New Ways to Treat Nonepilepsy Seizures or PNES?

• Nonepilepsy seizures are seizures that are not caused by electrical discharges in the brain.
• A new pilot study evaluates different treatments for psychogenic nonepileptic seizures.

Community Corner:  New ways to treat nonepilepsy seizures or PNES?

One of the biggest problems for people with seizures is finding the right treatment. Often, people try seizure medications for years without success. Later, they may find that their seizures weren’t caused by electrical discharges in the brain. As a result, these seizures don’t respond to standard seizure medications! If psychological factors are thought to be the cause of nonepilepsy seizures, a person may be diagnosed with PNES or psychogenic nonepileptic seizures.

So what will help? 
This is a great question! For years, if the events weren’t epilepsy, health care providers didn’t really know what to do and what would work best, if anything. Some people may have benefited from medications for mood or some form of therapy. For many others, no treatment has been found, or they have not received treatment for PNES.

In recent years, attention has focused on non-medication ways of treating PNES, mood disorders, or other chronic health conditions. One treatment receiving a lot of attention is cognitive behavioral therapy (CBT). This treatment aims to control people’s symptoms by helping them learn new ways of thinking about their symptoms and using new skills or behaviors to treat or respond to them.

A pilot study for treatment of PNES
Results of a long awaited pilot study to evaluate different treatments for psychogenic nonepileptic seizures was published in the Journal of the American Medical Association (JAMA). The study looked at the response of people who received one of the following treatments:

• Sertraline, a commonly used antidepressant medication
• A form of cognitive behavioral therapy
• A form of cognitive behavioral therapy and sertraline
• Standard medical care

The CBT incorporated techniques from other approaches to address the main issues found in people with PNES. A workbook was developed for this treatment and was used by people in the study.

Participants included 38 people who were diagnosed with PNES and did not have epilepsy. Results from 34 of the participants were evaluated to see if the treatment changed seizure frequency or other psychosocial and functional measures (for example, depression, anxiety, relationships, or overall quality of life).

What was found?

• CBT helped improve frequency of nonepileptic seizures in over half of the people who used this treatment.
• People treated with a form of CBT alone had a significant improvement in seizures – their seizure frequency decreased by 51.4% after treatment as compared to before treatment. Secondary measures (depression, anxiety, functioning, quality of life) also improved.
• People treated with the CBT and sertraline had a slightly greater decrease in seizure frequency of 59.3%. There was also a significant improvement in some of the secondary measures.
• There was no statistically significant change in seizure frequency for people who were taking sertraline alone. Yet people receiving this antidepressant alone did have a mild decrease in seizures each month by 26.5%.
• There were no improvements in people who received standard medical care.
• The number of people in each group was not enough to look at differences between groups.

What do these results mean?

• The study followed a small number of people at three academic epilepsy centers. This limits the ability to generalize these results to all people with PNES right now.
• The results suggest that psychotherapy using cognitive behavioral treatment and other strategies with a workbook format could be a very helpful way of treating PNES and other associated symptoms.
• More research in larger groups of people is needed to see how helpful this treatment will be. Additionally, many people with epilepsy also may have some events that are not epilepsy. Finding out how helpful these treatments are in people with epilepsy and PNES is very important too.
• Seizures not caused by electrical discharges in the brain (PNES) can be disabling for many people. Finding a better way of treating them will be a big advantage for so many people.

For more information on nonepileptic seizures:

• Learn about Non-Epilepsy Seizures
• Read the article, “Nonepileptic Seizures – What are they and what can I do?”

I hope this information is helpful. I am sure we will have more to come on this topic and new treatment approaches for seizures and epilepsy!

Hoping everyone has a safe and relaxing week!

Best wishes,

Patty Osborne Shafer RN, MN
Associate Editor/Community Manager