Psychological interventions for psychogenic non-epileptic seizures: a meta-analysis

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Abstract

Objectives

The aim of this meta-analysis was to evaluate and synthesise the available evidence from the previous 20 years regarding the utility of psychological interventions in the management of psychogenic non-epileptic seizures (PNES).

Methods

Studies were retrieved from MEDLINE via OvidSP and PsychINFO. Selection criteria included controlled and before-after non-controlled studies including case series, using seizure frequency as an outcome measurement. Studies were required to assess one or more types of psychological intervention for the treatment of PNES in adults. Data from 13 eligible studies was pooled to examine the effectiveness of psychological interventions in treating PNES on two primary outcomes; seizure reduction of 50% or more and seizure freedom. A meta-analysis was conducted with data extracted from 228 participants with PNES.

Results

Interventions reviewed in the analysis included CBT, psychodynamic therapy, paradoxical intention therapy, mindfulness and psychoeducation and eclectic interventions. Meta-analysis synthesised data from 13 studies with a total of 228 participants with PNES, of varied gender and age. Results showed 82% of people with PNES who complete psychological treatment experience a reduction in seizures of 50% or more. Additional meta-analysis synthesised data from 10 studies with a total of 137 participants with PNES. This analysis found 47% of people with PNES are seizure free on completion of a psychological intervention.

Conclusions

The studies identified for this analysis were diverse in nature and quality. The findings highlight the potential for psychological interventions as a favourable alternative to the limited treatment options currently offered to people with PNES.

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