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1. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial

Author

Goldstein, Laura H, primary, Robinson, Emily J, additional, Mellers, John D C, additional, Stone, Jon, additional, Carson, Alan, additional, Reuber, Markus, additional, Medford, Nick, additional, McCrone, Paul, additional, Murray, Joanna, additional, Richardson, Mark P, additional, Pilecka, Izabela, additional, Eastwood, Carole, additional, Moore, Michele, additional, Mosweu, Iris, additional, Perdue, Iain, additional, Landau, Sabine, additional, Chalder, Trudie, additional, Abe, A-M, additional, Adab, N, additional, Agrawal, N, additional, Allroggen, H, additional, Alvares, D, additional, Andrews, T, additional, Angus-Leppan, H, additional, Aram, J, additional, Armstrong, R, additional, Atalaia, A, additional, Bagary, M, additional, Baldellou Lopez, M, additional, Bennett, M, additional, Black, T, additional, Blackburn, D, additional, Bodani, M, additional, Broadhurst, M, additional, Brockington, A, additional, Bruno, E, additional, Buckley, M, additional, Burness, C, additional, Callaghan, H, additional, Chalmers, R, additional, Chong, S, additional, Chowdhury, M, additional, Chowdury, F, additional, Cikurel, K, additional, Cocco, G, additional, Cock, H, additional, Cooper, S, additional, Cope, S, additional, Copping, A, additional, Day, E, additional, Delamont, R, additional, Dennis, G, additional, Derry, C, additional, Devlin, R, additional, Dickson, J.M., additional, Diehl, B, additional, Donnelly, C, additional, Duncan, S, additional, Edwards, M, additional, Ellawella, S, additional, Ellis, C, additional, Elvish, J, additional, Elwes, R, additional, Eriemo, S, additional, Eriksson, S, additional, Evans, K, additional, Faruqui, R, additional, Feehan, S, additional, Finnerty, G, additional, Flores, L, additional, Firth, N, additional, Fung, R, additional, Gardiner, P, additional, Graham, C, additional, Green-Thompson, Z, additional, Grunewald, R, additional, Hadden, R, additional, Hamandi, K, additional, Harding, R, additional, Harikrishnan, S, additional, Harrison, S, additional, Healy, H, additional, Hewamadduma, C, additional, Higgins, S, additional, Howell, S, additional, Hunt, H, additional, Hussain, A, additional, Innocente, M, additional, Jensch, G, additional, Johnson, M, additional, Jordan, H, additional, Karlsson, J, additional, Kelso, A, additional, Kemp, S, additional, Knibb, J, additional, Kock, N, additional, Koutroumanidis, M, additional, Kovac, S, additional, Kumar, G, additional, Laker, A, additional, Leschziner, G, additional, Liu, R, additional, Lozsadi, D, additional, Ludwig, L, additional, MacDonald, B, additional, MacGregor, L, additional, Maguire, M, additional, Manford, M, additional, Martino, D, additional, McCorry, D, additional, McGorlick, A, additional, McKeown, K, additional, McKevitt, F, additional, Meadow, A, additional, Memon, S, additional, Miorelli, A, additional, Mitchell, C, additional, Mitchell, T.N., additional, Moffitt, V, additional, Moran, N, additional, Morgan-Boon, A, additional, Moriarty, J, additional, Mula, M, additional, Mullatti, N, additional, Nashef, L, additional, O'Hara, D, additional, Oakley, L, additional, O'Sullivan, S, additional, Page, L, additional, Patel, D, additional, Petrochilos, P, additional, Phoenix, D, additional, Pickerell, W, additional, Pieters, T, additional, Poole, N, additional, Price, G, additional, Protheroe, D, additional, Pullicino, P, additional, Purnell, J, additional, Quirk, J, additional, Rajakulendran, S, additional, Read, J, additional, Ridha, B, additional, Rockliffe-Fidler, C, additional, Rowbottom, C, additional, Rugg-Gunn, F, additional, Sachar, A, additional, Saha, R, additional, Saldanha, G, additional, Samarasekera, S, additional, Sanchez Sanchez, V, additional, Santhouse, A, additional, Scholes, K, additional, Shetty, A, additional, Shotbolt, P, additional, Simkiss, R, additional, Singh, J, additional, Sivagnanasundaram, J, additional, Slaght, S, additional, Smith, P, additional, Sokhi, D, additional, Stanton, B, additional, Suvorova, L, additional, Tahir, T, additional, Taylor, R, additional, Teare, L, additional, Tedesco, L, additional, Teo, J, additional, Thorpe, J, additional, Toplis, L, additional, Tsakopoulou, M, additional, Tylova, I, additional, Vick, T, additional, Vinnicombe, J, additional, Walker, M, additional, Walsh, C, additional, Watson, G, additional, Webb, T, additional, Wehner, T, additional, Welch, K, additional, Weyrich, K, additional, Whittaker, M, additional, Wickremaratchi, M, additional, Wicks, L, additional, and Yogarajah, M, additional

