Treatment options for psychogenic seizures

Barbara Dworetzky, MD, Brigham and Women’s Hospital, Boston, MA, discusses the treatment options for psychogenic non-epileptic seizures (PNES). Various treatments exist for non-epileptic seizures; however, the most common treatment option with the most data is cognitive behavioral therapy (CBT). The CODES trial (NCT02325544) run by Prof. Goldstein has been the largest trial to date investigating CBT as a treatment for non-epileptic seizures – with 150 participants in both the CBT group and the standard medical care group. The primary outcome of CODES, seizure frequency, was not significantly different after 12 months. However, the secondary outcomes significantly improved, including post-seizure distress, quality of life, and general wellbeing. Alternatively, the treatment of focus at Brigham and Women’s Hospital concerns a mindfulness-based form of CBT, which comprises a 12-week manualized program whereby patients are seen weekly. Although various treatments are available for PNES, only a limited number of randomized controlled trials have been conducted, highlighting the need for further work in the field. This interview took place during the 2022 World Congress on Controversies in Neurology (CONy) meeting.