Reflections on the CODES trial for adults with dissociative seizures: what we found and considerations for future studies.

The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures multicentre randomised controlled trial is the largest, fully-powered study to test the clinical and cost-effectiveness of a psychotherapeutic intervention in this population. We also explored predictors or moderators of outcomes and investigated mechanisms of change in therapy. In this current review of findings, we discuss issues related to the design of the trial and consider the study's nested qualitative studies which were undertaken not only to shed light on the original research questions but to provide insights and recommendations for other researchers in the field of functional neurological disorder. Finally, we consider issues relating to the possible clinical application of our study findings.

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© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: AC reports being a paid editor of the Journal of Neurology, Neurosurgery and Psychiatry, and is the director of a research programme on functional neurological disorders; he gives independent testimony in Court on a range of neuropsychiatric topics (50% pursuer, 50% defender). SL was a paid editor of the Journal of Child Psychology and Psychiatry. MR is the paid Editor-in-Chief of Seizure - European Journal of Epilepsy and receives authorship fees from Oxford University Press in relation to a number of books about dissociative seizures. JS reports independent expert testimony work for personal injury and medical negligence claims, royalties from UpToDate for articles on the functional neurological disorder and runs a free non-profit self-help website, www.neurosymptoms.org.