Improvements in Montreal Cognitive Assessment scores after neurobehavioral therapy in adults with functional (nonepileptic) seizures and traumatic brain injury.

Cognitive functioning impacts clinical symptoms, treatment response, and quality of life in adults with functional/nonepileptic seizures (FS/NES), but no study to date examines effects of behavioral FS/NES treatment on cognition in these patients. We hypothesized that there would be a reduction in cognitive symptoms in participants with FS/NES and traumatic brain injury (TBI) following neurobehavioral therapy (NBT). We also hypothesized that select seizure-related, medication, subjective cognitive, and mental health symptoms would be negatively correlated with improvements in cognitive performance after NBT. Participants were 37 adults with TBI + FS/NES and 35 adults with TBI only, recruited from medical centers in the northeastern or southeastern U.S. TBI + FS/NES participants completed a 12 session NBT intervention, and TBI without seizures participants were not treated. All participants completed pre-post assessments of cognition (Montreal Cognitive Assessment [MoCA]) and baseline sociodemographic factors and mental health symptoms. Pre-post MoCA scores increased significantly in TBI + FS/NES participants (28/37 [75.7%] improved) but not in TBI comparisons (10/35 [28.6%] improved). Language, memory, and visuospatial/executive functions, but not attention, improved over time in the TBI + FS/NES group. Gains in cognition were concentrated in those TBI + FS/NES participants with likely baseline cognitive impairments (MoCA total score <26), and 9/17 of these participants moved from the "impaired" range at baseline (<26) to the "intact" range at endpoint (≥26). Lastly, participants taking fewer medications and reporting lower subjective cognitive difficulties at baseline showed larger pre-post MoCA total score improvements. Overall, results from this study suggest the potential for positive change in cognition in FS/NES and co-occurring TBI using evidence-based psychotherapy.

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Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of competing interest Dr. Ryan Van Patten receives funding from VA Providence, RR&D Center for Neurorestoration and Neurotechnology. He engages in profit sharing with the International Neuropsychological Society for Continuing Education proceeds from the Navigating Neuropsychology podcast. He also receives royalties from publication of the book, Becoming a Neuropsychologist: Advice and Guidance for Students and Trainees (Springer, 2021). Dr. Tyler Gaston receives a consulting fee from GW Biosciences, honorarium from the American Academy of Neurology. Dr. A. M. Goodman is funded by US Department of Defense grant W81XWH-17-1-0619 and NIH grant (R01HD102723). Dr. L. E. Grayson has received research support from the Department of Defense (DoD W81XWH-17-0169) and the State of Alabama. She serves on the Board of the Epilepsy Foundation of Western North Carolina and is receiving consulting fees from Jazz Pharmaceuticals. A.M. Goodman is funded by US Department of Defense grant W81XWH-17-1-0619 and NIH grants (R01HD102723 and R21MH133055-01 [PI]). S. Correia is a Co-Investigator for the NIMH U01 MH 123427 study, “Low intensity focused ultrasound: A new paradigm for depression and anxiety.” J.B. Allendorfer is funded by the U.S. Department of Defense (W81XWH-17-1-0619), the state of Alabama Carlys Law, the Evelyn F. McKnight Brain Institute at UAB, and NIH (R01HD102723 [PI]), and has served as a consultant for LivaNova Inc. Dr. J. P. Szaflarski: • Funding: NIH, NSF, DoD, State of Alabama, Shor Foundation for Epilepsy Research, UCB Pharma Inc., NeuroPace Inc., Greenwich Biosciences Inc., Biogen Inc., Xenon Pharmaceuticals, Serina Therapeutics Inc., and Eisai, Inc. • Consulting/Advisory Boards: Greenwich Biosciences Inc., Pure Tech Health Inc., NeuroPace, Inc., Serina Therapeutics Inc., AdCel Biopharma Inc., iFovea Inc, LivaNova Inc., UCB Pharma Inc., SK Lifesciences Inc., and medico-legal services. • Paid Editorial Work: Editor-in-Chief – Epilepsy & Behavior Reports. • Dr. Szaflarski has served as a member on the Alabama State Medical Cannabis Study Commission (nominated by Gov. Ivey). • Dr. Szaflarski serves on the Alabama Medical Cannabis Commission (2021–2025; nominated by Dr. Scott Harris, State Health Officer). Dr. W. Curt LaFrance Jr. receives funding from the DoD, and co-author royalties from Oxford University Press for Taking Control of Your Seizures: Workbook and for Treating Nonepileptic Seizures: Therapist Guide. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.