William Curt LaFrance Jr, MD MPH, FAAN, FANPA, DFAPA, Brown University, Providence, RI, explains that the most valuable evidence on the mechanisms and treatment of psychogenic non-epileptic seizures (PNES) comes from double-blinded placebo-controlled randomized trials. Prof. LaFrance believes that for treating these patients, more is needed than just finding a drug. In fact, during a recent placebo-controlled study, it was found that there was a 45% reduction in seizures in patients treated with serotonin medication and an 8% increase in seizures in the placebo cohort. This means that there is more to the picture than originally thought. Therefore, Prof. LaFrance thinks the way forward is to incorporate psychotherapies, rehabilitation techniques (e.g., occupational, physical and speech therapy), and diagnostic and treatment outcome biomarkers. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.
Dr. LaFrance has served on the editorial boards of Epilepsia, Epilepsy & Behavior; Journal of Neurology, Neurosurgery and Psychiatry, and Journal of Neuropsychiatry and Clinical Neurosciences; receives editor’s royalties from the publication of Gates and Rowan’s Nonepileptic Seizures, 3rd ed. (Cambridge University Press, 2010) and 4th ed. (2018); author’s royalties for Taking Control of Your Seizures: Workbook and Therapist Guide (Oxford University Press, 2015); has received research support from the Department of Defense (DoD W81XWH-17-0169), NIH (NINDS 5K23NS45902 [PI]), Providence VAMC, Center for Neurorestoration and Neurorehabilitation, Rhode Island Hospital, the American Epilepsy Society (AES), the Epilepsy Foundation (EF), Brown University and the Siravo Foundation; serves on the Epilepsy Foundation New England Professional Advisory Board, the Board of the Functional Neurological Disorder Society, and on the Council of the American Neuropsychiatric Association; has received honoraria for the American Academy of Neurology Annual Meeting Annual Course; has served as a clinic development consultant at University of Colorado Denver, Cleveland Clinic, Spectrum Health, Emory University, and Oregon Health Sciences University; and has provided medico-legal expert testimony.