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Abstract Objective The following case study seeks to review implementation of CBT for NES, discuss psychotherapeutic adaptations and outcomes while balancing treatment fidelity, and offer preliminary recommendations for expansion of psychotherapeutic modalities for individuals with cognitive impairment. Methods 49-year-old Hispanic male with a history of mixed epileptic (non-lesional frontal lobe medically refractory) and non-epileptic events. Neurological workup included video EEG, which captured seven events without EEG correlate and an unremarkable brain MRI. Neuropsychological evaluation indicated mild cognitive impairment due to epilepsy with deficits in processing speed, executive functioning, and confrontation naming with borderline to low average core visual and verbal abilities. The patient participated in manualized CBT for PNES. Results Treatment adaptations included extending treatment sessions from 12–19 sessions and including the patient’s sister. They read the chapters together and practiced strategies outside of session. She participated in helping him notice patterns of manifestations of fear and anger and their influence on somatic symptoms. Omission of treatment elements with higher cognitive demand (i.e., thought chart). Outcomes included increased awareness of emotions, triggers, and warnings but not episode reduction in the context of increased epileptic seizures. Conclusions Feasibility of treatment may be limited for individuals with mixed epileptic and NES episodes, particularly if there is cognitive impairment and difficulty differentiating between the two. Psychotherapeutic techniques that are concrete and behaviorally based will = be beneficial for individuals with cognitive impairment. Episode reduction in isolation is likely reductionistic when considering treatment effectiveness. Ability to self-manage episodes, quality of life, functional status, and self-efficacy are valuable markers of improvement.
Messerly et al. (Thu,) studied this question.