One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: A nonrandomized controlled trial.

IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY
Epilepsia Pub Date : 2024-10-10 DOI:10.1111/epi.18137
Ryan Van Patten, Andrew Blum, Stephen Correia, Noah S Philip, Jane B Allendorfer, Tyler E Gaston, Adam Goodman, Leslie P Grayson, Krista Tocco, Valerie Vogel, Amber Martin, Samantha Fry, Mark Bolding, Lawrence Ver Hoef, Grayson L Baird, Jerzy P Szaflarski, W Curt LaFrance
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引用次数: 0

Abstract

Objective: Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy.

Methods: In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life.

Results: Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44-24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37-12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12-5.04) to 12-month postenrollment (mean = .98, 95% CI = .40-2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-only comparisons improved on only one of 19 (5.3%).

Significance: NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.

脑外伤功能性癫痫发作或癫痫的神经行为疗法一年随访:非随机对照试验。
目的:创伤性脑损伤(TBI)患者通常伴有癫痫发作(功能性和/或癫痫),但针对TBI合并癫痫发作患者的治疗方法却很有限。我们研究了创伤性脑损伤+功能性癫痫发作(FS)和创伤性脑损伤+癫痫患者接受神经行为疗法(NBT)后的治疗阶段和一年后的疗效:在这项多中心、前瞻性、三组、非随机对照试验中,共招募了三组成年人,进行了为期一年的入组后随访:创伤性脑损伤+视频脑电图(EEG)证实的FS(n = 89)、创伤性脑损伤+EEG证实的癫痫(n = 29)以及图表/病史证实的无癫痫发作的创伤性脑损伤(n = 75)。排除标准为近期精神错乱或自伤行为、当前有自杀倾向、未决诉讼或长期残疾、活动性药物使用障碍以及无法参与研究程序。创伤性脑损伤+FS组和创伤性脑损伤+癫痫组完成了针对癫痫发作的NBT治疗,这是一种以证据为基础的多模式心理治疗,为期12个疗程,而无癫痫发作的创伤性脑损伤组参与者则接受标准的医疗护理。主要结果是癫痫发作频率的变化;次要结果是心理健康、创伤性脑损伤相关症状、残疾和生活质量的变化:结果:在治疗期间,TBI + FS 参与者的每月平均癫痫发作次数有所减少(p = .002),并且从基线(平均值 = 16.75;95% 置信区间 [CI] = 11.44-24.53)到注册后 12 个月(平均值 = 7.28,95% 置信区间 = 4.37-12.13,p = .002,d = .38)期间的减少幅度显著。在治疗期间,创伤性脑损伤+癫痫参与者的每月癫痫发作次数有所减少(p = .002);从基线(平均 = 2.38,95% CI = 1.12-5.04)到入组后 12 个月(平均 = .98,95% CI = .40-2.42,p = .07,d = .22),减少幅度无统计学意义。关于次要结果测量中治疗阶段的变化,TBI + FS参与者在19个变量中的10个变量(52.6%)有显著改善,TBI +癫痫参与者在19个变量中的5个变量(26.3%)有改善,而仅TBI比较者在19个变量中仅有1个变量(5.3%)有改善:NBT使创伤性脑损伤+FS和创伤性脑损伤+癫痫患者受益。TBI+FS患者在接受 NBT 治疗 1 年后病情有所改善。NBT对癫痫发作患者可能是一种临床有用的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epilepsia
Epilepsia 医学-临床神经学
CiteScore
10.90
自引率
10.70%
发文量
319
审稿时长
2-4 weeks
期刊介绍: Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.
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