A meta-analytic evaluation of the effectiveness and durability of psychotherapy for adults presenting with functional dissociative seizures.

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.
Competing Interests: Declaration of competing interest Dr. Kerr writes paid review articles on this topic for Medlink Neurology; is a paid consultant for SK Life Sciences, Biohaven Pharmaceuticals (Data Management Committee), Cerebral Therapeutics (Scientific Advisory Board), EpiTel; and has collaborative or data use agreements with Eisai, Janssen, Johnson & Johnson, Radius Health, UCB, GlaxoSmithKline, and Jazz Pharmaceuticals. These companies had no part in the current work. We affirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with these guidelines.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)