Project Summary/Abstract
Functional seizures (FS) are a type of functional neurological disorder (FND) characterized by seizure-like
symptoms without EEG correlates. FS are severely debilitating to children and families, making this a
significant clinical and societal burden. Recent research has revealed sense of control as a potential target for
pediatric FS treatment. Our previously published study demonstrated children with FS have decreased sense
of control over their actions compared to matched controls. Only one randomized controlled trial (RCT) for
treatment of pediatric FS has been conducted to date, which evaluated Retraining and Control Therapy
(ReACT). ReACT, developed by the PI, is a novel, adaptive intervention that aims to increase sense of control
via mindfulness and principles of habit reversal, a well-established treatment for involuntary tics. Our recently
published pilot RCT demonstrated that ReACT resulted in significantly reduced FS frequency compared to
supportive therapy, with 82% of children remaining FS-free for ≥2 months after ReACT. Further, our
preliminary data suggest sense of control significantly improves after ReACT, and increased sense of control
after ReACT is significantly related to reduced FS frequency, indicating sense of control is an effective target
for improving FS. The purpose of this study is to conduct a multi-site pilot feasibility clinical trial of ReACT, a
mind and body treatment for pediatric FS. In the study, 54 11-18-year-olds diagnosed with FS will be
randomized to engage in ReACT or the CATCH-IT web-based intervention (validated for treating mood in
children) at three sites: the University of Alabama at Birmingham, the Yale School of Medicine/Yale New
Haven Children’s Hospital and Baylor College of Medicine/Texas Children’s Hospital. FS frequency will be
measured from 30 days before treatment to 2 months after treatment. Participants and a family member will
complete baseline and follow-up assessments 7 days before treatment and 7 days and 2 months after
treatment. Feasibility of recruitment and retention will be measured by meeting annual recruitment goals and
the percent of participants who complete the 2-month follow-up. Sessions will be videotaped, and 20% of
therapy sessions will be coded for treatment fidelity using published guides to assess intervention fidelity in
behavioral clinical trials. Participant adherence to ReACT will be assessed by the percent of recommended
treatment sessions completed, and participants and parents will report if the patient used the treatment plan for
each FS episode using a FS diary.