Published
2020
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2. Characteristics of 698 patients with dissociative seizures: A UK multicenter study

Author

Goldstein, LH, Robinson, EJ, Reuber, M, Chalder, T, Callaghan, H, Eastwood, C, Landau, S, McCrone, P, Medford, N, Mellers, JDC, Moore, M, Mosweu, I, Murray, J, Perdue, I, Pilecka, I, Richardson, MP, Carson, A, Stone, J, Abe, A-M, Adab, N, Agrawal, N, Allroggen, H, Alvares, D, Andrews, T, Angus-Leppan, H, Aram, J, Armstrong, R, Atalaia, A, Bagary, M, Bennett, M, Black, T, Blackburn, D, Bodani, M, Broadhurst, M, Brockington, A, Bruno, E, Buckley, M, Burness, C, Chalmers, R, Chong, S, Chowdhury, M, Chowdury, F, Cikurel, K, Cocco, G, Cock, H, Cooper, S, Cope, S, Copping, A, Day, E, Delamont, R, Dennis, G, Derry, C, Devlin, R, Dickson, JM, Diehl, B, Donnelly, C, Duncan, S, Edwards, M, Ellawella, S, Ellis, C, Elvish, J, Elwes, R, Eriemo, S, Eriksson, S, Evans, K, Faruqui, R, Feehan, S, Finnerty, G, Flores, L, Firth, N, Fung, R, Gardiner, P, Graham, C, Green-Thompson, Z, Grunewald, R, Hadden, R, Hamandi, K, Harding, R, Harikrishnan, S, Harrison, S, Healy, H, Hewamadduma, C, Higgins, S, Howell, S, Hunt, H, Hussain, A, Innocente, M, Jensch, G, Johnson, M, Jordan, H, Karlsson, J, Kelso, A, Kemp, S, Knibb, J, Kock, N, Koutroumanidis, M, Kovac, S, Kumar, G, Laker, A, Leschziner, G, Liu, R, Lozsadi, D, Ludwig, L, MacDonald, B, MacGregor, L, Maguire, M, Manford, M, Martino, D, McCorry, D, McGorlick, A, McKeown, K, McKevitt, F, Meadow, A, Memon, S, Miorelli, A, Mitchell, C, Mitchell, TN, Moffitt, V, Moran, N, Morgan-Boon, A, Moriarty, J, Mula, M, Mullatti, N, Nashef, L, O'Hara, D, Oakley, L, O'Sullivan, S, Page, L, Patel, D, Petrochilos, P, Phoenix, D, Pickerell, W, Pieters, T, Poole, N, Price, G, Protheroe, D, Pullicino, P, Purnell, J, Quirk, J, Rajakulendran, S, Read, J, Ridha, B, Rockliffe-Fidler, C, Rowbottom, C, Rugg-Gunn, F, Sachar, A, Saha, R, Saldanha, G, Samarasekera, S, Sanchez, VS, Santhouse, A, Scholes, K, Shetty, A, Shotbolt, P, Simkiss, R, Singh, J, Sivagnanasundaram, J, Slaght, S, Smith, P, Sokhi, D, Stanton, B, Suvorova, L, Tahir, T, Taylor, R, Teare, L, Tedesco, L, Teo, J, Thorpe, J, Toplis, L, Tsakopoulou, M, Tylova, I, Vick, T, Vinnicombe, J, Walker, M, Walsh, C, Watson, G, Webb, T, Wehner, T, Welch, K, Weyrich, K, Whittaker, M, Wickremaratchi, M, Wicks, L, Yogarajah, M, and Grp, CODESS

