Reflections on the CODES Trial for Adults with Dissociative Seizures: What We Found and Considerations for Future Studies

Overview

Journal BMJ Neurol Open

Specialty Neurology

Date 2024 Jun 11

PMID 38860230

Authors

Laura H Goldstein

Jon Stone

Markus Reuber

Sabine Landau

Emily J Robinson

Alan Carson

Nick Medford

Trudie Chalder

Affiliations

Soon will be listed here.

Abstract

The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures multicentre randomised controlled trial is the largest, fully-powered study to test the clinical and cost-effectiveness of a psychotherapeutic intervention in this population. We also explored predictors or moderators of outcomes and investigated mechanisms of change in therapy. In this current review of findings, we discuss issues related to the design of the trial and consider the study's nested qualitative studies which were undertaken not only to shed light on the original research questions but to provide insights and recommendations for other researchers in the field of functional neurological disorder. Finally, we consider issues relating to the possible clinical application of our study findings.

References

Mundt J, Marks I, Shear M, Greist J . The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002; 180:461-4. DOI: 10.1192/bjp.180.5.461. View

Goldstein L, Chalder T, Chigwedere C, Khondoker M, Moriarty J, Toone B . Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology. 2010; 74(24):1986-94. PMC: 2905892. DOI: 10.1212/WNL.0b013e3181e39658. View

Lagrand T, Jones M, Bernard A, Lehn A . Health Care Utilization in Functional Neurologic Disorders: Impact of Explaining the Diagnosis of Functional Seizures on Health Care Costs. Neurol Clin Pract. 2023; 13(1):e200111. PMC: 9973286. DOI: 10.1212/CPJ.0000000000200111. View

Wilkinson M, Day E, Purnell J, Pilecka I, Perdue I, Murray J . The experiences of therapists providing cognitive behavioral therapy (CBT) for dissociative seizures in the CODES randomized controlled trial: A qualitative study. Epilepsy Behav. 2020; 105:106943. PMC: 7156910. DOI: 10.1016/j.yebeh.2020.106943. View

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

Read J, Jordan H, Perdue I, Purnell J, Murray J, Chalder T . The experience of trial participation, treatment approaches and perceptions of change among participants with dissociative seizures within the CODES randomized controlled trial: A qualitative study. Epilepsy Behav. 2020; 111:107230. PMC: 7581898. DOI: 10.1016/j.yebeh.2020.107230. View

Rimes K, Chalder T . The Beliefs about Emotions Scale: validity, reliability and sensitivity to change. J Psychosom Res. 2010; 68(3):285-92. DOI: 10.1016/j.jpsychores.2009.09.014. View

Goldstein L, Robinson E, Pilecka I, Perdue I, Mosweu I, Read J . Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT. Health Technol Assess. 2021; 25(43):1-144. PMC: 8273679. DOI: 10.3310/hta25430. View

Chalder T, Landau S, Stone J, Carson A, Reuber M, Medford N . How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial. Psychol Med. 2024; 54(8):1725-1734. DOI: 10.1017/S0033291723003665. View

10.

Goldstein L, Robinson E, Chalder T, Stone J, Reuber M, Medford N . Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res. 2022; 158:110921. DOI: 10.1016/j.jpsychores.2022.110921. View

11.

LaFrance Jr W, Baird G, Barry J, Blum A, Frank Webb A, Keitner G . Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014; 71(9):997-1005. DOI: 10.1001/jamapsychiatry.2014.817. View

12.

Howlett S, Reuber M . An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy (Chic). 2011; 46(1):125-38. DOI: 10.1037/a0015138. View

13.

Gaskell C, Power N, Novakova B, Simmonds-Buckley M, Reuber M, Kellett S . A meta-analytic review of the effectiveness of psychological treatment of functional/dissociative seizures on non-seizure outcomes in adults. Epilepsia. 2023; 64(7):1722-1738. DOI: 10.1111/epi.17626. View

14.

Goldstein L, Robinson E, Mellers J, Stone J, Carson A, Reuber M . Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020; 7(6):491-505. PMC: 7242906. DOI: 10.1016/S2215-0366(20)30128-0. View

15.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

16.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

17.

OConnor P, Reuber M . 'It's both challenging and probably the most rewarding work' - A qualitative study of psychological therapy provider's experiences of working with people with dissociative seizures. Epilepsy Behav. 2021; 122:108156. DOI: 10.1016/j.yebeh.2021.108156. View

18.

Robinson E, Goldstein L, McCrone P, Perdue I, Chalder T, Mellers J . COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES): statistical and economic analysis plan for a randomised controlled trial. Trials. 2017; 18(1):258. PMC: 5461767. DOI: 10.1186/s13063-017-2006-4. View

19.

Reuber M, Mitchell A, Howlett S, Elger C . Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission?. Epilepsia. 2005; 46(11):1788-95. DOI: 10.1111/j.1528-1167.2005.00280.x. View

20.

Goldstein L, Robinson E, Mellers J, Stone J, Carson A, Chalder T . Psychological and demographic characteristics of 368 patients with dissociative seizures: data from the CODES cohort. Psychol Med. 2020; 51(14):2433-2445. PMC: 8506352. DOI: 10.1017/S0033291720001051. View