From the Research
Psychogenic seizures, also known as psychogenic non-epileptic seizures (PNES) or functional seizures, are best treated with psychotherapy rather than antiepileptic medications, with cognitive behavioral therapy (CBT) being the primary recommended treatment. The most recent and highest quality study, published in 2021 1, found that attending at least 7 sessions of CBT-informed psychotherapy (CBTip) in longer than 3 months was effective for seizure control, depression, and anxiety.
Key Components of Treatment
- CBT or specialized psychotherapy that focuses on identifying and addressing underlying psychological triggers
- A multidisciplinary approach involving psychiatrists, neurologists, and psychologists
- Treatment for comorbid conditions like depression or anxiety with medications such as SSRIs (e.g., sertraline 50-200mg daily or fluoxetine 20-80mg daily)
- Gradual tapering of previously prescribed antiepileptic drugs under medical supervision
- Patient education about the difference between epileptic and non-epileptic seizures
- Stress management techniques, including mindfulness meditation and progressive muscle relaxation, to help reduce seizure frequency
Evidence Supporting CBT
A meta-analysis published in 2017 2 found that 47% of people with PNES are seizure free upon completion of a psychological intervention, and 82% experience a reduction in seizures of at least 50%. Another study published in 2014 3 found that CBT-ip showed a 51.4% seizure reduction and significant improvement in secondary measures, including depression, anxiety, quality of life, and global functioning.
Importance of Individualized Treatment
The exact choice of treatment should be based on individual differences in the underlying factors, as proposed in a review published in 2009 4. A study published in 2021 1 also highlighted the importance of attending at least 7 sessions of CBTip in longer than 3 months for effective treatment.
Limitations and Future Directions
While the evidence supports the use of CBT for PNES, further studies are needed to assess larger-scale intervention dissemination and to explore the potential benefits of other psychological interventions.