Cognitive Behavioural Therapy as a therapeutic approach for Functional Non-Epileptic Seizures

Abstract

Background: Functional non-epileptic seizures (FNES) or dissociative seizures consist in paroxystic and episodic changes in motor behavior, consciousness or perception, which resemble epileptic seizures, but are not the result of any organic neurological disturbance. Psychotherapy is the treatment choice and several studies suggest that psychotherapeutic interventions can reduce the frequency of seizures and optimize the use of health services. Cognitive-Behavioral Psychotherapy (CBT) has been applied in somatoform disorders and more recently in the treatment of conversion disorders and dissociative disorders such as FNES.

Aims: To explore the use of cognitive-behavioral therapy in the treatment of patients with dissociative seizures / functional non-epileptic seizures.

Methods: Non-systematic review of the literature.

Results and Conclusions: Patients with FNES present significantly distorted beliefs and develop counterproductive and repetitive behavioral patterns with associated anxious and depressive affects. A psychotherapeutic intervention such as CBT may be useful in reducing negative emotions and stigma associated with seizures, as well as helping patients cope with the psychosocial stressors that can precipitate the seizures. A plausible explanatory model for FNES argues that these can represent a dissociative response to a state of hyperexcitability in the face of threatening or intolerable circumstances, accompanied by behavioral avoidance responses, which act as an important maintenance factor. The scientific evidence supports the use of CBT in the treatment of FNES and how these can positively respond to specific interventions. Cognitive-behavioral interventions seek to disrupt behavioral / physiological / cognitive responses experienced early in the crisis, encouraging patients to engage in previously avoided activities and addressing negative cognitions and erroneous beliefs related to their state of health. Studies under controlled methodology showed the benefit of CBT in reducing FNES frequency and increasing the free period without seizures. CBT can be useful in the management of emotional conflicts, in the improvement of comorbidities such as anxiety and depression, as well as in the recovery of self-esteem, self-confidence and a sense of autonomy in these patients.