Quality of life and psychological dysfunction in traumatized and nontraumatized patients with psychogenic nonepileptic seizures (PNES)

OBJECTIVES

Psychogenic nonepileptic seizures (PNES) have the appearance of epileptic seizures, yet show no epileptiform discharges in the brain. The quality of life (QOL) in patients with PNES is reportedly low and trauma eems to be a relevant risk factor. The objective of this study was to examine the difference between measures of (epilepsy-specific) QOL (Quality of Life in Epilepsy Inventory; QOLIE-31p) and psychological dysfunction (trauma symptom inventory; TSI) between patients with diagnosed PNES with self-reported trauma and those without self-reported trauma.

METHODS

Patients whose PNES diagnoses were through video-electroencephalogram (EEG) monitoring at the Northeast Regional Epilepsy Group between 2008 and 2018 were included. Patients who reported to have a history of psychological trauma and those who did not were assigned to separate groups. Scores from the TSI and QOLIE-31p were compared by using multivariate analysis of covariance.

RESULTS

The total sample was comprised of 217 adult patients, 148 of which self-reported as having experienced psychological trauma in the past and 69 who did not report any psychological trauma. Traumatized patients significantly differed in terms of QOL and TSI from nontraumatized patients. Traumatized patients were demonstrated to have lower scores on the subdomain "energy" of the QOLIE-31p and the total QOLIE-31p score compared to the nontraumatized group. Similarly, the traumatized group had significantly higher scores on nearly all TSI subscales with the exception of suicidality, sexual disturbances, and somatization.

CONCLUSION

This study demonstrated significant differences between patients with PNES who have been psychologically traumatized and those who have not. In particular, patients with a history of psychological trauma present greater psychopathology and would possibly benefit from rapid identification and referral to trauma-based therapy. In turn, this may result in a reduction of disease burden, increase QOL, and a reduction in healthcare costs resulting from diagnostic delays and implementation of less targeted treatments.

International health threats and global early warning and response mechanisms

The global community continues to incur the high costs of crisis mitigation and emergency response to outbreaks of emerging infectious diseases, such as those caused by the H5N1 highly pathogenic avian influenza virus, Ebola virus, Nipah virus, Zika virus or the Middle East respiratory syndrome coronavirus. These viruses are particularly dangerous in regions associated with poor development indicators and high vulnerability. The drivers of these disease crises include failures in the way that animal diseases are detected and reported and failures in the way in which disease response is implemented by animal health and public health systems. In addition, the lack of a coordinated response hampers disease control efforts. A comprehensive approach for disease prevention, detection and response, however, requires a coordinated and joint effort among governments, communities, donors and international networks to invest effectively in prevention systems that can identify early signals of the emergence, spillover and spread of animal pathogens at the local level. These signals include trade bans, market closures, civil unrest, heavy rains and droughts associated with climate change, and livestock intensification or changes in consumer behaviour. The global community needs to increase its investment in early warning and detection systems that can provide information that enables action to be taken at the national, regional and global levels in the event of an outbreak of a transboundary animal disease (TAD). Like any preventive measure, an early warning system requires financial resources, but these are insignificant when compared to the losses that are avoided. Building a global early warning and effective response system for outbreaks is value for money, as the benefits far outweigh the costs. The goal of the Food and Agriculture Organization of the United Nations (FAO) is to end hunger and poverty, which is a challenging and complex task. Building global capacity to prepare for and respond to TADs is an important element of the FAO's strategic objective to increase the resilience of livelihoods to threats and crises. Each year, livestock, and the people who rely upon them for their livelihoods, are confronted with animal disease and crises. They can strike suddenly, causing obvious illness and death, or emerge insidiously and become well established before becoming apparent. Animal disease emergencies threaten the production of, and access to, food; consequently, one of the FAO's missions is to help countries to prepare for and respond to animal health disasters.

Strategies for Increasing Participation in Mail-out Colorectal Cancer Screening Programs. A Systematic Review and Meta-Analysis

Background: Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite increased survival rates associated with early detection of CRC, in many countries 50% or more of eligible individuals do not participate in such programs, resulting in a substantial amount of cancers progressing undetected and wasted public health resources. Aim: The current study aimed to systematically review all of the interventions that have been applied internationally to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs, to make recommendations to policy makers and program organizers as to the most effective methods of increasing uptake. Method: Six electronic databases (PubMed, PsycINFO, Scopus, InformIT, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published in English before 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return of FOBT kits that had been mailed to individuals' homes. Results: PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane's risk of bias tool. The quality of evidence was assessed using GRADE guidelines. The review identified 53 interventions from 30 published studies. Nine distinct intervention strategy types were identified and pooled risk ratios and confidence intervals were estimated for each intervention type. Four key effective intervention strategies were identified including telephone contact, GP endorsement, simplified test procedures, and advance notification with small to moderate effect sizes. Conclusions: Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. Future research should examine the benefit of combining intervention strategies and tailoring to specific populations.

Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Sanders-Branca N, Sosenko J, Arazo L, Arce R, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Eck SP, Finney L, Fischer TA, Martin A, Muzamhindo CJ, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Linking animal diseases and social instability

Social instability occurs as a consequence of war, civil strife or natural disasters such as earthquakes, floods and droughts. Animal diseases, including zoonoses, can be both a precursor to social instability and a result of social instability. Coping mechanisms, such as sound policies, trust in government, and robust infrastructure break down at times of civil instability. Such breakdowns often lead to a decline in both public health and the food and agricultural livestock base, thus creating a vicious cycle that involves inadequate nutrition, threatened livelihoods, and fewer opportunities for safe trade. This article is principally a discussion of a theoretical nature on the dynamics between animal diseases and social instability. Based on their experience of working for the Food and Agriculture Organization of the United Nations (FAO), the authors provide numerous examples of the connection between the two, mostly in countries that have fragile environments and are experiencing protracted crises. Disease has a direct and immediate effect on a community, but, in addition, if the community is not able to recover from the impact of a disease on their health and livelihoods, the consequences of an outbreak can persist even after the disease is no longer present. Stability, therefore, depends on a variety of factors, including the ability of a community to overcome the effects of a disease outbreak or other destabilising event. The FAO approach to helping families and communities to cope with the destabilizing effects of animal diseases is to build resilience, particularly amongst the most vulnerable households. This requires individuals and governments to gain a better understanding of what drives disease at the interface between human and animal health. In addition, it requires governments to invest in social protection programmes, establish a long-term risk reduction strategy that decreases vulnerability, and improve the sustainability of safe agricultural and marketing practices.

Health related quality of life of people with non-epileptic seizures: The role of socio-demographic characteristics and stigma

PURPOSE

People with non-epileptic seizures (NES) consistently report poorer Health-Related Quality of Life (HRQoL) than people with epilepsy. Yet, unlike in epilepsy, knowledge of how social factors influence the HRQoL of adults with NES is limited. To add to the evidence base, this study explores the relationship between HRQoL and perceived stigma among adults with NES, and the role of socio-demographic characteristics.

METHODS

Data was gathered from a survey of 115 people living with the condition, recruited from online support groups. Participants provided socio-demographic and health-related data and completed a series of questions investigating their HRQoL (QOLIE-31) and stigma perceptions (10-item Epilepsy Stigma Scale).

RESULTS

Participants were found to experience high levels of perceived stigma (median 5.2, mean 4.9). A significant and moderate inverse correlation was observed between HRQoL and stigma (r_s - 0.474, p = < 0.001); suggesting higher perceptions of stigma contribute to poorer HRQoL among adults with NES. Stigma perceptions were found to be most strongly associated with the seizure worry (r_s = - 0.479), emotional wellbeing (r_s = - 0.421), and social functioning (r_s = 0.407) HRQoL domains. Participants who reported being in employment or education were found to have significantly better HRQoL than those who were not (p = < 0.001).

CONCLUSION

More (qualitative and quantitative) research is justified to understand how - and why - those with the condition experience stigmatisation, and the factors that impede and help facilitate the participation of people with NES in education and employment.

Are there gender differences in those diagnosed with psychogenic nonepileptic seizures?

OBJECTIVE

The objective of the study was to determine whether male and female populations of patients with psychogenic nonepileptic seizures (PNES) differ, in terms of demographic, social/clinical, and etiological factors as well as psychological measures.

BACKGROUND

Psychogenic nonepileptic seizures are overrepresented by females; therefore, information about PNES in males is limited. Only a handful of studies have examined PNES and gender, and of those, one was a literature review and with the exception of two, most have had small sample sizes. Of the existing literature, differences in abuse type, psychiatric diagnoses, and psychometric results have been observed in the two genders.

