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Randomized Controlled Trial
. 2010 Sep 28;75(13):1166-73.
doi: 10.1212/WNL.0b013e3181f4d5a9. Epub 2010 Aug 25.

Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

W C LaFrance Jr  1 , G I Keitner, G D Papandonatos, A S Blum, J T Machan, C E Ryan, I W Miller
Affiliations
Randomized Controlled Trial

Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

W C LaFrance Jr et al. Neurology. .

Abstract

Objective: There have been few treatment trials for psychogenic nonepileptic seizures (PNES). Some psychotherapies have been shown to improve PNES and comorbid symptom outcomes. We evaluated a pharmacologic intervention to test the hypothesis that sertraline would reduce PNES.

Methods: We conducted a pilot, double-blind, randomized, placebo-controlled trial in an academic medical hospital with epilepsy center outpatients. Subjects aged 18 to 65 years diagnosed with video-EEG-confirmed PNES were treated with flexible-dose sertraline or placebo over 12 weeks. Seizure calendars and symptom scales were charted prospectively. Secondary outcome measures included psychiatric symptom scales and psychosocial variables.

Results: Thirty-eight subjects enrolled, and 26 (68%) completed the trial. Thirty-three subjects with nonzero nonepileptic seizure rates at baseline were included in intent-to-treat analysis of the primary outcome. Subjects assigned to the sertraline arm experienced a 45% reduction in seizure rates from baseline to final visit (p = 0.03) vs an 8% increase in placebo (p = 0.78). Secondary outcome scales revealed no significant between-group differences in change scores from baseline to final visit, after adjustment for differences at baseline.

Conclusions: PNES were reduced in patients treated with a serotonin selective reuptake inhibitor, whereas those treated with placebo slightly increased. This study provides feasibility data for a larger-scale study.

Level of evidence: This study provides Class II evidence that flexible-dose sertraline up to a maximum dose of 200 mg is associated with a nonsignificant reduction in PNES rate compared with a placebo control arm (risk ratio 0.51, 95% confidence interval 0.25-1.05, p = 0.29), adjusting for differences at baseline.

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Figures

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Figure CONSORT flowchart: Psychogenic nonepileptic seizures pilot pharmacologic randomized controlled trial CONSORT = Consolidated Standards of Reporting Trials; ITT = intent-to-treat.
See this image and copyright information in PMC

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