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Psychological treatments for functional non-epileptic attacks: a systematic review

  • Danielle Gaynor (a1), Hannah Cock (a2) and Niruj Agrawal (a1)

Abstract

Objective:

There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA.

Methods:

A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded.

Results:

17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective.

Conclusion:

While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment.

Copyright

Corresponding author

Dr Niruj Agrawal Consultant Neuropsychiatrist, Department of Neuropsychiatry, Clare House, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. Tel: +44 208 725 3786; Fax: +44 208 725 2929; E-mail: Niruj.Agrawal@swlstg-tr.nhs.uk

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