Authors :
Dominick Demarsico, MPH – University of Colorado
Mackenzi Moore, MPH – University of Colorado
Presenting Author: Meagan Watson, MPH, MBA – University of Colorado
Laura Strom, MD – University of Colorado
Rationale:
Functional neurological disorder (FND) is characterized by physical neurological symptoms incongruent with structural disease, arising from impaired functioning of brain networks. Cognitive Behavioral Therapy (CBT) is regarded as an effective psychological treatment option for FND; however, limited evidence demonstrates whether certain patient characteristics are associated with treatment engagement and adherence. This study aimed to identify demographic and clinical features linked to non-adherence to group therapy treatment for Functional Seizures (FS). The secondary aim was to develop a predictive model to assess whether these factors could be used to accurately identify patients at risk of group therapy non-adherence.Methods:
We conducted a cross-sectional study of 617 patients with FS (ages 18–80) who participated in group therapy at the University of Colorado FND Clinic. Demographic, medical, and psychiatric data were extracted from medical records. Non-adherence was defined as attending ≤50% of scheduled sessions. Logistic regression assessed associations between patient characteristics and adherence, with model selection guided by Akaike Information Criterion and Bayesian Information Criterion. A secondary aim tested whether logistic regression with 10-fold cross-validation could predict risk of non-adherence.
Results:
Overall, 42% of patients were non-adherent. The final regression model identified younger age (OR 0.98, p = 0.013), unemployment (OR 1.54, p = 0.013), and non-white race (OR 0.65, p = 0.035) as significant predictors of non-adherence. Diagnosis of epileptic seizures was not significantly associated with adherence, although patients with an uncertain epilepsy diagnosis trended toward greater adherence. The predictive model did not perform better than chance (ROC = 0.57, accuracy = 0.58, p = 0.74), suggesting limited utility of demographic and clinical variables alone for individual-level prediction.
Conclusions:
Younger, unemployed, and non-white patients were significantly more likely to drop out of group therapy for FS. These findings highlight important disparities in treatment engagement, consistent with broader social determinants of health. Improving adherence of these populations may require culturally responsive interventions, additional support for unemployed individuals, or longer a triage period to accurately assess barriers. While predictive modeling suggests that a larger sample size is necessary for future investigation, the results underscore the complexity of adherence behavior and the need for more patient-centered data to guide clinical decision-making around treatment readiness and support.
Funding:
No funding to disclose