A novel psychological therapy approach for children with PNKD

Objectives: Paroxysmal Non-Kinesigenic Dyskinesias (PNKD) are movements precipitated by caffeine, alcohol, fatigue and emotional stress, manifesting as episodes of chorea and dystonia. PNKD has a limited response to medication. The few studies available recommend avoidance of environmental triggers to manage the condition. However, there is limited research investigating the benefit of psychological therapies in reducing emotional stress in PNKD. This single-case study aims to evaluate the effectiveness of using a novel Cognitive Behavioural Therapy (CBT) approach to target emotional distress in a 13-year-old male with PNKD. Specifically, it investigated if this approach reduced the impact of the PNKD movements, resulting in improvements in quality of life (QoL), and emotional wellbeing.

Methods: 11 CBT sessions were completed online with the client and his parent. Anxiety psychoeducation and cognitive restructuring strategies were the main tools used along with liaison with school to help generalising the strategies learnt. Emotional distress and QoL were assessed using the Revised Children’s Anxiety and Depression Scales, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory. Goal-based outcomes were also utilised to evaluate progress over the course of treatment.

Results: Post-therapy improvements in anxiety management and QoL were found. The client also reported increased acceptance and reduced distress by the condition, with an obvious reduction in PNKD attacks during times where he felt better able to manage emotional distress.

Conclusions: Psychological therapy, specifically CBT, may be a useful approach to consider for people affected by PNKD to help improve emotional wellbeing, acceptance of the condition, and QoL.
Keywords: PNKD, Psychological Therapy, Cognitive Behavioural Therapy, emotional distress