Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study.

Background: Psychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive‐behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities. Methods: We used a single‐case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini‐Maslow Assessment of Needs Scale‐Learning Disabilities), were used to assess the effectiveness of treatment. Findings: Results show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow‐up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant. Conclusions: This SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed. Accessible Summary: People sometimes experience episodes that look like epileptic seizures. Unlike epileptic seizures, these episodes are caused by psychological factors (such as stress). These are called 'psychogenic nonepileptic seizures' or PNES for short.We wanted to see if Cognitive Behaviour Therapy can help individuals with PNES and learning disabilities.We have written what we did with Susan (a woman with PNES and a learning disability) and how the therapy helped her.We met with Susan 15 times for therapy sessions.Susan reported fewer episodes of PNES after the therapy. The change in the number of episodes was not big. Following therapy, Susan also reported better mood and quality of life, and feeling less anxious. [ABSTRACT FROM AUTHOR]

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