Motivational Interviewing to Enhance Adherence of Patients With Psychogenic Non-epileptic Seizures

• Sponsor: Brigham and Women's Hospital (Other)
• Overall Status: Completed
• CT.gov ID: NCT02598076
• Collaborator: American Academy of Neurology (Other)
• Enrollment: 60
• Location: 1
• Arms: 2
• Actual Duration (Months): 22
• Patients Per Site Per Month: 2.7

Study Details

Study Description

Brief Summary

All subjects will attend an initial clinic visit with the neuropsychiatrist and epileptologist. At the end of this visit, those subjects randomized to motivational interviewing will be questioned using standardized motivational interviewing techniques by the study author who is a board certified neurologist and who will have formal training and certification in motivational interviewing.

Those subjects randomized to the control group will also undergo an initial clinic visit with a neuropsychiatrist and neurologists. However they will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference.

All subjects will be contacted by phone at 3 month follow-up. If necessary they will be called 5 times at various times during the day and early evening. If they are not reached, they will receive a letter requesting them to contact the study staff to complete the study. Subjects will be questioned about their adherence to treatment. The primary outcome will be the number of psychotherapy sessions for the treatment of PNES in which they have participated over the past three months. They will also be assessed for secondary outcomes including dichotomous adherence (either seizure freedom or active participation in psychotherapy for the treatment of PNES, with more than 5 sessions over the past 3 months), seizure frequency over the past month, number of hospitalizations and emergency department visits over the past 3 months, and quality of life as measured by the brief QOLIE-10 instrument. For those patients who give permission, their psychotherapists will be contacted by study staff to confirm the exact number of psychotherapy sessions over the past 3 months. A standard Partners clinical records release form with the patient's signature will be sent to the therapist's office.

Condition or Disease	Intervention/Treatment	Phase
Psychogenic Non-epileptic Seizures, Motivational Interviewing	Behavioral: motivational interviewing; Behavioral: standard psychotherapy	N/A

Detailed Description

Specific Aim: To determine whether motivational interviewing improves adherence to treatment (primary outcome), seizure frequency, healthcare usage, and quality of life (secondary outcomes).

Hypothesis: A brief in-person interview, using motivational interviewing techniques in addition to standard psychotherapy, will improve adherence, seizure frequency, healthcare usage, and quality of life at 6-month follow-up among patients with PNES when compared to a control group receiving only standard psychotherapy.

Baseline demographic data, psychiatric comorbidities, seizure frequency, quality of life, and healthcare resource utilization will be recorded following enrollment during the inpatient stay as part of PHRC IRB protocol 2013P000133. If the patient is not enrolled in protocol 2013P000133, baseline demographic data, seizure data, psychiatric comorbidities, qualities of life and healthcare resource utilization will be collected during the admission at which the patient is diagnosed. All enrolled subjects will be scheduled for an initial appointment in the joint psychiatry-neurology clinic with a board certified neuropsychiatrist and board certified neurologists, which is standard of care for newly diagnosed PNES patients at Brigham and Women's Hospital.

All subjects will attend the initial clinic visit with the neuropsychiatrist and epileptologist. At the end of this visit, those subjects randomized to motivational interviewing will be questioned using standardized motivational interviewing techniques by the study author who is a board certified neurologist and who will have formal training and certification in motivational interviewing.

Motivational interviews will include the classical 4 steps of MI:

1. engagement (in which the patient's goals and interests are elicited and the therapeutic alliance is established);

2. focusing (in which the specific subjects of discussion and intervention are negotiated);

3. strengthening motivation (in which the patients' reasons for healthcare intervention are made explicit, discussed, and reinforced); and

4. planning (in which actions for healthcare intervention are planned out based on the patients' own goals and interests).

The initial clinic visit and subsequent interview will be recorded with the patients' consent, and blinded reviewers hired through the department of psychiatry, trained and certified in motivational interviewing, will score the audio recordings using the Motivational Interviewing Treatment Integrity code (MITI) 4.0 to assess fidelity to standardized motivational interviewing techniques. Recordings and blinded review of interviews are for the sole purpose of ensuring that the interviewer is in fact using proper interviewing techniques (ie motivational interviewing techniques for patients in the motivational interviewing arm and abstinence from motivational interviewing techniques in the control arm). Such recordings and review are recommended in motivational interviewing research.

Those subjects randomized to the control group will also undergo an initial clinic visit with a neuropsychiatrist and neurologists - again recorded with the subjects' consent and scored using the MITI 4.0 to assess abstinence from motivational interviewing techniques. However they will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference.

All subjects will be contacted by phone at 3 month follow-up. If necessary they will be called 5 times at various times during the day and early evening. If they are not reached, they will receive a letter requesting them to contact the study staff to complete the study. Subjects will be questioned about their adherence to treatment. The primary outcome will be the number of psychotherapy sessions for the treatment of PNES in which they have participated over the past three months. They will also be assessed for secondary outcomes including dichotomous adherence (either seizure freedom or active participation in psychotherapy for the treatment of PNES, with more than 5 sessions over the past 3 months), seizure frequency over the past month, number of hospitalizations and emergency department visits over the past 3 months, and quality of life as measured by the brief QOLIE-10 instrument. For those patients who give permission, their psychotherapists will be contacted by study staff to confirm the exact number of psychotherapy sessions over the past 3 months. A standard Partners clinical records release form with the patient's signature will be sent to the therapist's office.