METHODS

This is a retrospective study of 51 consecutive males and 97 consecutive females with video-electroencephalogram (video-EEG) confirmed diagnosis of PNES. Patients were examined on demographics (age, education, working status), clinical (seizure frequency, trauma type: sexual, nonsexual, age of first trauma), and psychometric measures. The latter included the State Trait Anger Expression Inventory-2 (STAXI-2), Trauma Symptom Inventory-2 (TSI-2), the Coping Inventory for Stressful Situations (CISS), and the Quality of Life Inventory in Epilepsy-31 (QOLIE-31).

RESULTS

Women reported experiencing significantly more sexual traumas (p=0.007) than men. Women also endorsed significantly higher levels of dissociation (p=0.012) and sexual disturbances (p=0.46). In contrast, men reported significantly greater use of avoidance (p=0.001) as a stress coping strategy and higher levels of depression (p=0.006).

CONCLUSIONS

Gender differences were identified with males reporting a significantly higher use of avoidance (cognitive and behavioral avoidance of stress) and depressive symptoms. Women exhibited significantly higher rates of sexual trauma compared with male counterparts. Consequently, women also had significantly higher rates of trauma symptomatology (dissociation and sexual disturbances) which are often observed in those who have been traumatized sexually. These gender distinctions may support different first-line treatment approaches (e.g., trauma-focused; more traditional cognitive behavioral therapy) depending on the most prominent symptomatology.

Prolonged Exposure Therapy for Comorbid Psychogenic Nonepileptic Seizures and Posttraumatic Stress Disorder

Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures but are not associated with epileptic discharges in the brain. Instead, these episodes, which tend to occur with alterations in consciousness and body movements, are thought to be the result of mechanisms of conversion and dissociation. Psychological trauma and PTSD are very prevalent among patients with PNES. PNES can be conceived of as an extreme avoidance mechanism that serves the function of modulating distress and, in some cases, eliminating the precipitant stressor. Avoidance is also an essential component of PTSD. In patients who carry a dual diagnosis of PNES and PTSD, it is sensible that an empirically validated treatment for PTSD such as prolonged exposure (PE) therapy which targets avoidance by promoting exposure might be a useful approach to treat these patients. In this report, we present the case of a 52-year-old male with a 7-year history of PNES. His seizures, which were characterized by intense body shaking and loud guttural outbursts, were occurring up to 15 times per day. Because of these symptoms, he lost his employment and was ostracized by his family. Upon completion of a course of intensive outpatient PE, he achieved full remission of all psychogenic symptoms. Except for three brief seizures, he has maintained his health for 2 years. This constitutes the first detailed report of PE therapy used to effectively treat comorbid PNES and posttraumatic stress symptoms.

Socialization characteristics in persons with epilepsy

OBJECTIVE

The purpose of this report was to describe social behaviors and preferences in adults with epilepsy, including self-reported use of various socialization media (face-to-face and indirect communication) as well as perceived social barriers.

METHODS

1320 consecutive persons with epilepsy (PWEs) confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program.

RESULTS

Our sample revealed higher rates of unemployment and single status as compared to the US Census of 2012. With regard socialization however, many were quite social (86% reported daily/weekly communication with friends and family via telephone, 71% saw relatives in person weekly, 68% saw friends weekly, and 65% reported using the computer daily/weekly to socialize). Facebook® was the preferred on-line social media. Indoor/solitary activities were most common with 63% stating they watch TV/read/use the computer followed by physical exercise and spending time outdoors (36%). The frequency of socialization with friends, relatives, and coworkers decreased with the respondents' age and the longer the respondent had carried the diagnosis of epilepsy. Respondents who were taking a greater number of AEDs or were considered refractory were less likely to consider participating in socialization-enhancing activities. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side-effects. Respondents expressed the greatest interest in online support groups or educational programs (31%), office-based support groups (25%), and volunteering (19%).

CONCLUSION

Although the respondents indicate that they do face barriers to socialization, a majority report frequent communication with relatives and friends via phone, in-person and social media. When designing wellness interventions with this group of patients in the future, online, as well as face to face options for support appear to be desired by a number of PWEs.

The effects of lacosamide on cognition, quality-of-life measures, and quality of life in patients with refractory partial epilepsy

OBJECTIVE

The objective of this study was to examine cognitive and quality-of-life measures/quality of life outcomes with adjunctive lacosamide therapy in patients with treatment-resistant partial epilepsy.

