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Published in: Journal of Neurology 1/2022

Open Access 01-01-2022 | Psychotherapy | Original Communication

Evaluation of a new body-focused group therapy versus a guided self-help group program for adults with psychogenic non-epileptic seizures (PNES): a pilot randomized controlled feasibility study

Authors: Philine Senf-Beckenbach, Matthias Hoheisel, Janine Devine, Arnina Frank, Laura Obermann, Matthias Rose, Kim Hinkelmann

Published in: Journal of Neurology | Issue 1/2022

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Abstract

Objective

Psychogenic non-epileptic seizures (PNES), a common phenomenon in neurological settings, are regarded as a paroxysmal type of functional neurological disorder (FND). In a substantial proportion, PNES are disabling with poor long-term outcomes and high economic costs. Despite the clinical and financial consequences of PNES, there is still a lack of controlled clinical trials on the treatment of this challenging disorder. The study aims to evaluate the feasibility and collect first evidence of the efficacy of a group based-intervention in PNES-patients.

Methods

A pilot randomized controlled feasibility study with a parallel-group design was performed in adult outpatients with PNES to evaluate a new body-focused group therapy (CORDIS) versus guided self-help groups. Self-assessment of dissociation (Dissociation Experience Scale—DES-20) and seizure severity (Liverpool Seizure Severity Scale—LSSS) were assessed two weeks before and two weeks after the treatment intervention and also six months after treatment as primary outcome parameters.

Results

A total of 53 patients were recruited from a specialized outpatient clinic, and out of those, 29 patients completed either the body-focused group therapy program (n = 15) or a guided self-help group (SHG) therapy (n = 14). When analyzing the ITT sample (n = 22 CORDIS group, n = 20 SHG), both groups showed an effect on seizure severity and level of dissociation. In the per protocol sample (n = 13 CORDIS group, n = 12 SHG), CORDIS was superior to the self-help group for reducing seizure severity 6 months after the treatment.

