Highlights
- •ReACT improves sense of control, cognitive inhibition, selective attention, and somatic symptoms.
- •Sense of control is a possible mechanism by which ReACT improves pediatric FS.
- •Improved QOL after ReACT may be mediated by improvements in FS.
- •There were no significant improvements in anxiety, depression, or social stress.
- •Outcomes support the benefit of targeting FS directly without relying on treatment of mood.
Abstract
Background
Differences in sense of control, cognitive inhibition, and selective attention in
pediatric functional seizures (FS) versus matched controls implicate these as potential
novel treatment targets. Retraining and Control Therapy (ReACT), which targets these
factors, has been shown in a randomized controlled trial to be effective in improving
pediatric FS with 82% of patients having complete symptom remission at 60 days following
treatment. However, post-intervention data on sense of control, cognitive inhibition,
and selective attention are not yet available. In this study, we assess changes in
these and other psychosocial factors after ReACT.
Methods
Children with FS (N = 14, Mage = 15.00, 64.3% female, 64.3% White) completed 8 weeks of ReACT and reported FS frequency
at pre and post-1 (7 days before and after ReACT). At pre, post-1, and post-2 (60 days
after ReACT), all 14 children completed the Pediatric Quality of Life Inventory Generic
Core Scales, Behavior Assessment System (BASC2), and Children’s Somatic Symptoms Inventory-24
(CSSI-24), and 8 children completed a modified Stroop task with seizure symptoms condition
in which participants are presented with a word and respond to the ink color (e.g.,
“unconscious” in red) to assess selective attention and cognitive inhibition. At pre
and post-1, ten children completed the magic and turbulence task (MAT) which assesses
sense of control via 3 conditions (magic, lag, turbulence). In this computer-based
task, participants attempt to catch falling X’s while avoiding falling O’s while their
control over the task is manipulated in different ways. ANCOVAs controlling for change
in FS from pre- to post-1 compared Stroop reaction time (RT) across all time points
and MAT conditions between pre and post-1. Correlations assessed the relationships
between changes in Stroop and MAT performance and change in FS from pre- to post-1.
Paired samples t-tests assessed changes in quality of life (QOL), somatic symptoms,
and mood pre to post-2.
Results
Awareness that control was manipulated in the turbulence condition of the MAT increased
at post-1 vs. pre- (p = 0.02, η2 = 0.57). This change correlated with a reduction in FS frequency after ReACT (r = 0.84,
p < 0.01). Reaction time significantly improved for the seizure symptoms Stroop condition
at post-2 compared to pre- (p = 0.02, η2 = 0.50), while the congruent and incongruent conditions were not different across
time points. Quality of life was significantly improved at post-2, but the improvement
was not significant when controlling for change in FS. Somatic symptom measures were
significantly lower at post-2 vs. pre (BASC2: t(12) = 2.25, p = 0.04; CSSI-24: t(11) = 4.17,
p < 0.01). No differences were observed regarding mood.
Conclusion
Sense of control improved after ReACT, and this improvement was proportional to a
decrease in FS, suggesting this as a possible mechanism by which ReACT treats pediatric
FS. Selective attention and cognitive inhibition were significantly increased 60 days
after ReACT. The lack of improvement in QOL after controlling for change in FS suggests
QOL changes may be mediated by decreases in FS. ReACT also improved general somatic
symptoms independent of FS changes.
Keywords
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Article info
Publication history
Published online: March 03, 2023
Accepted:
February 12,
2023
Received in revised form:
February 2,
2023
Received:
October 28,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
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- Towards more targeted treatments in functional seizuresEpilepsy & BehaviorVol. 142
- PreviewDespite a proliferation in functional seizure (FS) studies over recent years, there remains no gold standard of treatment, and this is especially so for children [1]. The study that follows is important for two main reasons. First, it raises the possibility of a targeted intervention for FS that addresses specific neurophysiologic onset and maintenance factors. The second reason is that it suggests a delineation in the treatment of FS, whereby FS events are targeted independent of common psychiatric comorbidities such as anxiety and depression.
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