Brief Summary: This multi-site study will examine patients with epilepsy (ES) following head injury [i.e., posttraumatic epilepsy (PTE)] and posttraumatic psychogenic Non-epileptic seizures (PNES) and will compare them to patients with traumatic brain injury (TBI) who do not have seizures using functional neuroimaging.
Detailed Description: Numerous Veterans and civilians have seizures, which can be epileptic or nonepileptic in nature. Epileptic seizures are caused by abnormal brain cell firing. Nonepileptic seizures appear similar to epileptic seizures, but are associated with traumatic experiences and underlying psychological stressors. Both types of seizure are common and disabling, and many patients with seizures do not have adequate control resulting in loss of quality of life.
Impact: This grant application for the first study investigating mechanisms of PNES and PTE will provide increased understanding of neural circuitry in PTE and PNES, which can inform PTE and PNES treatments and could change clinical neurologic and psychiatric practice for PTE and PNES.
Anticipated study start date: March 1, 2018
Primary completion date: March 2021
Estimated study completion date: September 2011
Inclusion criteria for PNES, ES and TBI (w/o PNES or ES) participants
- Individuals with history of documented TBI (any severity).
- Males and Females ages 18-60 years .
- Women of child bearing potential, if currently using appropriate contraception.
Inclusion criteria of PNES and ES participants
- Diagnosed by video/EEG with lone PNES or by EEG with lone ES.
- Patients must have at least 1 PNES or 1 ES during the year prior to enrollment.
Exclusion Criteria of PNES, ES and TBI (w/o PNES or ES) participants
- Current or past year self-injurious behavior.
- Current suicidal intent (BDI suicide question 9 score of >1).
- Current or past year psychosis.
- Pending litigation or current application for long term disability.
- Active substance or alcohol use disorder (dependence), in past 3 months.
- Serious illness requiring systemic treatment or hospitalization; the participant either completes therapy or is clinically stable on therapy, for at least 30 days prior to study entry.
- Inability to fill out the self-report surveys.
- Women who are or/are attempting to become pregnant during the study.
- Ineligible or unwilling to complete MRI imaging.
- Inability to document TBI.
Exclusion Criteria for PNES and ES participants
- Inability or unwillingness to participate in CBT and assigned homework.
- Currently enrolled in cognitive therapy aimed at PNES (Current CBT or other psychotherapy may be administered).
- Concurrent mixed ES/PNES or equivocal video/EEG findings in discerning between ES and PNES will not be enrolled.