Clinical and Applied Psychology Unit, University of Sheffield, UK; Department of Neuropsychology, North Staffordshire Combined NHS Foundation Trust, Stoke-on-Trent, UK.
South West Yorkshire Partnership NHS Foundation Trust, UK.
Seizure. 2024 Jul;119:98-109. doi: 10.1016/j.seizure.2024.05.016. Epub 2024 May 25.
Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes.
This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes.
Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis.
The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
心理干预是治疗功能性/分离性发作（FDS）最推荐的治疗方法；然而，其对发作结局的有效性仍存在不确定性。
本系统评价和荟萃分析综合了现有数据。2023 年 2 月，我们完成了对四个电子数据库的系统检索。我们描述了所捕获的与发作相关结局的范围，使用荟萃分析方法分析治疗和随访期间收集的数据；并探索了结局之间异质性的来源。
总体而言，确定了 44 项相关研究，涉及 1300 名患者。大多数研究被归类为高（39.5%）或中（41.9%）偏倚风险。除一项研究外，所有研究均检查了发作频率；十项研究检查了发作强度、严重程度或困扰程度；一项研究检查了发作持续时间和发作群。可以对无发作和发作减少进行荟萃分析。治疗结束时无发作的合并估计值为 40%，而随访时为 36%。发作频率改善≥50%的合并率分别为 66%和 75%。无发作的纳入调节变量在组间水平上无显著性意义。在组间水平上，随着治疗阶段的进行，发作频率得到改善，具有中等程度的合并效应大小（d = 0.53）。FDS 频率每月减少 6.5 次发作。心理治疗也改善了其他（非频率）与发作相关的测量指标，但数据不足以进行荟萃分析。
本研究的结果补充了之前描述心理治疗相关非发作相关结局改善的荟萃分析。需要进一步研究最适合 FDS 严重程度测量的方法。
