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Brief group psychoeducation for psychogenic nonepileptic seizures: A neurologist‐initiated program in an epilepsy center
Author(s) -
Chen David K.,
Maheshwari Atul,
Franks Romay,
Trolley Gregory C.,
Robinson Jordan S.,
Hrachovy Richard A.
Publication year - 2014
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12481
Subject(s) - psychoeducation , psychogenic disease , psychosocial , epilepsy , medicine , intervention (counseling) , physical therapy , randomized controlled trial , pediatrics , psychiatry
Summary Objective To evaluate therapeutic efficacy upon augmenting the initial communication to patients regarding the diagnosis of psychogenic nonepileptic seizures ( PNES ) with a novel, brief group psychoeducation administered by the same team that provided the video–electroencephalography ( VEEG ) confirmed diagnosis and within 4 weeks of the diagnosis. Methods Prior to discharge from the epilepsy monitoring unit ( EMU ), a standardized communication strategy was utilized to explain the diagnosis of PNES to all patients prior to enrollment. Enrolled patients were then randomized to either participation in three successive and monthly group psychoeducational sessions (intervention group), or routine seizure clinic follow‐up visits (control group). Both groups completed questionnaires at time of enrollment, and then at approximately 3 months (follow‐up 1) and 6 months (follow‐up 2) after discharge, assessing for: (1) primary outcomes that include a measure of psychosocial functioning, as well as interval difference in seizure frequency/intensity; and (2) secondary outcomes that include interval seizure‐related emergency room visits or hospitalizations, development of new and medically unexplained symptoms, and results of an internal measure of knowledge and perception outcomes. Results The majority (73%) of patients from the intervention group commenced on therapy sessions within 4 weeks after learning of the diagnosis. Although we did not observe significant group difference in seizure frequency/intensity, patients from the intervention group showed significant improvement on the W ork and S ocial A djustment S cale ( WSAS ) scores at both follow‐up 1 (p = 0.013) and follow‐up 2 (p = 0.038) after discharge from the EMU . In addition, we observed a trend toward lesser likelihood for seizure‐related emergency room visits or hospitalizations for the intervention group (p = 0.184), as well as meaningful insights from an internal measure of intervention outcomes. Significance These findings suggest that our cost/resource effective, brief group psychoeducational program, when administered early and by the same team who confirmed and communicated the diagnosis of PNES , may contribute to significant functional improvement among participating patients.