Gaskell, C. orcid.org/0000-0002-7589-5246, Power, N. orcid.org/0000-0002-7788-7418, Novakova, B. orcid.org/0000-0001-9638-7032 et al. (5 more authors) (2024) A meta-analytic evaluation of the effectiveness and durability of psychotherapy for adults presenting with functional dissociative seizures. Seizure: European Journal of Epilepsy, 119. pp. 98-109. ISSN 1059-1311
Abstract
Background: Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes.
Methods: 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.
Results: 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.
Conclusions: 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Author(s). Published by Elsevier Ltd on behalf of British Epilepsy Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: | psychogenic non epileptic seizures; non epileptic attack disorder; non epileptic seizures; psychological therapy; cognitive behavioural therapy; psychological intervention |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield) The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 28 May 2024 09:13 |
Last Modified: | 06 Jun 2024 15:40 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.seizure.2024.05.016 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:212857 |