Significance

CORDIS is a newly developed body-focused group therapy program for adults with PNES. Further studies should include a multicentric design with a higher number of participants.
Literature
1.
go back to reference Avbersek A, Sisodiya S (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 81:719–725CrossRef Avbersek A, Sisodiya S (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 81:719–725CrossRef
2.
go back to reference Popkirov S, Asadi-Pooya AA, Duncan R, Gigineishvili D, Hingray C, Kanner AM, LaFrance WC, Pretorius C, Reuber M (2019) The aetiology of psychogenic-nonepileptic seizures: risk factors and comorbidities. Epileptic Disord 21(6):529–547PubMed Popkirov S, Asadi-Pooya AA, Duncan R, Gigineishvili D, Hingray C, Kanner AM, LaFrance WC, Pretorius C, Reuber M (2019) The aetiology of psychogenic-nonepileptic seizures: risk factors and comorbidities. Epileptic Disord 21(6):529–547PubMed
3.
go back to reference Asadi-Pooya AA, Sperling MR (2015) Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 46:60–65CrossRef Asadi-Pooya AA, Sperling MR (2015) Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 46:60–65CrossRef
4.
go back to reference Boesten N, Myers L, Wijnen B (2019) Quality of life and psychological dysfunction in traumatized and non-traumatized patients with psychogenic non-epileptic seizures (PNES). Epilepsy Behav 92:341–344CrossRef Boesten N, Myers L, Wijnen B (2019) Quality of life and psychological dysfunction in traumatized and non-traumatized patients with psychogenic non-epileptic seizures (PNES). Epilepsy Behav 92:341–344CrossRef
5.
go back to reference Oto M, Espie C, Pelosi A, Selkirk M, Duncan R (2005) The safety of antiepileptic drug withdrawal in patients with nonepileptic seizures. J Neurol Neurosurg Psychiatry 76(12):1682–1685CrossRef Oto M, Espie C, Pelosi A, Selkirk M, Duncan R (2005) The safety of antiepileptic drug withdrawal in patients with nonepileptic seizures. J Neurol Neurosurg Psychiatry 76(12):1682–1685CrossRef
6.
go back to reference Roenneberg C, Sattel H, Schaefert R, Henningsen P, Hausteiner-Wiehle C (2019) Clinical practice guideline: functional somatic symptoms. Dtsch Arztebl Int 116:553–560PubMedPubMedCentral Roenneberg C, Sattel H, Schaefert R, Henningsen P, Hausteiner-Wiehle C (2019) Clinical practice guideline: functional somatic symptoms. Dtsch Arztebl Int 116:553–560PubMedPubMedCentral
7.
go back to reference LaFrance WC, Grayson L, Baird MS, Barry JJ, Blum AS et al (2014) Multicenter pilot treatment trial for psychogenic nonepileptic seizures. A randomized clinical trial. JAMA Psychiat 71(9):997–1005CrossRef LaFrance WC, Grayson L, Baird MS, Barry JJ, Blum AS et al (2014) Multicenter pilot treatment trial for psychogenic nonepileptic seizures. A randomized clinical trial. JAMA Psychiat 71(9):997–1005CrossRef
8.
go back to reference Goldstein LH, Chalder T, Chigwedere C et al (2010) Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 74:1986–1994CrossRef Goldstein LH, Chalder T, Chigwedere C et al (2010) Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 74:1986–1994CrossRef
9.
go back to reference Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Reuber M, Medford N, McCrone P, Murray J, Richardson MP, Pilecka I, Eastwood C, Moore M, Mosweu I, Perdue I, Landau S, Chalder T (2020) Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre randomised controlled trial. Lancet Psychiatry 7:491–505CrossRef Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Reuber M, Medford N, McCrone P, Murray J, Richardson MP, Pilecka I, Eastwood C, Moore M, Mosweu I, Perdue I, Landau S, Chalder T (2020) Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre randomised controlled trial. Lancet Psychiatry 7:491–505CrossRef
10.
11.
go back to reference Gold SM, Enck P, Hasselmann H, Friede T, Hegerl U, Mohr DC, Otte C (2016) Control conditions for randomisde trials of behavioural interventions in psychiatry: a decision framework. Lancet Psychiatry 4(9):725–732CrossRef Gold SM, Enck P, Hasselmann H, Friede T, Hegerl U, Mohr DC, Otte C (2016) Control conditions for randomisde trials of behavioural interventions in psychiatry: a decision framework. Lancet Psychiatry 4(9):725–732CrossRef
13.
go back to reference Spitzer C, Stieglitz RD, Freyberger H (2014) Fragebogen zu dissoziativen Symptomen. Hogrefe 2014; Artikelnummer 0309101 Spitzer C, Stieglitz RD, Freyberger H (2014) Fragebogen zu dissoziativen Symptomen. Hogrefe 2014; Artikelnummer 0309101
14.
go back to reference Rodewald F, Gast U, Emrich HM (2006) Screening for major dissociative disorders with the FDS, the German version of the Dissociative Experience Scale. Psychother Psychosom Med Psychol 56(6):249–258CrossRef Rodewald F, Gast U, Emrich HM (2006) Screening for major dissociative disorders with the FDS, the German version of the Dissociative Experience Scale. Psychother Psychosom Med Psychol 56(6):249–258CrossRef
15.
go back to reference Scott-Lennox J, Bryant-Comstock L, Lennox R, Baker GA (2001) GAReliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale. Epilepsy Res 44(1)53–63CrossRef Scott-Lennox J, Bryant-Comstock L, Lennox R, Baker GA (2001) GAReliability, validity and responsiveness of a revised scoring system for the Liverpool Seizure Severity Scale. Epilepsy Res 44(1)53–63CrossRef
16.
