Cognitive Behavioural Therapy in Adults with Psychogenic Non-Epileptic Seizures: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BackgroundRandomised controlled clinical trials (RCTs) investigating cognitive-behavioural therapy (CBT) among adults with psychogenic non-epileptic seizures (PNES) has become increasingly available, prompting the opportunity to critically appraise the efficacy and safety of CBT in this population. MethodsWe conducted a systematic review and meta-analysis including RCTs comparing CBT in addition to standardised medical treatment (SMT) versus SMT alone for adults with PNES. The primary outcome was seizure freedom at the end of treatment. Secondary outcomes included measures of quality of life, anxiety and depression assessed via standardised clinical questionnaires. ResultsThree RCTs were included comprising 228 participants treated with CBT and 222 with SMT. The intervention was significantly associated with seizure freedom (Odds Ratio [OR] 1.98; 95% confidence interval [CI] 1.14, 3.46; p = 0.02; I2 = 0%), reductions in anxiety (standardised mean difference [SMD] -0.21; 95% CI -0.41, -0.003; p = 0.047; I2 = 0%) and improvements in quality of life (SMD 0.34; 95% CI 0.12, 0.57; p = 0.003; I2 = 0%) at the end of treatment. Conversely, no significant differences between groups were observed regarding depression symptoms (SMD -0.19; 95% CI -0.39, 0.02; p = 0.08; I2 = 0%). There was no statistically significant increase in the risk of suicidal ideation and self-harm with CBT (OR 2.11; 95% CI 0.81, 5.48; p = 0.13; I2 = 0%) nor were there differences in terms of discontinuation rates during follow-up (OR 0.92; 95% CI 0.49, 1.72; p = 0.79; I2 = 7%). ConclusionsThere is high-quality evidence supporting the efficacy and safety of CBT in treating PNES. Future research should investigate whether combining CBT with other therapeutic methods could potentially enhance treatment efficacy.