Abstract

Objective\ud We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology.\ud \ud Methods\ud We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non‐Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations.\ud \ud Results\ud In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self‐reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two‐thirds were unemployed.\ud \ud Significance\ud Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.

Published
2019

3. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial

Author

Goldstein, Laura H., Robinson, Emily J., Mellers, John D.C., Stone, Jon, Carson, Alan, Reuber, Markus, Medford, Nick, McCrone, Paul, Murray, Joanna, Richardson, Mark P., Pilecka, Izabela, Eastwood, Carole, Moore, Michele, Mosweu, Iris, Perdue, Iain, Landau, Sabine, Chalder, Trudie, Abe, A. M., Adab, N., Agrawal, N., Allroggen, H., Alvares, D., Andrews, T., Angus-Leppan, H., Aram, J., Armstrong, R., Atalaia, A., Bagary, M., Baldellou Lopez, M., Bennett, M., Black, T., Blackburn, D., Bodani, M., Broadhurst, M., Brockington, A., Bruno, E., Buckley, M., Burness, C., Callaghan, H., Chalmers, R., Chong, S., Chowdhury, M., Chowdury, F., Cikurel, K., Cocco, G., Cock, H., Cooper, S., Cope, S., Copping, A., Day, E., Delamont, R., Dennis, G., Derry, C., Devlin, R., Dickson, J. M., Diehl, B., Donnelly, C., Duncan, S., Edwards, M., Ellawella, S., Ellis, C., Elvish, J., Elwes, R., Eriemo, S., Eriksson, S., Evans, K., Faruqui, R., Feehan, S., Finnerty, G., Flores, L., Firth, N., Fung, R., Gardiner, P., Graham, C., Green-Thompson, Z., Grunewald, R., Hadden, R., Hamandi, K., Harding, R., Harikrishnan, S., Harrison, S., Healy, H., Hewamadduma, C., Higgins, S., Howell, S., Hunt, H., Hussain, A., Innocente, M., Jensch, G., Johnson, M., Jordan, H., Karlsson, J., Kelso, A., Kemp, S., Knibb, J., Kock, N., Koutroumanidis, M., Kovac, S., Kumar, G., Laker, A., Leschziner, G., Liu, R., Lozsadi, D., Ludwig, L., MacDonald, B., MacGregor, L., Maguire, M., Manford, M., Martino, D., McCorry, D., McGorlick, A., McKeown, K., McKevitt, F., Meadow, A., Memon, S., Miorelli, A., Mitchell, C., Mitchell, T. N., Moffitt, V., Moran, N., Morgan-Boon, A., Moriarty, J., Mula, M., Mullatti, N., Nashef, L., O'Hara, D., Oakley, L., O'Sullivan, S., Page, L., Patel, D., Petrochilos, P., Phoenix, D., Pickerell, W., Pieters, T., Poole, N., Price, G., Protheroe, D., Pullicino, P., Purnell, J., Quirk, J., Rajakulendran, S., Read, J., Ridha, B., Rockliffe-Fidler, C., Rowbottom, C., Rugg-Gunn, F., Sachar, A., Saha, R., Saldanha, G., Samarasekera, S., Sanchez Sanchez, V., Santhouse, A., Scholes, K., Shetty, A., Shotbolt, P., Simkiss, R., Singh, J., Sivagnanasundaram, J., Slaght, S., Smith, P., Sokhi, D., Stanton, B., Suvorova, L., Tahir, T., Taylor, R., Teare, L., Tedesco, L., Teo, J., Thorpe, J., Toplis, L., Tsakopoulou, M., Tylova, I., Vick, T., Vinnicombe, J., Walker, M., Walsh, C., Watson, G., Webb, T., Wehner, T., Welch, K., Weyrich, K., Whittaker, M., Wickremaratchi, M., Wicks, L., Yogarajah, M., Goldstein, Laura