Neuroimaging Biomarker for Seizures: Treatment Outcomes
Abstract number :
1.086
Submission category :
2. Translational Research / 2A. Human Studies
Year :
2022
Submission ID :
2204665
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Ryan Van Patten, PhD – Providence VA Medical Center and Brown University; Grayson Baird, PhD – Rhode Island Hospital and Brown University; Andrew Blum, MD, PhD – Rhode Island Hospital and Brown University; Stephen Correia, PhD – Providence VA Medical Center; Noah Philip, MD – Providence VA and Brown University; Jane Allendorfer, PhD – University of Alabama Birmingham; Tyler Gaston, MD – University of Alabama Birmingham; Adam Goodman, PhD – University of Alabama Birmingham; Leslie Grayson, MD – University of Alabama Birmingham; Krista Tocco, BA – VA Providence Health Care System and Brown University; Valerie Vogel, BA – VA Providence Health Care System, Rhode Island Hospital, and Brown University; Amber Martin, MPH – University of Alabama Birmingham; Samantha Fry, MPH – University of Alabama Birmingham; Mark Bolding, PhD – University of Alabama Birmingham; Lawrence Ver Hoef, MD – University of Alabama Birmingham; Jerzy Szaflarski, MD, PhD – University of Alabama Birmingham; W Curt LaFrance, MD, MPH – VA Providence Health Care System, Rhode Island Hospital, and Brown University
Rationale: Both epileptic (ES) and nonepileptic seizures (NES) include frequent, disabling neuropsychiatric symptoms, and traumatic brain injury (TBI) is a common comorbidity of both. This is the first study to our knowledge to measure the impact of multi-modal neuropsychiatric therapy on seizures and mental health outcomes in ES and NES, accounting for TBI.
Methods: Three groups of adults (civilians and US Veterans) with TBI prospectively completed baseline, midpoint, and end of treatment evaluations: TBI controls (n=75), TBI+NES (n=89), and TBI+ES (n=29), including self-report daily seizure counts, depression, anxiety, somatic symptoms, postconcussive symptoms, PTSD symptoms, quality of life, and overall clinical functioning. Structural and functional MRI were collected at baseline and at end of treatment (for seizures groups)/ study time window (for untreated TBI cohort; presented elsewhere). Within group changes for the 3 groups were analyzed, with the 2 seizure cohorts (TBI-NES and TBI-ES) compared pre- and post-treatment with an evidence-based, weekly, 12-session, manualized, multi-modality therapy for seizures, Neuro-Behavioral Therapy (NBT). Outcomes were modeled using generalized linear mixed modeling, where observations were nested within patients, and seizure frequencies were modeled as a slope over time, given that time occurs continuously, not categorically.
Results: Clinical variables and baseline symptom scores across all three TBI groups are summarized in Table 1. Clinical outcomes (baseline to end of study) are presented in Figure 1. For every month in the trial, seizure frequency decreased 34.4% (95% CI [14.5, 50.0], p=0.002) in the TBI+ES NBT treated group and 41.5% (95% CI [18.4, 58.0], p=0.002) in the TBI+NES NBT treated group. From baseline to posttreatment, the TBI+ES NBT treated group showed a significant decrease in depressive symptoms (p< .0001) and somatization (p=.03), with nonsignificant decreases in anxiety (p=.12) and postconcussive symptoms (p=.11), and nonsignificant improvements in quality of life (p=.06) and global clinical functioning (p=.06). The TBI+NES NBT treated group showed significant decreases in depression (p< .001), anxiety (p=.02), postconcussive symptoms (p=.004), and PTSD symptoms (p< .001), with an improvement in quality of life (p< .001). The untreated TBI control group showed increased somatization (p=.02) and decreased postconcussive symptoms (p=.01) over the study time window interval, with no significant changes in clinical symptomatology or functioning.
Translational Research