Treatments for Psychogenic Nonepileptic Seizures (NES)

描述(由申请者提供)：此申请是对以患者为导向的研究职业发展奖(K23)的请求，该奖项将使LaFrance博士能够继续发展他在治疗心理性非癫痫发作(NES)方面的计划研究。NE类似于癫痫发作，但与行为没有关联的癫痫样活动。NES没有单一的原因，而且与潜在的心理问题和共病的精神诊断有关。NES患者往往难以管理，严重残疾，经常在神经科、精神科和急诊科就诊。这种疾病对抗癫痫药物(AEDs)没有反应，一些NES患者接受了不适当的积极和侵入性措施。LaFrance博士的培训目标是：1)发展设计和执行研究NES患者治疗方法的临床试验方面的专业知识。2)获得生物统计分析方面的专业知识，以设计和评估临床和干预研究。3)发展特定心理治疗的技能，以便将心理社会治疗整合到NES研究中。4)在癫痫领域获得更多的专门知识，重点是癫痫监测技术。这些培训目标将通过一项为期5年的研究计划来实现，该计划利用了1)布朗医学院现有的资源，2)由Ivan Miller、Gabor Keitner和Andrew Blum博士提供的经验丰富的指导以及聚集的顾问团队的专业知识，3)专注于课程和临床经验，以及4)拟议的临床干预研究项目。这项拟议的研究扩展了LaFrance博士在NIH/Brown Institution T32奖学金下目前在NES进行的研究的自然进展。该应用程序建立在LaFrance博士在神经学和精神病学方面的临床培训的基础上，通过提供在勇气、研究设计和接触组合医疗干预方面的研究经验。这一应用的具体目的是1)调查舍曲林治疗心因性NES及其共病精神障碍的疗效，2)确定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.