Study Design

• Study Type: Interventional
• Actual Enrollment: 60 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Motivational Interviewing to Enhance Adherence of Patients With Psychogenic Non-epileptic Seizures: A Model of Patient Engagement in Functional Neurological Symptom Disorders
• Actual Study Start Date: Aug 1, 2015
• Actual Primary Completion Date: Jun 1, 2017
• Actual Study Completion Date: Jun 1, 2017

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: control Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference.	Behavioral: standard psychotherapy; Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Experimental: MI Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by the study author who is a board certified neurologist and who has formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference (identical treatment in control and MI arms).	Behavioral: motivational interviewing; Motivational interviews will include the classical 4 steps of MI: 1) engagement (in which the patient's goals and interests are elicited and the therapeutic alliance is established); 2) focusing (in which the specific subjects of discussion and intervention are negotiated); 3) strengthening motivation (in which the patients' reasons for healthcare intervention are made explicit, discussed, and reinforced); and 4) planning (in which actions for healthcare intervention are planned out based on the patients' own goals and interests). MI will be performed by the study author who is a board certified neurologist and who has formal training and certification in motivational interviewing.; Behavioral: standard psychotherapy; Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES

Outcome Measures

Primary Outcome Measures

1. Adherence [4 months]

   Patients are classified as adherent if they attend 8 or more of the recommended 12 weekly psychotherapy sessions over a 16 week period. Otherwise they are classified as non-adherent.

Secondary Outcome Measures

1. Percent Decrease in PNES Frequency [4 months]

   Percent decrease in monthly PNES frequency

2. Change in Number of Monthly Emergency Department Visits [4 months]

   Change from baseline number of Emergency Department visits per month.

3. PNES Freedom [4 months]

   Patients are classified as PNES free if they have had no PNES in 3 months, otherwise they are classified as not PNES free.

4. Change in Quality of Life [4 months]

   Change from baseline to 4 month follow-up, in quality of life in epilepsy (QOLIE)-10 score. Quality of Life in Epilepsy (QOLIE)-10 scale is a validated, reliable instrument measuring quality of life on a scale from 10 (best) to 50 (worst). Total score was used. No sub-scales were used.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• The study population will be screened from all patients diagnosed with PNES in Brigham and Women's Hospital by capture of a definitive event on video EEG without EEG correlate.

• Patients with a mixed diagnosis of both PNES and epileptic seizures will be included.

Exclusion Criteria:

• Pediatric patients (under age 18) are not evaluated by EEG in our hospital and will therefore be excluded

• Estimated IQ<70

• Active substance use disorder

• Pregnancy or active medical issues anticipated to preclude participation in weekly psychotherapy

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Brigham and Women's Hospital	Boston	Massachusetts	United States	02115

Sponsors and Collaborators

• Brigham and Women's Hospital
• American Academy of Neurology

Investigators

• Principal Investigator: Barbara Dworetzky, MD, Brigham and Women's Hospital

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Jul 8, 2015

More Information

Publications

None provided.

• Responsible Party: Benjamin Tolchin, Clinical Fellow, Brigham and Women's Hospital
• ClinicalTrials.gov Identifier: NCT02598076
• Other Study ID Numbers: 2015P001152
• First Posted: Nov 5, 2015
• Last Update Posted: Apr 24, 2019
• Last Verified: Apr 1, 2019

• Additional relevant MeSH terms: Seizures

Study Results

Participant Flow

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Period Title: Overall Study
STARTED	31	29
COMPLETED	29	26
NOT COMPLETED	2	3

Baseline Characteristics

Arm/Group Title	Control	Motivational Interviewing	Total
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Total of all reporting groups
Overall Participants	31	29	60
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	40.7 (14.3)	39.6 (16.8)	40.2 (15.4)
Sex: Female, Male (Count of Participants)
Female	26 83.9%	23 79.3%	49 81.7%
Male	5 16.1%	6 20.7%	11 18.3%
Race/Ethnicity, Customized (Count of Participants)
African-American	3 9.7%	3 10.3%	6 10%
Hispanic	7 22.6%	6 20.7%	13 21.7%
White, non-Hispanic	20 64.5%	20 69%	40 66.7%
Other	1 3.2%	0 0%	1 1.7%
Region of Enrollment (participants) [Number]
United States	31 100%	29 100%	60 100%
years of education (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	13.8 (2.5)	13.0 (2.7)	13.4 (2.6)
household income (dollars) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [dollars]	42000	30000	33000
major depressive disorder (Count of Participants)
Count of Participants [Participants]	13 41.9%	12 41.4%	25 41.7%
generalized anxiety disorder (Count of Participants)
Count of Participants [Participants]	19 61.3%	15 51.7%	34 56.7%
Post traumatic stress disorder (Count of Participants)
Count of Participants [Participants]	10 32.3%	12 41.4%	22 36.7%
History of abuse (Count of Participants)
physical abuse	11 35.5%	11 37.9%	22 36.7%
sexual abuse	15 48.4%	13 44.8%	28 46.7%
emotional abuse	11 35.5%	11 37.9%	22 36.7%
any abuse	18 58.1%	18 62.1%	36 60%
delay to diagnosis of PNES (months) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [months]	3	9	7
psychogenic seizure frequency (PNES per week) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [PNES per week]	3	4	4
Quality of Life in Epilepsy (QOLIE)-10 (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	28.0 (9.5)	28.4 (8.8)	28.2 (9.0)
Emergency Department visits per month (visits per month) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [visits per month]	1	1	1
referred to psychotherapy at Brigham and Women's Hospital (Count of Participants)
Count of Participants [Participants]	17 54.8%	13 44.8%	30 50%

