Van Patten Ryan, Blum Andrew, Correia Stephen, Philip Noah S, Allendorfer Jane B, Gaston Tyler E, Goodman Adam, Grayson Leslie P, Tocco Krista, Vogel Valerie, Martin Amber, Fry Samantha, Bolding Mark, Ver Hoef Lawrence, Baird Grayson L, Szaflarski Jerzy P, LaFrance W Curt
VA Providence Healthcare System, Center forNeurorestoration and Neurotechnology, and Brown University, Providence, Rhode Island, USA.
Rhode Island Hospital and Brown University, Providence, Rhode Island, USA.
Epilepsia. 2024 Dec;65(12):3545-3560. doi: 10.1111/epi.18137. Epub 2024 Oct 10.
Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy.
In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life.
Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44-24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37-12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12-5.04) to 12-month postenrollment (mean = .98, 95% CI = .40-2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-only comparisons improved on only one of 19 (5.3%).
NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.
创伤性脑损伤（TBI）患者常伴有癫痫发作（功能性和/或癫痫性），但针对TBI合并癫痫发作患者的治疗方法有限。我们研究了神经行为疗法（NBT）对TBI合并功能性癫痫（FS）和TBI合并癫痫患者的治疗阶段及入组后1年的结局。
在这项多中心、前瞻性、三组、非随机对照试验中，对入组后进行1年随访的三组成年患者进行了招募：TBI合并视频脑电图（EEG）确诊的FS（n = 89）、TBI合并EEG确诊的癫痫（n = 29）以及经病历/病史确诊的无癫痫发作的TBI（n = 75）。排除标准包括近期有精神病或自伤行为、当前有自杀意念、正在进行诉讼或长期残疾、活动性物质使用障碍以及无法参与研究程序。TBI+FS组和TBI+癫痫组完成了针对癫痫发作的NBT，这是一种基于证据的、为期12节的多模式心理治疗，而无癫痫发作的TBI参与者接受标准医疗护理。主要结局是癫痫发作频率的变化；次要结局是心理健康、TBI相关症状、残疾和生活质量的变化。
TBI+FS参与者在治疗期间平均每月癫痫发作次数减少（p = 0.002），从基线（均值 = 16.75；95%置信区间[CI] = 11.44 - 24.53）到入组后12个月（均值 = 7.28，95%CI = 4.37 - 12.13，p = 0.002，d = 0.38）有显著差异。TBI+癫痫参与者在治疗期间每月癫痫发作次数也减少（p = 0.002）；从基线（均值 = 2.38，95%CI = 1.12 - 5.04）到入组后12个月（均值 = 0.98，95%CI = 0.40 - 2.42，p = 0.07，d = 0.22）的减少在统计学上不显著。关于次要结局指标在治疗阶段的变化，TBI+FS参与者在19个变量中的10个（52.6%）上有显著改善，TBI+癫痫参与者在19个变量中的5个（26.3%）上有改善，而仅TBI组在19个变量中的1个（5.3%）上有改善。
NBT对TBI+FS和TBI+癫痫患者有益。在入组后1年，TBI+FS患者有改善。NBT可能是一种对癫痫发作患者临床上有用的治疗方法。
