Authors :
Mackenzi Moore, MPH – University of Colorado
Meagan Watson, MPH, MBA – University of Colorado
Presenting Author: Austin Berry, MPH – University of Colorado Anschutz Medical Campus
Laura Strom, MD – University of Colorado
Stefan Sillau, PhD – University of Colorado School of Medicine, Aurora, CO, USA
Rationale:
Cognitive behavioral therapy (CBT) approaches are promising treatments for reducing seizure frequency and improving quality of life (QoL) in patients living with functional seizures (FS). Future directions from prior clinical trials have identified the need for further work to identify patients who would benefit most from FS-specific CBT approaches. While studies of FS outcomes have commonly included psychiatric histories and comorbidities as covariates in analysis, few have explored how treatment outcomes are influenced by overall patient psychiatric burden. This study explores the heterogeneity of psychiatric burden in patients living with FS and evaluates the impact of 6-week and 6+12-week group psychoeducational therapy compared to individualized therapy on patient-reported outcomes (PROs).
Methods:
This retrospective cohort study analyzed patient records of 823 individuals referred to the University of Colorado Functional Neurological Disorders Clinic between April 2020 and January 2025 with a diagnosis of FS. Logistic regression was used to explore the relationship between psychiatric burden and baseline severity of five PROs: QoL, anxiety, dissociative experiences, post-traumatic stress disorder (PTSD) and depression via the QOLIE-10P, GAD-7, DES-B, SPRINT, and PHQ-9, respectively, in 436 patients completing baseline PRO questionnaires. Mixed effects linear regression was employed to quantify the change in PROs between baseline and follow-up in 165 patients who completed PRO questionnaires at both time points.
Results:
Patients identifying as nonbinary or transgender more frequently experienced high psychiatric burden than those identifying as female or male (77.78% vs. 44.26% and 39.29%, respectively. Those aged 51-89 experienced a high psychiatric burden at a significantly lower frequency than all younger age groups (27.78%). High psychiatric burden was associated with lower QoL (OR: 2.40) and more severe anxiety (OR: 2.06), depression (OR: 1.99), and PTSD (OR: 2.47) symptoms at baseline. Improvements of small effect size were observed in the 6-week cohort in QoL (p = 0.0214), and in the 6+12-week cohort in PTSD (p = 0.0014) and depression (p = 0.0301) between baseline and follow-up. No significant differences were observed when comparing PRO changes between group and individual cohorts.
Conclusions:
High psychiatric burden at baseline was found to be associated with higher severity of four PROs (QoL, anxiety, depression, and PTSD). Considering psychiatric burden at baseline may help to set FS therapy expectations and tailor integrated treatment options by meeting patients where they are at the time of clinic entry. While effect sizes of all PRO changes were small between baseline and follow-up, future work should explore changes in PROs at multiple time points post-treatment as these multidimensional outcomes may take more time to be influenced by CBT effects than this study had sufficient data to capture.
Funding: No funding