An evaluation of initial engagement with a virtual group-based psychological treatment for functional seizures.

Functional seizures are a common neurological presentation but access to evidence-based treatments is sporadic and often delayed. Patient engagement is an essential prerequisite to any treatment benefits, but previous research has not investigated engagement with psychological group treatments. In this service evaluation, we compared patients who initially engaged and disengaged from an online CBT-based group treatment on demographic and clinical variables, and illness-related beliefs. A self-report survey was used to explore reasons for disengagement. Of 64 patients invited to the group treatment, 39 (60.1%) disengaged before the first session. Older age was associated with engagement with the functional seizures group. There were no other group differences between demographic, clinical, or belief-based variables. Patients who disengaged reported the timing and format as barriers to joining and had preferences for individual and in-person interventions. These findings have implications for the role of clinicians in providing regular tangible information about referral pathways, and motivating patients to engage with available treatments.

Cognitive behavior therapy for comorbid dissociative seizures in patients with epilepsy.

OBJECTIVES: The main aim of this study was to assess the effectiveness of cognitive behavior therapy (CBT) for comorbid dissociative seizures (DS) in patients with epilepsy. METHODS: We conducted a retrospective case note review of 14 patients with epilepsy who underwent outpatient CBT for DS in a tertiary neuropsychiatry service. The diagnosis of DS was confirmed by neurologists clinically and/or following video-telemetry electroencephalogram (EEG). We evaluated the outcome of the CBT treatment with respect to frequency of DS, measures of depression, anxiety, and social functioning. RESULTS: Measures of depression and anxiety significantly reduced following CBT treatment. Overall, frequency of DS reduced following CBT treatment but did not reach statistical significance. SIGNIFICANCE: This study provides evidence that CBT can be effective in reducing depression and anxiety in patients with both epilepsy and DS. Anxiety and depression are likely to be associated with DS. Further research in larger samples and longitudinal studies are recommended to evaluate the long-term efficacy of CBT in this patient group.

Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND): exploring the role of multidisciplinary group education sessions.

Background: A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, with some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions, illness perceptions and stigma affect distress, functioning, quality of life and engagement. Exploring relationships between these factors could lead to deeper understanding of the impact of education. Methods: Questionnaires assessing illness perceptions, quality of life, mood, anxiety, comorbidities, treatment engagement and stigma (both experienced and anticipated) were completed before, immediately and 1 month after a multidisciplinary online group education session for FND at a regional neurosciences centre. Free-text data on causal attributions and needs were also collected. Results: 166 patients attended online education sessions from January 2022 to July 2023; 61 (37%) completed presession surveys, 42 (25%) completed postsession and 35 (21%) completed 1 month postsession surveys. Patients reported multiple comorbidities, poor quality of life, functioning and high levels of stigma. Illness perception scores indicated FND as threatening, mysterious and unpredictable, with low personal or treatment control over symptoms. Illness coherence/understanding (mean difference 2.27, p<0.01, 95% CI 1.22 to 4.23) and engagement (mean difference 2.42, p<0.01, 95% CI 0.46 to 4.36) increased after the session. There were no significant changes in stigma, distress, sense of control or anticipated discrimination. Free-text analysis revealed stress and trauma as the most common causal attributions, followed by physical illnesses. Patients requested personalised formulations, practical disability advice, help with explaining the condition to others (eg, employers), peer support and treatment. Conclusion: Multidisciplinary group FND education sessions potentially improve patient understanding and engagement. Clinicians should consider the possible benefits of personalised formulations and linking to practical and peer support. Further work assessing illness perceptions is needed, such as adapting measures for FND.

Electrophysiological correlates of facial configuration and audio-visual congruency: evidence that face processing is a visual rather than a multisensory task.

Behavioural, neuroimaging and lesion studies show that face processing has a special role in human perception. The purpose of this EEG study was to explore whether auditory information influences visual face perception. We employed a 2 × 2 factorial design and presented subjects with visual stimuli that could be cartoon faces or scrambled faces where size changes of one of the components, the mouth in the face condition, was either congruent or incongruent with the amplitude modulation of a simultaneously presented auditory signal. Our data show a significant main effect for signal congruence at an ERP peak around 135 ms and a significant main effect of face configuration at around 200 ms. The timing and scalp topology of both effects corresponds well to previously reported data on the integration of non-redundant audio-visual stimuli and face-selective processing. Our analysis did not show any significant statistical interactions. This double disassociation suggests that the early component, at 135 ms, is sensitive to auditory-visual congruency but not to facial configuration and that the later component is sensitive to facial configuration but not to AV congruency. We conclude that facial configurational processing is not influenced by the congruence of simultaneous auditory signals and is independent from featural processing where we see evidence for multisensory integration.

Telephone psychotherapy in multiple sclerosis: A systematic review and meta-analysis.

OBJECTIVE: The objective of the study was to review the evidence for the effectiveness of telephone psychotherapy on psychological outcomes in people with multiple sclerosis (MS). METHOD: We conducted a systematic search of EMBASE, PsycINFO, PsycARTICLES, MEDLINE, CINAHL, Web of Science, and hand-searched relevant journals to identify randomized controlled trials (RCTs) that evaluated the effectiveness of telephone psychotherapy on psychological outcomes in people with MS (last search completed on October 1, 2015). The methodological quality of each included trial was assessed, based on a standardized list of methodological criteria. Where available, data were extracted and combined in a meta-analysis to compute effect size estimates. RESULTS: Eleven RCTs and 1,104 participants were identified. The meta-analysis found a moderate effect of the intervention on depression (SMD 0.47 [95% confidence interval 0.21-0.73]). The meta-analysis also found small to moderate short-term effects of the intervention on fatigue, quality of life, MS symptoms, physical activity, and medication adherence, compared with controls and other interventions. RCT designs were heterogeneous. All studies had at least 1 high or unclear risk of bias. CONCLUSIONS: Telephone psychotherapy provides small and moderate benefits in depression, fatigue, quality of life, MS symptoms, physical activity, and medication adherence in the short term. Few gains were sustained in the long term. Studies of better quality are needed. (PsycINFO Database Record