METHODS

This was a prospective, open-label, nonblinded, adjunctive therapy test-retest (within subjects) study of patients with treatment-resistant partial epilepsy in which outcome (cognitive functioning and mood/quality of life) was measured in the same subject before and after adjunctive lacosamide administration for 24weeks. The cognitive assessment included the following: Controlled Oral Word Association Test, Buschke Selective Reminding Test, Brief Visuospatial Memory Test-Revised, Stroop Color Word Test, Symbol Digit Modalities Test, Digit Span, Digit Cancellation, and Trails A and B. The quality-of-life measures/quality-of-life assessment included the following: Beck Depression Inventory-II, Profile of Mood States, and Quality of Life Inventory-89. Lacosamide was started at 100mg (50mg twice daily) and could be titrated as needed up to 400mg/day (200mg twice daily). Baseline concomitant AEDs were kept constant. Composite scores were calculated for a pre-post difference score for the cognitive and mood/quality-of-life measures separately and used in regression analyses to correct for the effects of age, education, seizure frequency, seizure severity, dose of lacosamide, and number of AEDs at baseline.

RESULTS

Thirty-four patients were enrolled (13 males, 21 females). Mean age was 38.8±2.43years. Mean seizure frequency decreased significantly from 2.0±2.55 seizures per week at baseline to 1.02±1.72 seizures per week at posttreatment (t=4.59, p<.0001) with a 50% responder rate seen in 18 patients (52.9%). No significant differences were found on the composite scores of the cognitive or the mood/quality-of-life measures after 6months of lacosamide.

SIGNIFICANCE

Lacosamide appeared to have low risks of significant changes in cognition or mood/quality of life. In addition, the present study supports prior studies that have proven lacosamide as an effective adjunctive therapy for the treatment of resistant partial epilepsy.

Interleukin-17 promotes prostate cancer via MMP7-induced epithelial-to-mesenchymal transition

Chronic inflammation has been associated with a variety of human cancers including prostate cancer. Interleukin-17 (IL-17) is a critical pro-inflammatory cytokine, which has been demonstrated to promote development of prostate cancer, colon cancer, skin cancer, breast cancer, lung cancer, and pancreas cancer. IL-17 promotes prostate adenocarcinoma with a concurrent increase of matrix metalloproteinase 7 (MMP7) expression in mouse prostate. Whether MMP7 mediates IL-17’s action and the underlying mechanisms remain unknown. We generated Mmp7 and Pten double knockout (Mmp7^−/− in abbreviation) mouse model and demonstrated that MMP7 promotes prostate adenocarcinoma through induction of epithelial-to-mesenchymal transition (EMT) in Pten-null mice. MMP7 disrupted E-cadherin/β-catenin complex to up-regulate EMT transcription factors in mouse prostate tumors. IL-17 receptor C and Pten double knockout mice recapitulated the weak EMT characteristics observed in Mmp7^−/− mice. IL-17 induced MMP7 and EMT in human prostate cancer LNCaP, C4-2B, and PC-3 cell lines, while siRNA knockdown of MMP7 inhibited IL-17-induced EMT. Compound III, a selective MMP7 inhibitor, decreased development of invasive prostate cancer in Pten single knockout mice. In human normal prostates and prostate tumors, IL-17 mRNA levels were positively correlated with MMP7 mRNA levels. These findings demonstrate that MMP7 mediates IL-17’s function in promoting prostate carcinogenesis through induction of EMT, indicating IL-17-MMP7-EMT axis as potential targets for developing new strategies in the prevention and treatment of prostate cancer.

Psychogenic non-epileptic seizures (PNES) on the Internet: Online representation of the disorder and frequency of search terms

PURPOSE

The nature of the symptoms associated with PNES require a multidisciplinary health team. There are too few professionals with an adequate understanding of PNES and therefore many are not able to provide patients with necessary information. In the age of the internet, it is not surprising that patients or caregivers might look for answers online. The purpose of this project was to investigate the online representation of PNES and search frequency for PNES and its associated terms.

METHODS

To determine online representation, searches of: Google®, twitter®, YouTube®, and Instagram® for "PNES" and associated terms were conducted. Websites, tweets, and films were classified by host and exclusivity of information. PNES and associated terms search frequency was determined through Google Trends®.

RESULTS

Professional and patient sites exclusively about PNES were outnumbered by sites that only mentioned PNES in fewer than three posts. Patients tended to favor less traditional hosting options than did professionals. On twitter®, different keyword preferences were identified for professionals and patients. On YouTube® there was a substantial selection of videos of which 22 were professionally produced. Google Trends®, revealed the terms most commonly used to search for this topic were in order: (1) "PNES;" (2) "NEAD;" and (3) "pseudoseizure."

