Reading materials on PNES


(Abst. 1.178), 2015The utility of Prolonged Exposure Therapy (PET) in the treatment of patients who are dually diagnosed with PNES and PTSD

Lorna Myers, Urmi Vaidya, Maria Lizardo

Rationale: The percentage of patients with PNES who exhibit post-traumatic stress disorder features ranges from 22-100%. Prolonged exposure therapy is an empirically validated form of cognitive behavioral therapy designed to treat post-traumatic stress disorder (PTSD). Our premise is that PET has the potential to be a useful treatment modality for patients dually diagnosed with PNES/PTSD.

Methods: Video-EEG monitoring was utilized to confirm a diagnosis of PNES in 7 adults. PTSD was diagnosed through neuropsychological testing. Patients were enrolled in a 12-15 week prolonged exposure program. Symptoms were assessed with the Beck Depression Inventory II and Post Traumatic Stress Diagnostic Scale (PDS). Scoring for the BDI II: 0--13: minimal depression, 14--19: mild, 20--28: moderate, 29--63: severe. The PDS cut-offs for symptom severity are:≤ 10 mild,≥11 and ≤20 moderate, ≥21 and ≤35 moderate to severe, ≥ 36 severe. Seizure frequency was noted every week of treatment. Seizure recurrence was monitored through post-treatment follow ups. Pre and post treatment scores were compared using the Wilcoxon Signed Rank test.

Results: At treatment initiation, 5/7 patients were in the severely depressed range, 1 in the moderate range and 1 in the mild range. Four patients were in the severe range for PTSD symptomatology and 3 in the moderate to severe range. By the final session, patients had experienced a significant reduction in depressive symptoms (W-value= 1; p≤ 0.05) and in post-traumatic symptomatology (W-value = 0; p≤ 0.05). Seizure frequency diminished at the time of treatment discharge in all patients (W-value=0; p≤ 0.05). Follow up revealed sustained or improved seizure control with the exception of one patient who had returned to baseline at 23 month follow up. One patient experienced a progressive reduction from 15-20 seizures per day, to 3-4 per week at 8 months and seizure freedom at 10 months.

Conclusions: Administration of PE to 7 patients with PNES and PTSD resulted in significant improvements in depression and post-traumatic stress symptomatology and reduction in seizures in all patients which was sustained at follow up with the exception of one patient. Five are now working or in school.