Peter Kellaway Section of Neurophysiology, Department of Neurology, Baylor College of Medicine, Houston, Texas, U.S.A.; Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A.
Epilepsia. 2014 Jan;55(1):156-66. doi: 10.1111/epi.12481. Epub 2013 Dec 20.
To evaluate therapeutic efficacy upon augmenting the initial communication to patients regarding the diagnosis of psychogenic nonepileptic seizures (PNES) with a novel, brief group psychoeducation administered by the same team that provided the video-electroencephalography (VEEG) confirmed diagnosis and within 4 weeks of the diagnosis.
Prior to discharge from the epilepsy monitoring unit (EMU), a standardized communication strategy was utilized to explain the diagnosis of PNES to all patients prior to enrollment. Enrolled patients were then randomized to either participation in three successive and monthly group psychoeducational sessions (intervention group), or routine seizure clinic follow-up visits (control group). Both groups completed questionnaires at time of enrollment, and then at approximately 3 months (follow-up 1) and 6 months (follow-up 2) after discharge, assessing for: (1) primary outcomes that include a measure of psychosocial functioning, as well as interval difference in seizure frequency/intensity; and (2) secondary outcomes that include interval seizure-related emergency room visits or hospitalizations, development of new and medically unexplained symptoms, and results of an internal measure of knowledge and perception outcomes.
The majority (73%) of patients from the intervention group commenced on therapy sessions within 4 weeks after learning of the diagnosis. Although we did not observe significant group difference in seizure frequency/intensity, patients from the intervention group showed significant improvement on the Work and Social Adjustment Scale (WSAS) scores at both follow-up 1 (p = 0.013) and follow-up 2 (p = 0.038) after discharge from the EMU. In addition, we observed a trend toward lesser likelihood for seizure-related emergency room visits or hospitalizations for the intervention group (p = 0.184), as well as meaningful insights from an internal measure of intervention outcomes.
These findings suggest that our cost/resource effective, brief group psychoeducational program, when administered early and by the same team who confirmed and communicated the diagnosis of PNES, may contribute to significant functional improvement among participating patients.
评估在视频脑电图（VEEG）确诊诊断后 4 周内，通过同一团队提供的新的简短团体心理教育，增强对心因性非癫痫性发作（PNES）患者初始沟通的治疗效果。
在癫痫监测单元（EMU）出院前，对所有入组患者使用标准化沟通策略解释 PNES 诊断。然后，将入组患者随机分配至连续 3 个月的每月团体心理教育课程（干预组）或常规癫痫诊所随访（对照组）。两组患者在入组时和出院后约 3 个月（随访 1）和 6 个月（随访 2）时完成问卷调查，评估：（1）主要结局，包括心理社会功能的衡量标准，以及发作频率/强度的间隔差异；（2）次要结局，包括癫痫相关急诊就诊或住院的间隔、新出现的和无法解释的医疗症状的发展，以及内部知识和认知结果衡量标准的结果。
干预组中，大多数（73%）患者在得知诊断后的 4 周内开始接受治疗。尽管我们未观察到发作频率/强度的显著组间差异，但干预组患者在 EMU 出院后的随访 1（p=0.013）和随访 2（p=0.038）时，在工作和社会适应量表（WSAS）评分上均有显著改善。此外，我们观察到干预组癫痫相关急诊就诊或住院的可能性降低（p=0.184），以及干预结果内部衡量标准的有意义见解。
这些发现表明，我们的成本/资源有效、简短的团体心理教育计划，在由确诊和沟通 PNES 诊断的同一团队尽早实施时，可能有助于参与患者的功能显著改善。
