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Keywords:

  • Psychogenic nonepileptic seizures;
  • Psychodynamic interpersonal therapy;
  • Health care utilization;
  • Outcome

Summary

Purpose: Most neurologists endorse psychotherapy as the treatment of choice for psychogenic nonepileptic seizures (PNES), but its effectiveness remains unproven, and there are no previous reports of long-term outcome after psychotherapy. This study aimed to establish the outcome of brief augmented psychodynamic interpersonal therapy (PIT) for 47 patients with PNES in terms of seizures and health care utilization 31–65 months (median 50 months) after diagnosis.

Methods: Participants completed questionnaires before starting therapy (Clinical Outcomes in Routine Evaluation Outcome Measure [CORE-OM]; Patient Health Questionnaire [PHQ15]; Short-Form Health Survey [SF-36]). Forty-seven of 66 consecutive patients (71%) also completed a follow-up questionnaire about current seizure frequency, employment status, and health care utilization 42 months after the end of therapy (range 12–61 months). Factors associated with seizure outcome and predictors of seizure cessation were evaluated.

Results: At follow-up, 25.5% of patients had become seizure-free; a further 40.4% achieved a seizure reduction of >50%. Logistic regression showed “economic activity” status to be the only significant baseline predictor of seizure cessation (p < 0.021). Health care utilization declined significantly from baseline to follow-up (p < 0.039), suggesting minimum expected annual health care expenditure savings of £245 ($408).

Discussion: These results indicate that this intervention is associated with a significant improvement in seizure frequency and health care utilization, suggesting that a randomized controlled study of the intervention is justified.