Neurobehavioral Therapy Is Associated With Improvements in Social Functioning in Patients With Functional Seizures and Traumatic Brain Injury.

OBJECTIVE

Functional (nonepileptic) seizures (FS) frequently co-occurs with traumatic brain injury (TBI) and reduces social functioning. In the current study, we aimed to identify whether psychotherapy is associated with changes in social functioning in TBI + FS.

METHODS

Participants were 96 adults with TBI, 48 of whom had FS and 48 of whom did not. Both TBI cohorts received standard medical care (SMC), and the TBI + FS group received adjunctive 12-session neurobehavioral therapy (NBT) for seizures. Neuropsychiatric evaluations measured sociodemographics, mental health, cognition, medications, social functioning, and quality of life, with a subset of items completed at 8- and 12-month post-enrollment follow ups. Social functioning was assessed with a quality of life scale.

RESULTS

Baseline seizure worry was the most reliable correlate of baseline social functioning (r = 0.52; p < 0.001; multivariable linear regression: β = 0.42, t = 2.80, p = 0.04) in the TBI + FS cohort. A 2-time (treatment baseline to endpoint) × 2-group (TBI + FS vs. TBI comparison) mixed ANOVA showed improved QOLIE-31 Social Functioning in the SMC + NBT-treated TBI + FS cohort but not for SMC TBI-only participants, F(1, 94) = 17.62, p < 0.001, partial η2 = 0.16. NBT was associated with improved social activities and leisure time, reduced social limitations, and increased work status. None of the baseline clinical variables predicted pre-post change in social functioning in TBI + FS participants.

CONCLUSION AND IMPLICATIONS FOR PRACTICE: Seizure worry appears to be an important component of social functioning in patients with FS and TBI and could be a worthwhile target of intervention. Our results suggest that multimodal NBT may be associated with improvements in aspects of social functioning for these patients. Those with TBI who were treated with SMC (no NBT) displayed no symptomatic or social benefit. This study highlights the importance of assessing and considering treatments for social functioning in FS.

TRIAL REGISTRATION: Data in this secondary analysis came from ClinicalTrials. gov: NCT03441867.