Treatments for Psychogenic Nonepileptic Seizures (NES)

描述（由申请人提供）：本申请是一个指导的以患者为导向的研究职业发展奖（K23），这将使LaFrance博士继续发展他在治疗心因性非癫痫性癫痫发作（内斯）的研究方案线的请求。内斯类似癫痫发作，但没有相关的癫痫样活动的行为。内斯没有单一的原因，并与潜在的心理问题和共病的精神病诊断。患有内斯的患者通常难以管理，严重残疾，并且经常在神经科，精神科和急诊科遇到。这种疾病对抗癫痫药物（AED）没有反应，并且许多患有内斯的患者被不适当地采用积极和侵入性措施进行治疗。LaFrance博士的培训目标是：1）发展设计和执行临床试验的专业知识，研究内斯患者的治疗方法。2)获得生物统计分析的专业知识，用于设计和评估临床和干预性研究。3)发展技能与具体的心理治疗整合心理治疗在内斯研究。4)获得癫痫领域的额外专业知识，专注于癫痫监测技术。这些培训目标将通过一个5年的研究计划来实现，该计划利用1）布朗医学院的可用资源，2）由博士提供的经验丰富的指导。伊万米勒，盖博·凯特纳和安德鲁·布卢姆和组装顾问团队的专业知识，3）重点课程和临床经验，以及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 Institutional T32奖学金下对内斯的研究的自然进展。该应用程序建立在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granimetry，研究设计和接触综合模式干预方面的研究经验。本申请的具体目的是1）研究舍曲林治疗心因性内斯及其共病精神障碍的疗效，2）确定治疗反应的预测因子，并确定内斯的潜在机制。

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.