NEW YORK (Reuters Health) – Brief augmented psychodynamic interpersonal therapy can abolish psychogenic nonepileptic seizures (PNES) or significantly reduce their frequency in many instances, a British team has shown.
As they report in Epilepsia, Dr. Markus Reuber at Royal Hallamshire Hospital in Sheffield and colleagues offered 108 such patients 20 sessions of augmented psychodynamic interpersonal therapy.
“In fact (as our paper states) the mean number of sessions utilised by patients accessing our service is much lower than that (making the treatment more cost effective),” Dr. Reuber noted in emailed comments.
Individualized treatment was formulated in the first session, based on predisposing, precipitating, and perpetuating factors, the authors explain.
“There are some differences between our augmented PIT (psychodynamic interpersonal therapy) approach and more ‘classical’ PIT,” Dr. Reuber continued. The main difference was incorporating some cognitive-behavioral techniques into the PIT approach.
“These techniques are mainly used to teach patients ways of controlling seizures when they happen (so that seizures occurring in therapy can be controlled) and techniques which tackle excessive avoidance behaviour,” he explained. “We have also integrated techniques originally designed for patients with PTSD, because many of our patients have been severely traumatised and because, in our experience, poorly processed traumas can give rise to PNES.”
The team approached 66 of the subjects for follow-up information an average of 42 months after completion of therapy, and 47 subjects responded. These subjects were representative of the cohort as a whole.
“At follow-up, 25.5% of patients had become seizure-free; a further 40.4% achieved a seizure reduction of >50%,” Dr. Reuber and associates report.
Another main finding was that patients classified as ‘‘economically active’’ at baseline — basically meaning they were employed and not receiving disability benefits — were 5 times more likely to become seizure free.
“The fact that receipt of health-related benefits is a negative prognostic factor is difficult to interpret,” Dr. Reuber said. “This does not (necessarily) mean that the patients are so attached to their benefits that they cannot allow themselves to get better. Benefit receipt may be a marker of severity of psychopathology (or comorbid physical disease).”
Still, while patients who are employed or in education do much better than the others, there are also some successes in the patients on benefits.
Overall, the Sheffield team says their findings justify a randomized controlled study of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures.
“We do think that PIT is a particularly useful approach for PNES because of the interpersonal elements of the disorder,” Dr. Reuber concluded. “In our view, abnormal emotional processing is one of the core aetiological factors … Many of the processes which trigger abnormal emotional processing (and the traumas which may have caused the abnormal emotional processing to develop) are played out in the interpersonal domain. Our treatment is intended to give patients a better understanding of emotional processing, how this affects physical symptoms and cognitions and how emotional processing problems can be mitigated by changing behaviours and interpersonal relationships.”
Reference:
http://dx.doi,org/10.1111/j.1528-1167.2010.02656.x
Epilepsia 2010.
