Marc Boudreaux

A new Yale study has shown that psychotherapy improves the quality of life for those suffering from non-epileptic seizures.

Also known as PNES, non-epileptic seizures result from a psychiatric disorder rather than a neurological one. For those with PNES, Yale researchers linked the continued use of psychotherapy with reduction in seizure frequency, improved quality of life and reduction in emergency department utilization. The study was published in the American Academy of Neurology on Jan. 4.

“The real takeaway is that neurologists, psychiatrists and psychologists need to collaborate to help patients both get into psychotherapy and get through the regimen,” said Benjamin Tolchin, neurologist, epileptologist and professor at Yale, who led the study.

The study followed 105 patients who received psychotherapy either at Brigham and Women’s Hospital or with a local therapist. In the following months, detailed follow-up data was collected for 89 percent of the participants to inform the results of the study.

To treat PNES, the study used cognitive behavioral therapy, which involves teaching patients both cognitive and behavioral skills. Cognitive skills help those suffering with PNES identify thought patterns leading to seizures and learn how to modify them. Behavioral skills use techniques such as meditation, deep breathing or total body relaxation after the onset of negative symptoms.

“The inspiration for the study is the enormous number of PNES patients we see here at Yale, at Brigham and Women’s Hospital and really at every epilepsy center across the country,” Tolchin said. “It’s really painful to see the patients’ lives torn apart by the condition.”

Despite the evidence for the success of psychotherapy, 60 percent of patients who have access to this treatment are non-adherent, failing to complete the regimen. Adherence to psychotherapy was defined as attending at least eight sessions within a 16-week period starting at the time of referral.

“The immediate direction for research is developing interventions that can address non-adherence,” said Tolchin.

Indeed, the research team recently submitted a second manuscript that looks at biological and technological interventions to address non-adherence as well as improvements in the availability of psychotherapy to those suffering from PNES.

Tolchin added that researchers have also begun to investigate the causes of PNES.

“There is some interesting research that is starting to develop but we don’t really have any definite answers yet,” he said.

Tolchin highlighted that at this stage, it is clear that there are certain risk factors for developing PNES. Significant risk factors include psychologically traumatic events such as physical, sexual and emotional abuse and certain psychological characteristics, including an inability to consciously recognize and communicate emotions.

What is yet to be discovered is why some patients who have been subjected to these risk factors develop PNES, while others do not.

“There is some early research being done with fMRI looking at the neurobiological differences between patients who do develop psychogenic seizures and those who don’t,” Tolchin explained.

According to the Epilepsy Foundation, approximately 25 percent of people who have been diagnosed with epilepsy and are not responding to drug therapy have been misdiagnosed.

Sophie Oestergaard | sophie.oestergaard@yale.edu