dissociative seizures

Trial By Error: My Letter to Author of CODES Commentary

27 June 2020 by David Tuller

By David Tuller, DrPH

Earlier today, I sent the following letter to Dr David Perez, a neurologist and psychiatrist at Massachusetts General Hospital in Boston. Dr Perez, an expert on functional neurological disorders, wrote a commentary for Lancet Psychiatry that accompanied the publication of the results for CODES, a major study of cognitive behavior therapy as a treatment for dissociative seizures.

My critique of the commentary is here. My previous posts on CODES are here and here.

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Trial By Error: CODES Trial Commentary Promotes ‘Eminence-Based Medicine’

26 June 2020 by David Tuller

By David Tuller, DrPH

By all accounts, the recently published CODES trial was the most authoritative study to date of whether cognitive behavior therapy (CBT) was an effective treatment for so-called dissociative seizures–a point confirmed in a commentary accompanying the paper in Lancet Psychiatry. Unfortunately, the CODES investigators and the commentary author seem to interpret the null results for the primary outcome as a call to find other assessment measures–not as a reason to seriously question the therapeutic intervention and its theoretical foundation.

Trial By Error: More Questions About CODES Trial of CBT for Seizures

23 June 2020 by David Tuller

By David Tuller, DrPH

[*In the last paragraph, I mistakenly referred to the CODES protocol rather than the CODES statistical analysis plan. I apologize for the error.]

I have recently written about CODES, the high-profile clinical trial investigating whether cognitive behavior therapy (CBT) could reduce the frequency of dissociative seizures, also known as psychogenic non-epileptic seizures. The trial, published by Lancet Psychiatry, was an open-label study relying on self-reported outcomes–a design highly vulnerable to bias. The 368 participants were randomized into two armsâ€”a group that received standardized medical care (SMC) along with a form of CBT designed to impart seizure-reduction strategies, and a group that received SMC alone.