Question: In adults with non-epileptic or dissociative seizures, what is the most effective treatment (psychological or medical, with particular focus on trauma focused treatment such as EMDR) in improving patient outcomes, such as a reduction in the frequency of seizures and improved quality of life?


The authors of a systematic review (SR) reported that there is currently no sound evidence on which to base treatment decisions for people with non-epileptic attacks. Two randomised controlled trials (RCTs) presented some evidence to suggest that behavioural treatment may reduce the number of seizures, however, the trials had small sample sizes - and no definite clinical implications can be made from this evidence. The authors of one pilot RCT stated that they could neither substantiate nor refute the utility of a serotonin selective reuptake inhibitor treatment in patients with psychogenic non-epileptic seizures.

The need for further large, multi-centre, randomised controlled trials that evaluate a number of treatments was commonly reported in the included studies. The author of one RCT also suggested that future studies may benefit by stratifying groups on the presence of personality disorders.

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