Psychological treatment of patients with psychogenic non-epileptic seizures: an outcome study.

Introduction: It is estimated that up to 25% of patients referred to specialised epilepsy centers suffer from psychogenic non-epileptic seizures (PNES). The prognosis is unfavourable and there are no generally accepted treatment protocols.

Method: In this study, the effect of an uncontrolled, prospective inpatient treatment program for PNES patients is evaluated. The treatment is multidisciplinary and based on cognitive behavioural principles. Seizure control, general psychopathology, anxiety, depression, coping, dissociation and health related quality of life are evaluated. Twenty-two patients participated in the study of which 16 patients were followed 6 months after treatment.

Results: After follow-up, 81% of patients had a seizure reduction of over 50%, and half of them became seizure-free. Measures of anxiety, depression and dissociation tended to normalize, coping was more adequate and health related quality of life was increased slightly. In the period between the end of treatment and follow-up the most positive effects are maintained and even strengthened. Patients who became seizure-free at follow-up improved more on the psychological outcome measures than patients with continuing seizures.

Conclusion: The outcome suggests effectiveness of the treatment. PNES patients may profit from a comprehensive, multidisciplinary treatment program following cognitive behavioural principles. Seizure cessation appears to be an important factor in the improvement of psychological functioning.