From the Comprehensive Epilepsy Center, Department of Neurology (B.T., H.B., L.J.H.), and Department of Psychiatry (S.M.), Yale University School of Medicine, New Haven, CT; Epilepsy Center of Excellence, Neurology Service (B.T.), and Psychology Service (S.M.), VA Connecticut Healthcare System, Newington; and Departments of Neurology (B.T., B.A.D.) and Psychiatry (G.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Neurology. 2019 Feb 12;92(7):e675-e679. doi: 10.1212/WNL.0000000000006848. Epub 2019 Jan 4.
We conducted a prospective cohort study of patients with psychogenic nonepileptic seizures (PNES) to examine the association between adherence with psychotherapy and outcomes, including significant (≥50%) reduction in PNES frequency, PNES freedom, improvement in quality of life, and reduction in emergency department (ED) utilization.
A total of 105 participants were referred to receive psychotherapy either at Brigham and Women's Hospital or with a local therapist. We called participants at 12-24 months follow-up and obtained detailed follow-up data from 93 participants (89%). Participants were considered adherent with psychotherapy if they attended at least 8 sessions within a 16-week period starting at the time of referral.
Adherence with psychotherapy was associated with reduction in seizure frequency (84% in adherent group vs 61% in nonadherent, = 0.021), improvement in quality of life ( = 0.044), and reduction in ED utilization ( = 0.040), with medium effect sizes; there was no difference in PNES freedom. The association between adherence and ≥50% reduction in PNES frequency persisted when controlling for potential confounders in a multivariate model. Psychotherapy nonadherence was associated with baseline characteristics of self-identified minority status (odds ratio 7.47, = 0.019) and history of childhood abuse (odds ratio 3.30, = 0.023).
Our study is limited in that it cannot establish a causal relationship between adherence with psychotherapy and outcomes, and the results may not generalize beyond the single quaternary care center study site. Among participants with documented PNES, adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in ED visits.
我们对精神性非癫痫性发作（PNES）患者进行了一项前瞻性队列研究，以检验心理治疗的依从性与结局之间的关系，包括发作频率显著降低（≥50%）、PNES 发作无、生活质量改善和急诊部（ED）就诊减少。
共有 105 名患者被转诊到布列根妇女医院或当地治疗师处接受心理治疗。我们在 12-24 个月的随访中联系了参与者，并从 93 名参与者（89%）中获得了详细的随访数据。如果患者在转诊后 16 周内至少参加了 8 次治疗，我们将其视为对心理治疗依从。
心理治疗的依从性与发作频率的降低（依从组为 84%，不依从组为 61%， = 0.021）、生活质量的改善（ = 0.044）和 ED 就诊的减少（ = 0.040）有关，具有中等的效应大小；在多变量模型中控制潜在混杂因素后，PNES 发作无的差异仍然存在。在依从性与 PNES 频率降低≥50%的关联中，当控制潜在混杂因素时，在多变量模型中仍存在关联。心理治疗的不依从与自我认定的少数族裔身份（比值比 7.47， = 0.019）和儿童期虐待史（比值比 3.30， = 0.023）的基线特征有关。
我们的研究存在一定的局限性，因为它无法确定心理治疗的依从性与结局之间的因果关系，而且结果可能无法推广到除单一四级保健中心研究地点以外的地方。在有记录的 PNES 患者中，心理治疗的依从性与发作频率降低、生活质量改善和 ED 就诊减少有关。
