What is the role of cognitive behavior therapy (CBT) in the treatment of psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Goldstein et al reported that, compared with standard medical care, cognitive-behavioral therapy significantly reduced seizure activity in patients with psychogenic nonepileptic seizures. [13] Another study by LaFrance Jr. et al. found that a cognitive behavior therapy-informed psychotherapy significantly reduces the seizures in patients with PNES. [22] This study evaluated the efficacy of medication (flexible-dose sertraline hydrochloride) only, cognitive behavioral therapy informed psychotherapy (CBT-ip) only, CBT-ip with medication (sertraline), and treatment as usual. The CBT-ip group showed a 51.4% seizure reduction and significant improvement from baseline in secondary measures including depression, anxiety, quality of life, and global functioning. The CBT-ip with sertraline group showed 59.3% seizure reduction and the sertraline-only group did not show a reduction in seizures. [22]

Unfortunately, mental health services are not always easily available, especially for noninsured patients. A critical obstacle is that psychiatrists tend to be skeptical about the diagnosis of psychogenic symptoms. Even in PNES, for which EEG video monitoring allows for near-certain diagnosis, psychiatrists tend to disbelieve the diagnosis. [14] A useful approach to combat this skepticism is to provide the treating psychiatrist with video recordings of the findings, can be more convincing than written reports.


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