Abstract
The CODES trial for dissociative seizures: a landmark study and inflection point.
Highlights
In the care for adults with Dissociative non-Epileptic Seizures (CODES) trial, patients with dissociative seizures were recruited from 27 neurology and epilepsy services in the UK and subsequently randomly assigned from 17 liaison or neuropsychiatry services following psychiatric assessment. 368 patients were randomly assigned (1:1) to 12 sessions of manualised cognitive behavioural therapy (CBT) (1 h duration), based on fear avoidance models, plus standardised medical care (n=186) or to standardised medical care alone (n=182)
In nine of 16 secondary outcomes, CBT plus standardised medical care showed clinical benefit compared with standardised medical care alone
The clinical benefits of CBT for dissociative seizures are highlighted by the improvements observed across secondary outcome measures, the study did not identify a statistically significant treatment effect on the primary outcome of seizure frequency
Summary
In the CODES trial, patients with dissociative seizures were recruited from 27 neurology and epilepsy services in the UK and subsequently randomly assigned from 17 liaison or neuropsychiatry services following psychiatric assessment. 368 patients were randomly assigned (1:1) to 12 sessions of manualised CBT (1 h duration), based on fear avoidance models, plus standardised medical care (n=186) or to standardised medical care alone (n=182). Psychotherapy, cognitive behavioural therapy (CBT), has been highly regarded by leaders in the field as a promising treatment for dissociative seizures.[2,3] As such, the publication of the COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) clinical trial[4] by Laura Goldstein and colleagues is an important and landmark event in this area of research.
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