go back to reference Rawlings GH, Brown I, Reuber M (2017) Predictors of health-related quality of life in patients with epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 68:153–158CrossRef Rawlings GH, Brown I, Reuber M (2017) Predictors of health-related quality of life in patients with epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 68:153–158CrossRef
17.
go back to reference Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 282:1737–1744CrossRef Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 282:1737–1744CrossRef
19.
go back to reference Ford AC, Moayyedi P (2010) Meta-analysis: factors affecting placebo response rate in the irritable bowel syndrome. Aliment Pharmacol Ther 32:144–158CrossRef Ford AC, Moayyedi P (2010) Meta-analysis: factors affecting placebo response rate in the irritable bowel syndrome. Aliment Pharmacol Ther 32:144–158CrossRef
20.
go back to reference Flik CE, Bakker L, Laan W, Van Rood YR, Smout AJ, De Wit NJ (2017) Systematic review: the placebo effect of psychological interventions in the treatment of irritabel bowel syndrome. World J Gastroenterol 23:2223–2233CrossRef Flik CE, Bakker L, Laan W, Van Rood YR, Smout AJ, De Wit NJ (2017) Systematic review: the placebo effect of psychological interventions in the treatment of irritabel bowel syndrome. World J Gastroenterol 23:2223–2233CrossRef
21.
go back to reference Lorig K, Ritter PL, Plant K (2005) A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Rheum 53:950–957CrossRef Lorig K, Ritter PL, Plant K (2005) A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Rheum 53:950–957CrossRef
22.
go back to reference Baker AJ, Maiorino E (2010) Assessments of emotional abuse and neglect with the CTQ: Issues and estimates. Child Youth Serv Rev 32:740–748CrossRef Baker AJ, Maiorino E (2010) Assessments of emotional abuse and neglect with the CTQ: Issues and estimates. Child Youth Serv Rev 32:740–748CrossRef
23.
go back to reference Donovan HS, Kwekkeboom KL, Rosenzweig MQ, Ward SE (2009) Non-specific effects in psycho-educational intervention research. West J Nurs Res 31(8):983–998CrossRef Donovan HS, Kwekkeboom KL, Rosenzweig MQ, Ward SE (2009) Non-specific effects in psycho-educational intervention research. West J Nurs Res 31(8):983–998CrossRef
24.
go back to reference Reuber M, Mitchell AJ, Howlett S, Elger CE (2005) Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission? Epilepsia 46:1788–1795CrossRef Reuber M, Mitchell AJ, Howlett S, Elger CE (2005) Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission? Epilepsia 46:1788–1795CrossRef
25.
go back to reference Cohen J (1988) Statistical power analysis for the behavioral sciences. Routledge Academic, New York Cohen J (1988) Statistical power analysis for the behavioral sciences. Routledge Academic, New York
26.
go back to reference Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t tests and ANOVAs. Front Psychol 4:863CrossRef Lakens D (2013) Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t tests and ANOVAs. Front Psychol 4:863CrossRef
27.
go back to reference Payne H, Stott D (2010) Change in the moving bodymind: quantitative results from a pilot study on the use of the BodyMind approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs). Cousn Psychother Res 10:295–306CrossRef Payne H, Stott D (2010) Change in the moving bodymind: quantitative results from a pilot study on the use of the BodyMind approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs). Cousn Psychother Res 10:295–306CrossRef
28.
go back to reference Gerhardt C, Hamouda K, Irorutola F, Rose M, Hinkelmann K, Buchheim A, Senf-Beckenbach P (2020) Insecure and unresolved/disorganized attachment in patients with psychogenic non-epileptic seizures. Psychosomatics S0033–3182(20)30154Nov;112:107492 Gerhardt C, Hamouda K, Irorutola F, Rose M, Hinkelmann K, Buchheim A, Senf-Beckenbach P (2020) Insecure and unresolved/disorganized attachment in patients with psychogenic non-epileptic seizures. Psychosomatics S0033–3182(20)30154Nov;112:107492
29.
go back to reference Irorutola F, Gerhardt C, Hamuoda K, Rose M, Hinkelmann K, Senf-Beckenbach P (2020) Emotional and cognitive empathy in patients with psychogenic non-epileptic seizures. Seizure 81:280–286CrossRef Irorutola F, Gerhardt C, Hamuoda K, Rose M, Hinkelmann K, Senf-Beckenbach P (2020) Emotional and cognitive empathy in patients with psychogenic non-epileptic seizures. Seizure 81:280–286CrossRef
30.
go back to reference Senf-Beckenbach P, Hamouda K, Irorutola F, Gerhardt C, Rose M, Hinkelmann K (2020) Ictal level of awareness in psychogenic nonepileptic seizures correlates with the experience of traumatic events in childhood: a cross-sectional study. Epilepsy Behav 112:107492CrossRef Senf-Beckenbach P, Hamouda K, Irorutola F, Gerhardt C, Rose M, Hinkelmann K (2020) Ictal level of awareness in psychogenic nonepileptic seizures correlates with the experience of traumatic events in childhood: a cross-sectional study. Epilepsy Behav 112:107492CrossRef
Metadata
Title
Evaluation of a new body-focused group therapy versus a guided self-help group program for adults with psychogenic non-epileptic seizures (PNES): a pilot randomized controlled feasibility study
Authors
Philine Senf-Beckenbach
Matthias Hoheisel
Janine Devine
Arnina Frank
Laura Obermann
Matthias Rose
Kim Hinkelmann
Publication date
01-01-2022
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 1/2022
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-021-10652-0

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