One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: 2024 LaFrance Jr et al

[Andy]

Full title: One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: A nonrandomized controlled trial

Abstract

Objective
Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy.

Methods
In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life.

Results
Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44–24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37–12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12–5.04) to 12-month postenrollment (mean = .98, 95% CI = .40–2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-only comparisons improved on only one of 19 (5.3%).

Significance
NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.

Paywall, https://onlinelibrary.wiley.com/doi/10.1111/epi.18137

 

[Andy]

I'm not sure that they are using the term 'controlled' in the same way as I would use it.

 

[Amw66]

I think the concept of " controlled" in trials has changed meaning in practice - very few trials actually are " controlled" .Is is a big issue.

 

[Arnie Pye]

I've added the bolding for emphasis.

NBT may be a clinically useful treatment for patients with seizures.

"May be" = weasel words, and this research just comes across to me as a Job Creation Scheme for therapists.

How are functional seizures confirmed in someone with a traumatic brain injury?

I don't understand how someone with a physical injury to the brain, who develops seizures as a result, can be diagnosed with "functional" seizures, particularly if the patient had never had seizures before the TBI.

Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited.

I would complete that last quote with "but treatments for patients with TBI and seizures are limited" so let's give them a psychiatric diagnosis instead" so that they (the patient) will never be trusted to be telling the truth ever again, and it will save lots of money while achieving nothing.

 

[rvallee]

The primary outcome was change in seizure frequency

reductions were not statistically significant from baseline

Improvements were demonstrated at 1 year post-enrollment

On secondary outcomes, which the 'treatment' explicitly tries to influence.

may be a clinically useful treatment for patients with seizures

"We could not fix your car but it smells fresh because we sprayed it a bit with an aerosol cleaner, it may not be what you wanted but we are satisfied that it's basically the same to us".

There really ought to be consequences to promoting ineffective treatments. Without this, it explicitly encourages useless pseudoscience taking the place of real health care. In most countries you can't sell defective products, there are guaranteed return laws for this. Not in health care. In health care it's encouraged, buyer beware with actual authorities vouching for them despite knowing that they are defective.