title: Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures.
abstract: OBJECTIVE
  There have been few treatment trials for psychogenic nonepileptic seizures (PNES). Some psychotherapies have been shown to improve PNES and comorbid symptom outcomes. We evaluated a pharmacologic intervention to test the hypothesis that sertraline would reduce PNES.
  
  
  METHODS
  We conducted a pilot, double-blind, randomized, placebo-controlled trial in an academic medical hospital with epilepsy center outpatients. Subjects aged 18 to 65 years diagnosed with video-EEG-confirmed PNES were treated with flexible-dose sertraline or placebo over 12 weeks. Seizure calendars and symptom scales were charted prospectively. Secondary outcome measures included psychiatric symptom scales and psychosocial variables.
  
  
  RESULTS
  Thirty-eight subjects enrolled, and 26 (68%) completed the trial. Thirty-three subjects with nonzero nonepileptic seizure rates at baseline were included in intent-to-treat analysis of the primary outcome. Subjects assigned to the sertraline arm experienced a 45% reduction in seizure rates from baseline to final visit (p = 0.03) vs an 8% increase in placebo (p = 0.78). Secondary outcome scales revealed no significant between-group differences in change scores from baseline to final visit, after adjustment for differences at baseline.
  
  
  CONCLUSIONS
  PNES were reduced in patients treated with a serotonin selective reuptake inhibitor, whereas those treated with placebo slightly increased. This study provides feasibility data for a larger-scale study.
  
  
  METHODS
  This study provides Class II evidence that flexible-dose sertraline up to a maximum dose of 200 mg is associated with a nonsignificant reduction in PNES rate compared with a placebo control arm (risk ratio 0.51, 95% confidence interval 0.25-1.05, p = 0.29), adjusting for differences at baseline.
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Rhode Island Hospital, Brown Medical School, Providence, RI 02903, USA. william_lafrance_jr@brown.edu
authors.forename: W C
authors.initials: WC
authors.lastname: LaFrance
authors.forename: G I
authors.initials: GI
authors.lastname: Keitner
authors.forename: G D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: A S
authors.initials: AS
authors.lastname: Blum
authors.forename: J T
authors.initials: JT
authors.lastname: Machan
authors.forename: C E
authors.initials: CE
authors.lastname: Ryan
authors.forename: I W
authors.initials: IW
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012640:Seizures / Q000188:drug therapy* / Q000523:psychology*; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline