Treatments for Psychogenic Nonepileptic Seizures (NES)

NCT ID: NCT00159965

Last Updated: 2014-11-20

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-12-31

Study Completion Date

2009-06-30

Brief Summary

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The investigators propose that treatment of the comorbid disorders (depression, anxiety, and impulsivity) with sertraline in patients with lone psychogenic nonepileptic seizures (NES), will result in a decreased number of NES. The purpose of this study is to provide pilot testing and data to inform the future randomized controlled trial based on the hypothesis.

Detailed Description

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This is a pilot, prospective, single center, randomized, placebo-controlled, double-blind trial, that assesses the number of NES in patients treated with flexible dose sertraline (Zoloft). This study will provide outcomes data and the effect size necessary for a future R01, multi-center randomized control trial. Secondary objective variables include reduction in depression, anxiety, impulsivity scores, and improvement in psychosocial functioning.

After being diagnosed with NES by video electroencephalogram monitoring (vEEG), up to 50 participants will be enrolled and monitored during a two week lead in period for their baseline NES and psychosocial symptoms and functioning. At week 2, they will be blindly randomized to the treatment arm with flexible dose sertraline (25 to 200mg) or to the placebo control arm. The dose will be titrated over 4 weeks up to 200mg or to dose limited by side effects. The subjects will stay on their maximum fixed dose for the next 4 weeks. At week 10, the subjects may elect to remain on the sertraline or they can taper off the medication over the final two weeks of the treatment trial.

After the treatment trial, the subjects will have follow up phone calls at month 4, 8, and 12 after enrollment to assess seizure status, medication usage, and global functioning.

Upon enrollment, subjects will be evaluated with a structured psychiatric and neurological exam, and with bi-weekly, 30 to 60 minute appointments where they will complete symptom and function scales. They will keep a seizure diary prospectively, to evaluate their daily seizure activity. They will be given two weeks of the medication at each visit.

In the first phase of the study 12 patients were screened and 8 enrolled in an open label trial of flexible dose sertraline. In the second phase of the study, 38 patients enrolled in the pilot, randomized, placebo-controlled trial.

Conditions

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Convulsion, Non-Epileptic Conversion Disorder Depression Stress Disorders, Post-Traumatic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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sertraline

flexible dose sertraline, 25 to 200mg titration as tolerated, administered over 12 weeks with a two week untreated lead in period monitoring their baseline NES

Group Type ACTIVE_COMPARATOR

sertraline

Intervention Type DRUG

flexible dose sertraline

placebo

flexible dose placebo, administered over 12 weeks with a two week untreated lead in period monitoring their baseline NES

Group Type PLACEBO_COMPARATOR

placebo

Intervention Type DRUG

flexible dose placebo

Interventions

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sertraline

flexible dose sertraline

Intervention Type DRUG

placebo

flexible dose placebo

Intervention Type DRUG

Other Intervention Names

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Zoloft

Eligibility Criteria

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Inclusion Criteria

* Video electroencephalogram (vEEG) confirmed diagnosis of NES
* Have at least one nonepileptic seizure per month
* Comorbid diagnosis of either depression, anxiety, or post traumatic stress disorder (PTSD)
* Able to complete self report symptom scales
* Not receiving optimized antidepressant medication

Exclusion Criteria

* Equivocal electroencephalogram (EEG) findings
* Current suicidality, litigation, or self-mutilation
* Using monoamine oxidase inhibitors (MAOIs), pimozide, or sumatriptan
* Allergy/sensitivity to sertraline
* Current alcohol/drug dependence
* Serious medical illness requiring current hospitalization
Minimum Eligible Age

18 Years

Maximum Eligible Age

95 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

Rhode Island Hospital

OTHER

Sponsor Role lead

Responsible Party

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W. Curt LaFrance Jr., M.D.

