Treatments for Psychogenic Nonepileptic Seizures (NES)

描述（由申请人提供）：本申请是对指导患者导向研究职业发展奖（K23）的请求，这将使LaFrance博士能够继续发展他在心因性非癫痫发作（NES）治疗方面的程序性研究。NES类似癫痫发作，但没有癫痫样活动与行为相关。NES没有单一的病因，与潜在的心理问题和共病精神诊断有关。NES患者通常难以管理，严重残疾，经常在神经病学，精神病学和急诊科遇到。这种疾病对抗癫痫药物（AEDs）没有反应，许多NES患者使用积极和侵入性措施治疗不当。LaFrance博士的培训目标是：1)发展设计和执行NES患者临床试验研究治疗的专业知识。2)获得生物统计分析方面的专业知识，用于设计和评估临床和介入性研究。3)发展特定心理疗法的技能，以便在NES研究中整合社会心理治疗。4)在癫痫领域获得更多专业知识，重点是癫痫监测技术。这些培训目标将通过一个5年的研究项目来实现，该项目将利用1)布朗医学院现有的资源，2)布朗医学院博士提供的经验丰富的指导。Ivan Miller， Gabor Keitner和Andrew Blum以及集结的顾问团队的专业知识，3)专注于课程和临床经验，4)拟议的临床干预研究项目。拟议的研究扩展了LaFrance博士目前在NIH/Brown机构T32奖学金下的NES研究的自然进展。该申请建立在LaFrance博士在神经病学和精神病学方面的临床培训基础上，提供了在资助、研究设计和暴露于综合模式干预方面的研究经验。本应用的具体目的是：1)研究舍曲林治疗心因性NES及其共病精神障碍的疗效；2)确定对治疗反应的预测因素，并确定NES的潜在机制。

DESCRIPTION (provided by applicant): This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) that will enable Dr. LaFrance to continue to develop his programmatic line of research in the treatment of psychogenic nonepileptic seizures (NES). NES resemble epileptic seizures, but have no associated epileptiform activity with the behaviors. NES have no single cause and are associated with underlying psychological problems and co-morbid psychiatric diagnoses. Patients with NES are often difficult to manage, severely disabled and frequently encountered in neurology, psychiatry, and emergency departments. The disorder is not responsive to antiepileptic drugs (AEDs), and a number of patients with NES are inappropriately treated with aggressive and invasive measures. Dr. LaFrance's training goals are to: 1) Develop expertise in designing and executing clinical trials studying treatments for patients with NES. 2) Gain expertise in biostatistical analysis, for designing and evaluating clinical and interventional studies. 3) Develop skills with specific psychotherapies for integrating psychosocial treatments in NES research. 4) Gain additional expertise in the field of epilepsy, focusing on epilepsy monitoring techniques. These training goals will be achieved through a 5 year research program that utilizes 1) the resources available at the Brown Medical School, 2) the experienced mentorship provided by Drs. Ivan Miller, Gabor Keitner and Andrew Blum and the expertise of the assembled consultant team, 3) focused coursework and clinical experiences, and 4) the proposed clinical intervention research project. The proposed research extends the natural progression of Dr. LaFrance's current research in NES under his NIH/Brown Institutional T32 fellowship. The application builds on Dr. LaFrance's clinical training in neurology and psychiatry by providing research experience in grantsmanship, research design, and exposure to combined modality interventions. The Specific Aims of this application are 1) to investigate the efficacy of sertraline in treatment of psychogenic NES and its co-morbid psychiatric disorders and 2) to identify predictors of response to treatment and to identify potential mechanisms of NES.