Cognitive behavioural therapy used as treatment for psychogenic non-epileptic seizures in woman with learning disabilities

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Non-epileptic seizures can have a major impact on the quality of life of people affected. Those with an organic, physical cause may be relatively easy to diagnose, and if the underlying cause can be found, it may of course be amenable to treatment and if that treatment is successful, the seizures may stop.

Some seizures however have a psychological cause and are known as ‘psychogenic seizures’, caused by the impact of thoughts and feelings on the way that the brain works, and these are known as psychogenic seizures..

The epilepsy society website describes three types of psychogenic seizures:

  • Dissociative seizures, which are involuntary and the most common type.
  • Panic attacks, which may cause the person to lose consciousness and shake or convulse.
  • Factitious seizures, which happen under some conscious control of the person.

The authors of this paper describe a case study of a young woman in her twenties who had a high frequency of psychogenic non-epileptic seizures. The community learning disability team were asked to work with her by the neurologist and decided to use Cognitive Behavioural Therapy as part of the therapeutic approach to working with her.

What they did was focus initially on the frequency of the seizures through the use of relaxation and distraction techniques.

They then used an approach known as graded exposure. This is an approach used in helping people to manage anxiety, whereby the person stays in the situations that cause some anxiety and gradually works their way up a pre-agreed ‘ladder; of situations that cause anxiety,  working their way to the situation that causes them the most anxiety. For the young woman concerned, this was working her way towards a goal of going on the bus alone.

The team worked with the young woman over a period of twelve sessions using these techniques.

To look at the impact of the treatment they used self-report of seizure frequency as an outcome measure. The young woman reported a reduction in the frequency of the psychogenic non-epileptic seizures. They reduced from seven to two-three per week. As a result of this, she has successfully completed several bus journeys on her own, having worked her way up the ‘ladder’ of situations that had caused her most anxiety.

In addition to the self-report outcome measure, the authors also completed pre and post therapy measures for anxiety and depression using the Glasgow Anxiety Scale for Intellectual Disability, where the scores for the young woman reduced from 23 to 19 and the Glasgow Depression Scale for Intellectual Disability where she scored sub-clinically.

The authors conclude that the case report presented adds to the evidence base for cognitive behavioural therapy as a viable treatment for psychogenic non-epileptic seizures and that it is possible to adapt the approach to meet the needs of people with learning disabilities.

Cognitive behaviour therapy with a woman in her twenties with a mild intellectual disability presenting with psychogenic non-epileptic seizures, Atnas C and ippold T, in Advances in Mental Health and Intellectual Disabilities, 7 4,.245 – 250

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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