PI

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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W. Curt LaFrance, Jr., MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Rhode Island Hospital/Brown Medical School

Locations

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Rhode Island Hospital

Providence, Rhode Island, United States

Site Status

Countries

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United States

References

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LaFrance WC Jr, Devinsky O. The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia. 2004;45 Suppl 2:15-21. doi: 10.1111/j.0013-9580.2004.452002.x.

Reference Type BACKGROUND
PMID: 15186340 (View on PubMed)

LaFrance WC. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology. 2002 Mar 26;58(6):990; author reply 990-1. doi: 10.1212/wnl.58.6.990. No abstract available.

Reference Type BACKGROUND
PMID: 11914432 (View on PubMed)

LaFrance WC Jr, Alper K, Babcock D, Barry JJ, Benbadis S, Caplan R, Gates J, Jacobs M, Kanner A, Martin R, Rundhaugen L, Stewart R, Vert C; NES Treatment Workshop participants. Nonepileptic seizures treatment workshop summary. Epilepsy Behav. 2006 May;8(3):451-61. doi: 10.1016/j.yebeh.2006.02.004. Epub 2006 Mar 15.

Reference Type BACKGROUND
PMID: 16540377 (View on PubMed)

LaFrance WC Jr, Barry JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav. 2005 Nov;7(3):364-74. doi: 10.1016/j.yebeh.2005.07.010. Epub 2005 Sep 16.

Reference Type BACKGROUND
PMID: 16150653 (View on PubMed)

LaFrance WC Jr, Rusch MD, Machan JT. What is "treatment as usual" for nonepileptic seizures? Epilepsy Behav. 2008 Apr;12(3):388-94. doi: 10.1016/j.yebeh.2007.12.017. Epub 2008 Feb 20.

Reference Type BACKGROUND
PMID: 18282812 (View on PubMed)

LaFrance WC Jr. Psychogenic nonepileptic seizures. Curr Opin Neurol. 2008 Apr;21(2):195-201. doi: 10.1097/WCO.0b013e3282f7008f.

Reference Type BACKGROUND
PMID: 18317280 (View on PubMed)

LaFrance WC Jr, Devinsky O. Treatment of nonepileptic seizures. Epilepsy Behav. 2002 Oct;3(5 Suppl):19-23. doi: 10.1016/s1525-5069(02)00505-4.

Reference Type BACKGROUND
PMID: 12609316 (View on PubMed)

LaFrance WC Jr, Benbadis SR. Avoiding the costs of unrecognized psychological nonepileptic seizures. Neurology. 2006 Jun 13;66(11):1620-1. doi: 10.1212/01.wnl.0000224953.94807.be. No abstract available.

Reference Type BACKGROUND
PMID: 16769930 (View on PubMed)

LaFrance WC Jr, Blum AS, Miller IW, Ryan CE, Keitner GI. Methodological issues in conducting treatment trials for psychological nonepileptic seizures. J Neuropsychiatry Clin Neurosci. 2007 Fall;19(4):391-8. doi: 10.1176/jnp.2007.19.4.391.

Reference Type RESULT
PMID: 18070841 (View on PubMed)

LaFrance WC Jr, Syc S. Depression and symptoms affect quality of life in psychogenic nonepileptic seizures. Neurology. 2009 Aug 4;73(5):366-71. doi: 10.1212/WNL.0b013e3181b04c83.

Reference Type RESULT
PMID: 19652140 (View on PubMed)

LaFrance WC Jr, Keitner GI, Papandonatos GD, Blum AS, Machan JT, Ryan CE, Miller IW. Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures. Neurology. 2010 Sep 28;75(13):1166-73. doi: 10.1212/WNL.0b013e3181f4d5a9. Epub 2010 Aug 25.

Reference Type RESULT
PMID: 20739647 (View on PubMed)

Other Identifiers

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5K23NS045902

Identifier Type: NIH

Identifier Source: secondary_id

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5K23NS045902-05

Identifier Type: NIH

Identifier Source: org_study_id

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