Outcome Measures

1. Primary Outcome

Title	Adherence
Description	Patients are classified as adherent if they attend 8 or more of the recommended 12 weekly psychotherapy sessions over a 16 week period. Otherwise they are classified as non-adherent.
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

Analysis population includes all participants for whom follow-up data was available. Patients who were lost to contact (after 7 phone calls and a mailed letter) for whom follow-up data was not available, were excluded from analysis.

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Measure Participants	29	26
Count of Participants [Participants]	9 29%	17 58.6%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Motivational Interviewing
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.015
	Comments
	Method	t-test, 2 sided
	Comments

2. Secondary Outcome

Title	Percent Decrease in PNES Frequency
Description	Percent decrease in monthly PNES frequency
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

Analysis population includes all participants for whom follow-up data was available. Patients who were lost to contact (after 7 phone calls and a mailed letter) for whom follow-up data was not available, were excluded from analysis.

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Measure Participants	28	26
Mean (Standard Deviation) [percentage of baseline seizures]	34.8 (89.7)	76.2 (39.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Motivational Interviewing
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.034
	Comments
	Method	t-test, 2 sided
	Comments

3. Secondary Outcome

Title	Change in Number of Monthly Emergency Department Visits
Description	Change from baseline number of Emergency Department visits per month.
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

Participants who provided this data at 4 month telephone follow-up.

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Measure Participants	28	26
Mean (Standard Deviation) [ED visits per month]	0.06 (0.47)	-0.15 (0.76)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Motivational Interviewing
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.23
	Comments
	Method	t-test, 2 sided
	Comments

4. Secondary Outcome

Title	PNES Freedom
Description	Patients are classified as PNES free if they have had no PNES in 3 months, otherwise they are classified as not PNES free.
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

Participants who provided information at 4 month telephone follow-up

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Measure Participants	28	26
Count of Participants [Participants]	3 9.7%	8 27.6%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Motivational Interviewing
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.095
	Comments
	Method	Fisher Exact
	Comments

5. Secondary Outcome

Title	Change in Quality of Life
Description	Change from baseline to 4 month follow-up, in quality of life in epilepsy (QOLIE)-10 score. Quality of Life in Epilepsy (QOLIE)-10 scale is a validated, reliable instrument measuring quality of life on a scale from 10 (best) to 50 (worst). Total score was used. No sub-scales were used.
Time Frame	4 months

Outcome Measure Data

Analysis Population Description

Participants who provided QOLIE-10 information at 4-month follow-up

Arm/Group Title	Control	Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES	Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
Measure Participants	23	24
Mean (Standard Deviation) [units on QOLIE-10 scale]	1.8 (7.9)	7.2 (10.0)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Motivational Interviewing
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.047
	Comments
	Method	t-test, 2 sided
	Comments

Adverse Events

Time Frame	4 months
Arm/Group Title	Control		Motivational Interviewing
Arm/Group Description	Group will receive standard treatment for psychogenic non-epileptic seizures. They will undergo an initial clinic visit with a neuropsychiatrist and neurologists. They will not undergo any subsequent motivational interview. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at Brigham and Women's Hospital or referred to a local psychotherapist according to their preference. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES		Group will receive an initial clinic visit with a neuropsychiatrist and neurologists, identical to the initial clinic visit for the control group. In addition they will receive 1 session of motivational interviewing immediately following the initial clinic visit. These patients will be questioned using standardized motivational interviewing techniques by a board certified neurologist with formal training and certification in motivational interviewing. Following the initial clinic visit, all subjects with ongoing seizures will either be scheduled for ongoing psychotherapy for treatment of PNES at BWH or referred to a local psychotherapist according to their preference. motivational interviewing: Motivational interviews will include the classical 4 steps of MI: 1) engagement; 2) focusing; 3) strengthening motivation; and 4) planning. standard psychotherapy: Standard cognitive behavioral therapy based psychotherapy for the treatment of PNES
All Cause Mortality
	Control		Motivational Interviewing
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/31 (0%)		0/29 (0%)
Serious Adverse Events
	Control		Motivational Interviewing
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/31 (0%)		0/29 (0%)
Other (Not Including Serious) Adverse Events
	Control		Motivational Interviewing
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/31 (0%)		0/29 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.