title: The effect of selective serotonin reuptake inhibitors on the frequency of psychogenic nonepileptic seizures: a critically appraised topic.
abstract: BACKGROUND
  Psychogenic nonepileptic seizures (PNES) are commonly encountered problem in neurological practice and usually are accompanied by other psychiatric comorbidities. Despite its prevalence and profound impact on patients and families, there have been few trials addressing treatment. Cognitive behavioral therapy may be effective but the role of pharmacologic therapy remains unclear.
  
  
  OBJECTIVE
  To critically evaluate evidence that PNES frequency may be reduced by treatment with selective serotonin reuptake inhibitors.
  
  
  METHODS
  The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, epileptology, and psychiatry content experts.
  
  
  RESULTS
  A pilot randomized control clinical trial was selected for critical appraisal. Thirty-eight PNES patients were randomized to flexible-dose sertraline (target dose, 200 mg/d) or placebo. Only 68% of patients contributed data to the primary analysis and baseline PNES frequency was notably dissimilar. Twelve-week seizure frequency rates, as compared with baseline, were 45% lower in the sertraline group (P=0.03) but unchanged in the placebo group (8% increase; P=0.78). After adjustment for baseline differences, between-treatment group comparison revealed a trend toward lower event frequency in the sertraline group (risk ratio 0.51; 95% confidence interval, 0.25-1.05; P=0.29). Psychosocial and quality of life measures did not differ between treatment groups.
  
  
  CONCLUSIONS
  There is insufficient evidence to recommend routine treatment with sertraline to reduce PNES event frequency but these pilot data suggest a possible benefit worthy of further exploration.
authors.affiliation: Department of Neurology, Mayo Clinic, Scottsdale, AZ 95259, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bravo
authors.forename: Charlene R
authors.initials: CR
authors.lastname: Hoffman-Snyder
authors.forename: Kay E
authors.initials: KE
authors.lastname: Wellik
authors.forename: Kari A
authors.initials: KA
authors.lastname: Martin
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Hoerth
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D003291:Conversion Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use; D016239:MEDLINE / Q000706:statistics & numerical data; D008875:Middle Aged; D012640:Seizures / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D014151:Anti-Anxiety Agents; D000927:Anticonvulsants; D008140:Lorazepam; D017367:Selective Serotonin Reuptake Inhibitors