Reduced Subjective Cognitive Concerns With Neurobehavioral Therapy in Functional Seizures and Traumatic Brain Injury
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Abstract
Objective:
Functional seizures are common among people with traumatic brain injury (TBI). Subjective cognitive concerns refer to a person’s own perception of problems with cognitive functioning in everyday life. The authors investigated the presence and correlates of subjective cognitive concerns and the response to neurobehavioral therapy among adults with TBI and functional seizures (TBI+FS group).
Methods:
In this observational study, participants in the TBI+FS group (N=47) completed a 12-session neurobehavioral therapy protocol for seizures, while participants in the comparison group (TBI without seizures) (N=50) received usual treatment. Subjective cognitive concerns, objective cognition, mental health, and quality of life were assessed before and after treatment. Data collection occurred from 2018 to 2022.
Results:
Baseline subjective cognitive concerns were reported for 37 (79%) participants in the TBI+FS group and 20 (40%) participants in the comparison group. In a multivariable regression model in the TBI+FS group, baseline global mental health (β=−0.97) and obsessive-compulsive symptoms (β=−1.01) were associated with subjective cognitive concerns at baseline. The TBI+FS group had fewer subjective cognitive concerns after treatment (η2=0.09), whereas the TBI comparison group showed a nonsignificant increase in subjective cognitive concerns.
Conclusions:
Subjective cognitive concerns are common among people with TBI and functional seizures and may be related to general mental health and obsessive-compulsive symptoms. Evidence-based neurobehavioral therapy for functional seizures is a reasonable treatment option to address such concerns in this population, although additional studies in culturally diverse samples are needed. In addition, people with functional seizures would likely benefit from rehabilitation specifically targeted toward cognitive functioning.
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History
Received: 22 August 2023
Revision received: 22 October 2023
Accepted: 13 December 2023
Published online: 14 March 2024
Published in print: Summer 2024
Keywords
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Competing Interests
Dr. Van Patten engages in profit sharing with the International Neuropsychological Society for continuing education proceeds and receives royalties from Springer. Dr. Altalib has received research funding from Cerevel, Congressionally Directed Medical Research Programs, Eisai, the Epilepsy Study Consortium, the Epilepsy Research Program, and UCB Pharma. Dr. Gaston has received a consulting fee from GW Biosciences and an honorarium from the American Academy of Neurology, and he serves on the advisory board for Neurelis. Dr. Grayson serves on the board of the Epilepsy Foundation of Western North Carolina and receives speakers bureau fees from Jazz Pharmaceuticals. Dr. Allendorfer has received funding from the Evelyn F. McKnight Brain Institute, LivaNova, and the State of Alabama Carly’s Law; she has served as Associate Editor for Epilepsy & Behavior Reports; she has received honoraria from the Cleveland Clinic and the University of Auckland; she has received travel funds from the International League Against Epilepsy; and she has served as a consultant for LivaNova. Dr. Szaflarski has received funding from Biogen, Eisai, Greenwich Biosciences, NeuroPace, Serina Therapeutics, Shor Foundation for Epilepsy Research, UCB Pharma, and Xenon Pharmaceuticals; he serves as a consultant to or on the advisory boards of AdCel Biopharma, Greenwich Biosciences, iFovea, LivaNova, NeuroPace, Pure Tech Health, Serina Therapeutics, SK Lifesciences, and UCB Pharma; he has served as Editor-in-Chief of Epilepsy & Behavior Reports and on the editorial boards of several journals; he has served as a member of the Alabama State Medical Cannabis Study Commission; he has provided expert opinion in medicolegal cases, including those related to functional neurological disorders; and he has served on the Alabama Medical Cannabis Commission. Dr. LaFrance has received royalties from Cambridge University Press and Oxford University Press. The other authors report no financial relationships with commercial interests.
Funding Information
Supported by NIH (grant R01HD102723 to Drs. Goodman and Allendorfer and grant R21MH133055-01 to Dr. Goodman); the U.S. Department of Defense (DoD grant W81XWH-17-1-0619 to Drs. Goodman and Allendorfer and grant W81XWH-17-0169 to Drs. Grayson and LaFrance); DoD Office of the Assistant Secretary of Defense for Health Affairs through the Epilepsy Research Program; and the Veterans Health Administration, Veterans Integrated Services Network 1 (Career Development Award to Dr. Van Patten). The U.S. Army Medical Research Acquisition Activity (Fort Detrick, Md.) is the awarding and administering acquisition office. This work was supported with resources and the use of facilities at the VA Providence Health Care System, Providence, R.I.Data for this trial funded by the DoD will be shared 1 year after completion of the study and will be available in the Federal Interagency Traumatic Brain Injury Research Informatics System (fitbir.nih.gov).The opinions, interpretations, conclusions, and recommendations of this study are those of the authors and are not necessarily endorsed by Brown University, Rhode Island Hospital, or the University of Alabama at Birmingham, and the contents do not represent the views of the DoD, VA, or U.S. government.
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