Seizure Reduction Is Not the Only Treatment Goal for Persons with NES
Abstract number :
3.488
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2023
Submission ID :
1474
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Luke Kim, BS – University of Colorado
Steve Savinoff, MD, PGY4 – Neurology – University of Colorado; Meagan Watson, MPH, MBAc – Neurology – University of Colorado; Beth Rush, PhD, ABPP – Psychiatry and Psychology – Mayo Clinic; Laura Strom, MD, FAES – Neurology – University of Colorado
Rationale:
The current gold-standard treatment for persons with nonepileptic seizures (NES) utilizes a multidisciplinary clinic model. Target treatment outcomes are disproportionately defined by seizure frequency reduction, yet other patient-identified outcomes are rarely considered. Randomized clinical trials have shown inconsistent statistical significance using seizure reduction alone. We aim to identify patient-defined NES treatment goals with the purpose of highlighting additional variables for evaluating intervention outcomes.
Methods:
The University of Colorado (CU) NES Clinic requests patients report their personal treatment goals as standard of care at the outset of treatment. Between 2019 and 2022, 826 patients identified 885 total goals at their first appointment. Qualitative analysis of patient goal responses was conducted by two independent researchers. Uncertainties were reviewed and reconciled by NES clinician experts.
Results:
Six unique goal categories resulted from analyses with entries sorted in the following proportions: 32% Seizure Management (i.e., “reduce frequency”), 20% Concrete Functional Improvement (i.e. ,“work return”), 21% Abstract Functional Improvement (i.e., “get better”), 14% Seizure Education (i.e., “why seizures”), 10% Psychological Understanding/Toolbox Building (addressing anxiety, relationships), or 3% Other.
Conclusions:
Of all patient-defined NES treatment goals reported, only 32% prioritized seizure management. The majority wished to be educated about NES and other psychological factors triggering and perpetuating symptoms. Additionally, patients identified abstract and concrete functional improvements they hoped to observe in themselves once treated. Findings highlight that patient-defined goals may differ from what clinician stakeholders prioritize, and that treatment success is defined more variably by the patient. Clinical trials should prioritize patient-defined outcomes to better ensure treatment is personalized and treatment efficacy reflects how they evaluate success.
Funding: None
Behavior