Moro Pierludovico, Lattanzi Simona, Beier Christoph P, Di Bonaventura Carlo, Cerulli Irelli Emanuele
Department of Human Neurosciences, Sapienza University, Rome, Italy.
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
Epilepsy Behav. 2024 Oct;159:109981. doi: 10.1016/j.yebeh.2024.109981. Epub 2024 Aug 24.
Randomized controlled clinical trials (RCTs) investigating cognitive-behavioral therapy (CBT) among adults with functional seizures (FS) have become increasingly available, prompting the opportunity to critically appraise the efficacy and safety of CBT in this population.
We conducted a systematic review and meta-analysis including RCTs comparing CBT in addition to standardized medical treatment (SMT) versus SMT alone for adults with FS. The primary outcome was seizure freedom at the end of treatment. Secondary outcomes included measures of quality of life, anxiety and depression assessed via standardized clinical questionnaires.
Three RCTs were included comprising 228 participants treated with CBT and 222 with SMT. The intervention was significantly associated with seizure freedom (Odds Ratio [OR] 1.98; 95 % confidence interval [CI] 1.14, 3.46; p = 0.02; I2 = 0 %), reductions in anxiety (standardized mean difference [SMD] -0.21; 95 % CI -0.41, -0.003; p = 0.047; I2 = 0 %) and improvements in quality of life (SMD 0.34; 95 % CI 0.12, 0.57; p = 0.003; I2 = 0 %) at the end of treatment. Conversely, no significant differences between groups were observed in depression symptoms (SMD -0.19; 95 % CI -0.39, 0.02; p = 0.08; I = 0 %). There was no statistically significant increase in the risk of suicidal ideation and self-harm with CBT (OR 2.11; 95 % CI 0.81, 5.48; p = 0.13; I = 0 %) nor were there differences in terms of discontinuation rates during follow-up (OR 0.92; 95 % CI 0.49, 1.72; p = 0.79; I = 7 %).
There is high-quality evidence supporting the efficacy and safety of CBT in treating FS. Future research should investigate whether combining CBT with other therapeutic methods could potentially enhance treatment efficacy.
针对功能性癫痫（FS）成人患者的认知行为疗法（CBT）的随机对照临床试验（RCT）越来越多，这促使人们有机会严格评估CBT在该人群中的疗效和安全性。
我们进行了一项系统评价和荟萃分析，纳入了比较CBT联合标准化药物治疗（SMT）与单纯SMT治疗FS成人患者的RCT。主要结局是治疗结束时无癫痫发作。次要结局包括通过标准化临床问卷评估的生活质量、焦虑和抑郁指标。
纳入了三项RCT，共228名接受CBT治疗的参与者和222名接受SMT治疗的参与者。该干预措施与治疗结束时无癫痫发作显著相关（优势比[OR]1.98；95%置信区间[CI]1.14，3.46；p = 0.02；I² = 0%）、焦虑减轻（标准化均值差[SMD] -0.21；95% CI -0.41，-0.003；p = 0.047；I² = 0%）以及生活质量改善（SMD 0.34；95% CI 0.12，0.57；p = 0.003；I² = 0%）。相反，两组在抑郁症状方面未观察到显著差异（SMD -0.19；95% CI -0.39，0.02；p = 0.08；I² = 0%）。CBT导致自杀意念和自我伤害风险无统计学显著增加（OR 2.11；95% CI 0.81，5.48；p = 0.13；I² = 0%），随访期间的停药率也无差异（OR 0.92；95% CI 0.49，1.72；p = 0.79；I² = 7%）。
有高质量证据支持CBT治疗FS的疗效和安全性。未来研究应调查将CBT与其他治疗方法联合使用是否可能提高治疗效果。