H., Robinson, Emily J., Mellers, John D.C., Stone, Jon, Carson, Alan, Reuber, Markus, Medford, Nick, McCrone, Paul, Murray, Joanna, Richardson, Mark P., Pilecka, Izabela, Eastwood, Carole, Moore, Michele, Mosweu, Iris, Perdue, Iain, Landau, Sabine, Chalder, Trudie, Abe, A. M., Adab, N., Agrawal, N., Allroggen, H., Alvares, D., Andrews, T., Angus-Leppan, H., Aram, J., Armstrong, R., Atalaia, A., Bagary, M., Baldellou Lopez, M., Bennett, M., Black, T., Blackburn, D., Bodani, M., Broadhurst, M., Brockington, A., Bruno, E., Buckley, M., Burness, C., Callaghan, H., Chalmers, R., Chong, S., Chowdhury, M., Chowdury, F., Cikurel, K., Cocco, G., Cock, H., Cooper, S., Cope, S., Copping, A., Day, E., Delamont, R., Dennis, G., Derry, C., Devlin, R., Dickson, J. M., Diehl, B., Donnelly, C., Duncan, S., Edwards, M., Ellawella, S., Ellis, C., Elvish, J., Elwes, R., Eriemo, S., Eriksson, S., Evans, K., Faruqui, R., Feehan, S., Finnerty, G., Flores, L., Firth, N., Fung, R., Gardiner, P., Graham, C., Green-Thompson, Z., Grunewald, R., Hadden, R., Hamandi, K., Harding, R., Harikrishnan, S., Harrison, S., Healy, H., Hewamadduma, C., Higgins, S., Howell, S., Hunt, H., Hussain, A., Innocente, M., Jensch, G., Johnson, M., Jordan, H., Karlsson, J., Kelso, A., Kemp, S., Knibb, J., Kock, N., Koutroumanidis, M., Kovac, S., Kumar, G., Laker, A., Leschziner, G., Liu, R., Lozsadi, D., Ludwig, L., MacDonald, B., MacGregor, L., Maguire, M., Manford, M., Martino, D., McCorry, D., McGorlick, A., McKeown, K., McKevitt, F., Meadow, A., Memon, S., Miorelli, A., Mitchell, C., Mitchell, T. N., Moffitt, V., Moran, N., Morgan-Boon, A., Moriarty, J., Mula, M., Mullatti, N., Nashef, L., O'Hara, D., Oakley, L., O'Sullivan, S., Page, L., Patel, D., Petrochilos, P., Phoenix, D., Pickerell, W., Pieters, T., Poole, N., Price, G., Protheroe, D., Pullicino, P., Purnell, J., Quirk, J., Rajakulendran, S., Read, J., Ridha, B., Rockliffe-Fidler, C., Rowbottom, C., Rugg-Gunn, F., Sachar, A., Saha, R., Saldanha, G., Samarasekera, S., Sanchez Sanchez, V., Santhouse, A., Scholes, K., Shetty, A., Shotbolt, P., Simkiss, R., Singh, J., Sivagnanasundaram, J., Slaght, S., Smith, P., Sokhi, D., Stanton, B., Suvorova, L., Tahir, T., Taylor, R., Teare, L., Tedesco, L., Teo, J., Thorpe, J., Toplis, L., Tsakopoulou, M., Tylova, I., Vick, T., Vinnicombe, J., Walker, M., Walsh, C., Watson, G., Webb, T., Wehner, T., Welch, K., Weyrich, K., Whittaker, M., Wickremaratchi, M., Wicks, L., and Yogarajah, M.

Abstract

Background: Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. Methods: In this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without cor

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