Does 'event viewing' alter psychological status in functional/dissociative seizures? A pilot randomised controlled trial

Abstract

Objectives: Functional/dissociative seizures (FDS) represent a common disorder that mimics epilepsy or movement disorder, yet there are currently no established treatment guidelines. This study aimed to investigate the impact of viewing one's event as a novel treatment strategy for FDS.

Methods: This was a single-centre, double-blinded, randomised (1:1) controlled trial. Patients with at least one habitual FDS recorded in the epilepsy monitoring unit were recruited. All participants received cognitive behavioural therapy (CBT), while the intervention arm alone was shown their own recorded event. Psychological status (primary outcome), measured using standard questionnaires (HADS and QoLIE-31), and event frequency (secondary outcome) were compared between both groups at 3 months' follow-up. The Mann-Whitney U test was used to compare both arms. Intention-to-treat analysis was performed.

Results: Seventy-two patients (35 in the intervention arm and 37 in the control arm) with a median age of 29 years and 22 years, respectively, were randomised. The median (IQR) HADS-A score showed significant improvement in the intervention arm [7.0 (5.0-8.0)] compared to the control arm [8.0 (7.0-9.2)], p = 0.026. The outcomes on HADS-D, QoLIE-31 scores, and event frequency reduction were not statistically significant. Analysis of mean change in scores showed small to medium effect size improvement in anxiety score (Cohen's d = 0.47) and QoLIE-31 overall score (Cohen's d = -0.38) with event viewing.

Conclusion: Viewing recorded FDS events in addition to CBT may be beneficial in reducing anxiety symptoms in patients with FDS.

Keywords: HADS; Neuropsychology; QoLIE-31; Quality of life.