強制療法可有效用於非癲癇性發作,我們仍需要對於NES治療的隨機臨床試驗。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

我們尚未得到可靠的證據支持使用任一種方法來治療患有非癲癇性發作的病人。目前針對非癲癇性發作的病因已展開廣泛研究。但是有關非癲癇性發作治療的文獻還不明確。我們回顧了治療非癲癇性發作的隨機對照試驗後後,發現只有3個研究,且無法從中獲得相關療效的結論。

Plain language summary

Behavioural treatments for non-epileptic attack disorder

There is no reliable evidence to support the use of any interventions for people with non-epileptic seizures.

There has been extensive investigation of the aetiology of non-epileptic seizures. However, the literature on the treatment of such seizures is less well defined. We conducted a review of randomised controlled trials of interventions for non-epileptic seizures. We found only three studies and from these no conclusive results can be drawn.

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