Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Re-PROGRAM: A Brief Intervention Program for Patients With Functional Seizures in an Outpatient Hospital Setting
TAKE-HOME MESSAGE
- This study evaluated the feasibility of Re-PROGRAM, a novel intervention for functional seizures, in an outpatient setting. Overall, 29 patients at the Alfred Hospital Functional Seizures Clinic participated between August 2020 and January 2022. The intervention included five weekly 60- to 90-minute telehealth sessions focusing on seizure management, lifestyle changes, and behavioral strategies. All participants completed the sessions, with 15 of 16 respondents reporting reduced seizure frequency in postintervention questionnaires. Follow-up analyses revealed further seizure frequency reductions and improvements in seizure duration, intensity, and control and daily functioning.
- Many postdiagnosis interventions similar to the one investigated in this study are becoming available for patients with psychogenic nonepileptic spells. This study helps validate one such therapy and raises awareness for providers to encourage and refer patients to such clinics or therapies because these interventions are associated with improvements in outcomes, including seizure frequency reduction. The fact that this therapy was delivered via telehealth and demonstrated effectiveness is especially encouraging.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
Functional seizures (FS) account for 20%-25% of referrals to specialist epilepsy clinics. They are associated with major disability, increased mortality, and frequent and costly health care use. Current guidelines emphasize the importance of implementing clinical pathways to coordinate and deliver effective treatment, but there are few targeted evidence-based interventions that reliably improve patient outcomes, and treatment resources are limited. We conducted a retrospective evaluation of Re-PROGRAM, a novel, brief intervention for functional seizure patients, to assess its feasibility in an outpatient setting.
METHODS
Twenty-nine patients with FS undertook Re-PROGRAM between August 2020 and January 2022 at the Alfred Hospital Functional Seizures Clinic, Melbourne, Australia. The intervention comprised five 60-90-min consecutive weekly appointments via telehealth, where psychologists engaged patients in a structured program of seizure management skills, lifestyle modification, and behavioral activation strategies. Following the intervention, patient feedback was collected in routine clinical follow-up as well as with a 24-item self-report pre-/postintervention comparison questionnaire.
RESULTS
All 29 patients who enrolled in Re-PROGRAM completed the scheduled sessions. Of those who returned the postintervention questionnaire (n = 16), 15 reported a reduction in seizure frequency. Four patients were lost to follow-up. Of the remaining nine, eight reported seizure frequency reduction during clinical follow-up. Qualitative analysis of the feedback revealed the majority of patients reported reduced seizure duration, intensity, and bothersomeness, and patients felt improvements in their sense of control over seizures, confidence to use seizure control strategies, assertive communication, problem solving, coping skills, relationships with others, and their day-to-day functioning.
SIGNIFICANCE
This retrospective evaluation demonstrates the feasibility and acceptability of Re-PROGRAM as a brief intervention for individuals diagnosed with FS delivered in a clinical outpatient setting and warrants further investigation in larger scale, randomized controlled studies.
Additional Info
Disclosure statements are available on the authors' profiles:
Re-PROGRAM: The evaluation of a brief intervention program for patients with functional seizures in an outpatient hospital setting
Epilepsia 2024 Aug 03;[EPub Ahead of Print], L Higson, TJ O'Brien, G Rayner, R Alpitsis, T Winton-BrownFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Treatment for people with functional (nonepileptic) seizures (FS) can be challenging because of the symptomatic heterogeneity of the population in addition to the lack of training in FS management for many clinicians. Randomized clinical trials regarding psychotherapies for FS include conventional cognitive behavioral therapy1 and multimodal neurobehavioral therapy (NBT).2 These 12-session protocols are available around the UK, the US, and the world and have demonstrated seizure and symptom improvement and quality-of-life improvement. When such interventions are not readily accessible or practical, clinicians can communicate the FS diagnosis and provide clinical support and psychoeducation, possibly with a mental health referral to address comorbidities.3,4 Although brief group psychoeducation has been used successfully in some epilepsy centers,5 many patients, especially in underserved areas, may receive only one-session diagnostic feedback. A small group of patients with FS may receive psychotherapy focused on FS symptoms, if available via specialty centers. This scenario leaves a gap, where there are few brief (ie, <6 sessions), structured, evidence-based, psychotherapeutic approaches for individuals to provide a bridge between diagnosis and intensive treatment.
Higson and colleagues attempt to address the gap, adding another potential FS treatment option by presenting retrospective feasibility data for 29 patients with FS who completed Re-PROGRAM. Following in the steps of the prior time-limited, multimodal workbooks for seizures,6 Re-PROGRAM is a manualized, 5-session intervention that provides instruction on a collection of both general (eg, physical activity and coping strategies) and FS-specific (eg, interoceptive awareness and seizure triggers) techniques. Similar to NBT,7 Re-PROGRAM can be delivered as either digital or in-person modalities and could serve as a bridge between initial FS diagnosis and longer-term or comorbidity-specific therapies (eg, trauma-focused therapy or family therapy). The results showed that most participants experienced benefits, with specific improvements reported in interpersonal communication, intrapersonal development, agency, and everyday functioning.
To improve healthcare for people with FS, there is a need for better training of clinicians, appreciation for the integrative mind/brain/body nature of the condition, and availability of targeted evidence-based treatment that is tailored to the individual patient. Higson and colleagues provide another incremental step in this direction. The study was small, uncontrolled, and retrospective and measured only a limited set of outcomes, with low survey response rates, meaning that it reflects only preliminary support for Re-PROGRAM; thus, larger, well-designed, controlled studies are indicated. In the meantime, leaders in neurology, psychiatry, psychology, neuropsychology, and related disciplines should provide all trainees with education about FS; provide patients, families, clinicians, and researchers with resources8; and improve access to, and availability of, empirically supported treatments for patients with FS.
References