Sustained improvement with mindfulness-based therapy for psychogenic nonepileptic seizures

Gaston Baslet; Robert Ridlon; Geoffrey Raynor; Irene Gonsalvez; Barbara A Dworetzky

doi:10.1016/j.yebeh.2021.108478

Sustained improvement with mindfulness-based therapy for psychogenic nonepileptic seizures

Epilepsy Behav. 2022 Jan:126:108478. doi: 10.1016/j.yebeh.2021.108478. Epub 2021 Dec 15.

Authors

Gaston Baslet¹, Robert Ridlon², Geoffrey Raynor³, Irene Gonsalvez⁴, Barbara A Dworetzky⁵

Affiliations

¹ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: gbaslet@bwh.harvard.edu.
² Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: rridlon@bwh.harvard.edu.
³ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: graynor@bwh.harvard.edu.
⁴ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: igonsalvez@bwh.harvard.edu.
⁵ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. Electronic address: bdworetzky@bwh.harvard.edu.

PMID: 34922325
DOI: 10.1016/j.yebeh.2021.108478

Abstract

Background: We previously reported on the efficacy of a manualized 12-session mindfulness-based therapy (MBT) for psychogenic nonepileptic seizures (PNES). Completion of MBT provided improvements in weekly PNES frequency and self-rated intensity.

Objectives: In this study, we aimed to determine sustainability of improvement of seizure-related measures at 3- to 6-month follow-up after treatment completion. We also examined changes at treatment end and at follow-up on therapeutic targets of the MBT program.

Methods: Patients with documented PNES were recruited from 2014 to 2018. Baseline measures were collected at time of diagnosis (T0) and at first follow-up post-diagnosis (T1). Outcomes are reported at MBT treatment completion (T3) and 3- to 6-month follow-up (T4). The Wilcoxon signed-rank test was used for pair-wise comparisons of PNES frequency; linear mixed models were used for other outcomes.

Results: Fourteen of the 26 MBT completers (54%) attended follow-up (median 147.5 days between T3 and T4). PNES frequency, intensity, and number of days/week with PNES remained reduced at T4 (p < 0.01 for all; median frequency reduction 1.3/week from T1). Illness perception and feeling understood remained improved at T4 (p < 0.001 for both) as did worry about PNES (p < 0.05). Illness attribution (physical, mental or both) changed from T0 to T3 (p < 0.01), but not to T4. Psychological flexibility did not change over time.

Conclusion: Previously reported improvements in seizure-related measures with MBT at treatment conclusion were maintained at 3- to 6-month follow-up. There were sustained improvements in some underlying processes (illness perception, feeling understood, and symptom worry) over the course of treatment and at follow-up. Long-term benefits of MBT need to be established with randomized controlled trials.

Keywords: Functional neurological disorder; Mindfulness; Psychogenic nonepileptic seizures; Psychotherapy; Trial.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety
Electroencephalography
Humans
Mindfulness*
Psychogenic Nonepileptic Seizures
Psychophysiologic Disorders / complications
Psychophysiologic Disorders / diagnosis
Psychophysiologic Disorders / therapy
Seizures / psychology
Treatment Outcome