Dissociations and Cognitive Distortions: True, True, and Possibly Related

• Published in: Epilepsy currents 2020-11, Vol.20 (6), p.362-364
• Main Author: Salpekar, Jay A.
• Format: Article
• Language: English
• Subjects: Anxiety disorders; Behavior modification; Clinical trials; Cognitive ability; Convulsions & seizures; Current Literature in Clinical Science; Epilepsy; Patients; Quality of life; Questionnaires; Seizures; Social interactions; Statistical analysis; Syncope
• ISSN: 1535-7597; 1535-7511
• DOI: 10.1177/1535759720954242

Cognitive Behavioural Therapy for Adults With Dissociative Seizures (CODES): A Pragmatic, Multicentre, Randomized Controlled Trial. Goldstein LH, Robinson EJ, Mellers JDC, et al Lancet Psych. 2020;7(6):491-505. doi:10.1016/S2215-0366(20)30128-0. 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 behavioral therapy (CBT) plus standardized medical care with standardized medical care alone for the reduction of dissociative seizure frequency. Methods: In this pragmatic, parallel-arm, multicenter, randomized 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 standardized medical care or CBT plus standardized medical care, using a web-based system. Randomization 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 randomization. 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 correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised