Pilotäre Zwischenergebnisse zur Evaluation eines störungsspezifischen, körperpsychotherapeutisch orientierten Gruppenbehandlungsprogramms für Menschen mit psychogenen Anfällen

Zusammenfassung

Psychogene nicht-epileptische Anfälle (PNES) treten im Kontext verschiedener Erkrankungen auf. Die Ätiologie ist noch weitgehend unverstanden. Bisherige Konzepte gehen von einer erhöhten Rate an Trauma – Folgestörungen als ätiologische Erklärung für PNES aus, was sich durch Studien mehrfach belegen ließ [1] [2]. Klinisch imponiert das Krankheitsbild bedrohlich, wodurch die Betroffenen häufig intensivmedizinische Maßnahmen erhalten, ohne dass sie davon profitieren [3]. v. a. in Epilepsiezentren häufen sich Betroffene, da hier eine diagnostische Abgrenzung zu epileptischen Anfällen möglich ist. Oft gestaltet sich der Übergang von der Diagnosestellung in der Epileptologie zur Weiterbehandlung in die Psychosomatik schwierig, da sowohl Patienten/innen als auch Behandelnde oft in somatischen Krankheitskonzepten verhaftet sind [28]. Aufgrund der notwendigen Interdisziplinarität zwischen Neurologie und Psychosomatik wurde an der Charité Universitätsmedizin Berlin eine Spezialambulanz für Menschen mit dissoziativen Anfällen gegründet, welche sich im Übergang von Neurologie zu Psychosomatik ansiedelt und als Kooperationsprojekt funktioniert [27]. Aus der Ambulanz heraus wurde zudem ein Gruppenbehandlungsprogramm (Kördis) entwickelt. Dieses modularisierte 10-wöchige Therapieprogramm wird im Folgenden inhaltlich vorgestellt und ist weiterhin Gegenstand einer aktuell noch laufenden randomisierten, kontrollierten Evaluationsstudie. In den hier vorgestellten Pilotdaten aus der laufenden RCT Studie zeigte sich eine signifikante Verbesserung der Anfallsstärke (gemessen mit der Liverpool Seizure Severity Scale LSSS) sowie der Dissoziationsneigung (gemessen mit dem Fragebogen für dissoziative Symptome FDS-20) durch das Therapieprogramm (LSSS-Wert prä-interventionell: 49,2±4,2; LSSS-Wert post-interventionell: 46,8±5,4; t(10)=2,73; p=0,02; FDS-20 -Wert prä-interventionell: 25,3±14,6; FDS-20 -Wert post-interventionell: 19,7±8,8; t(10)=2,18; p=0,05).

Abstract

Psychogenic non-epileptic seizures (PNES) occur in the context of various diseases. Therefore, PNES patients represent a heterogeneous group with different causative disorders. The etiology is still poorly understood. Previous concepts assume an increased rate of trauma disorders in PNES, which has been proven several times by previous studies [1] [2]. The clinical picture is threatening, which means that those affected often receive intensive care measures without benefiting from them [3]. PNES patients accumulate especially in epilepsy centers, since a diagnostic differentiation from epileptic seizures is possible at those specialized centers. Often, the transition from making the diagnosis in epilepsy centers to follow-up treatment in psychosomatic/psychiatric settings is difficult. A reason could be that patients and practitioners are often involved in somatic disease concepts, which might be caused by the threatening clinical picture of PNES [28]. Due to this difficulties, a special outpatient clinic was set up at the Charité Berlin for people with dissociative seizures, which settles in the transition from neurology to psychosomatics and works as a cooperation project [27]. Out of the ambulance, a group treatment program (CORDIS) was developed, which aims at a better care of PNES patients at the interface between neurology and psychosomatic medicine. This modularized 10-week treatment program will be presented in this article and is the subject of a currently ongoing randomized, controlled evaluation study. The pilot data from the ongoing RCT study presented here showed significant effects in the effectiveness of the program, in particular the primary and secondary outcome measures.

Schlüsselwörter

Dissoziation - Behandlungsprogramm - psychogene nicht-epileptische Anfälle - Körperpsychotherapie

Keywords

psychogenic nonepileptic seizures - treatment program - dissociation - body psychotherapy

Publication History

Received: 26 November 2019

Accepted: 16 March 2020

Article published online:
30 April 2020

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