Rationale:
Psychotherapy is the first-line treatment for functional seizures (FS), but access barriers and poor adherence remain major challenges [1]. Our prior study found that virtual care was associated with improved patient engagement compared to in-office visits [2]. This follow-up study examines whether the two platforms are associated with different clinical outcomes. Understanding these differences may inform tailored treatment strategies to increase access and optimize patient-centered care.
Methods:
Because psychiatric and medical comorbidities affect FS outcomes, this retrospective study examined changes in mood and overall physical functioning. Patients with FS from the original study who received outpatient psychotherapy either in-office or virtually between 2019 and 2021 were assessed using validated self-report measures: PHQ-9 for depression and PROMIS Mental and Physical Health T-scores. The patients with FS who completed at least six sessions of Neurobehavioral Therapy (NBT) with a psychologist [3] were included. A total of 21 patients met these criteria and had complete pre-treatment and post-treatment data. Linear regression models were used to evaluate changes in outcomes and the influence of sociodemographic factors.
Results:
Patients in the in-office format showed significant improvement in PHQ-9 scores (mean change = -4.70, p = 0.03), but not in PROMIS Mental or Physical scores. Patients in the virtual group showed significant improvement in PROMIS Physical scores (mean change = +3.12, p = 0.045), but not in mood-related outcomes. Additionally, higher median household income was significantly associated with greater reduction in PHQ-9 scores (β = -1.2 per $10,000 increase, 95% CI: -2.2 to -0.25, p = 0.024), showing a potential link between socioeconomic status and depression outcome.
Conclusions:
Preliminary findings suggest that treatment type and socioeconomic context may influence FS outcomes, with in-office and virtual platforms potentially affecting mood and physical functioning differently. This nuanced finding tells us that treatment platforms may need to be tailored to different presenting symptoms. Patient preference for a specific treatment platform may also predict clinical outcomes. These results, however, are exploratory due to the small sample size and limited exposure to the full treatment course. Larger studies are needed to confirm these findings and guide future care models.
References:
1. Tolchin B, Dworetzky BA, Baslet G. Long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures. Epilepsia. 2018;59: e18–e22.
2. Tilahun BBS, Thompson NR, Bautista JF, Sankary LR, Stanton S, Punia V. Telepsychology may improve treatment adherence in patients with psychogenic nonepileptic seizures. Telemed J E Health. 2022;28:1159–1165.
3. Reiter J, Andrews D, Reiter C, LaFrance WC Jr. Taking Control of Your Seizures: Workbook. Oxford: Oxford University Press; 2015.
Funding: No funding was received to support this abstract.