CONCLUSION

A variety of professional and patient internet content about PNES can be found online. Professional sites offered accurate and empirically-validated information on the disorder and tended to use traditional hosting options. Future professional initiatives might consider novel hosting options and higher-frequency terms to reach their audience more effectively.

Socialization characteristics in patients with psychogenic nonepileptic seizures (PNES)

OBJECTIVE

The purpose of this study was to describe social behaviors and preferences in adults with psychogenic nonepileptic seizures (PNES) including self-reported use of various socialization mediums (face-to-face and indirect communication) as well as perceived social barriers.

METHODS

One hundred forty-one consecutive patients with a diagnosis of PNES that was later confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first outpatient appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program.

RESULTS

Contrary to prevalent assumptions that patients with PNES tend to be socially isolated, our responders reported that they were in fact quite socially connected (72.2% reported daily communication with friends and family via telephone, 68.54% saw relatives in person weekly, 65.28% saw friends weekly, and 51.2% reported using the computer daily to socialize). Facebook was the preferred online social media. Indoor/solitary activities were most common with 57.44% stating that they watch TV/read/use the computer. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side effects. Respondents expressed the greatest interest in online support groups or educational programs (29.46%), office-based support groups (28.57%), and volunteering (23.21%).

CONCLUSION

Although it has been speculated that social isolation is a significant problem for patients with PNES, considerable participation in social activities was reported. Characteristics of socialization practices may be more nuanced than first believed. When addressing therapeutic interventions with this group of patients in the future, it might be beneficial to offer both distance-based options as well as face-to-face options for treatment and support depending on age and personal preference.

Depression and quality of life in Spanish-speaking immigrant persons with epilepsy compared with those in English-speaking US-born persons with epilepsy

OBJECTIVE

This study aimed to examine levels of depression and quality of life in Spanish-speaking (less acculturated) immigrants with epilepsy compared with those in English-speaking US-born persons with epilepsy (PWEs).

METHODS

The study included 85 PWEs - 38 Spanish-speaking immigrants with epilepsy and 47 US-born PWEs. All patients underwent video-EEG monitoring and completed depression and quality-of-life inventories in their dominant language (Spanish/English). Chart review of clinical epilepsy variables was conducted by an epileptologist.

RESULTS

Our study revealed that depression scores were significantly higher in Hispanic PWEs (21.65±14.6) than in US-born PWEs (14.50±10.2) (t (64.02)=-2.3, two-sided p=.025). Marital status, medical insurance, antidepressant use, seizure frequency, and number of antiepileptic drugs (AEDs) were tested as covariates in the ANCOVA framework and were not statistically significant at the 0.05 significance level. Fewer Hispanics were prescribed antidepressant medications (13.15% for Hispanics and 40.42% for US-born, χ(2) (1,85) 7.71, p=.005) and had access to comprehensive health insurance coverage (χ(2) (1,85)=13.70, p=0.000). Hispanic patients were also found to be receiving significantly less AEDs compared with their US-born peers (t (83, 85)=2.33, p=.02). Although quality of life was diminished in both groups, Seizure Worry was worse for Hispanics after accounting for potential effects of marital status, medical insurance, use of antidepressants, seizure frequency, and number of antiepileptic drugs (AEDs) ((1, 83), F=7.607, p=0.007).

SIGNIFICANCE

The present study is the first of its kind to examine depression and quality of life in Spanish-speaking US immigrants with epilepsy. Spanish-speaking immigrants with epilepsy have been identified as a group at risk. They demonstrated higher depression scores and more Seizure Worry independent of epilepsy and demographic characteristics compared with their US-born peers. The Hispanic group was receiving less treatment for depression, was taking less AEDs, and had less access to comprehensive health coverage compared with non-Hispanics.

Serum and bal beta-D-glucan for the diagnosis of Pneumocystis pneumonia in HIV positive patients

BACKGROUND/PURPOSE

The diagnosis of patients with pulmonary infiltrates and human immunodeficiency virus (HIV) infection remains a challenge. In current clinical practice the gold standard for Pneumocystis jirovecii pneumonia (PCP) diagnosis remains the identification of the organism in bronco alveolar lavage (BAL) using microscopy (e.g., silver stain). (1->3)-β -d-glucan (BG) is a polysaccharide that is present within the cell wall of Pneumocystis and other fungi.

METHODS

We analyzed serum and BAL lavage fluid from a cohort of 119 patients that did have HIV, a diagnosis of pneumonia and underwent bronchoscopy (FOB) for diagnosis of PCP.

RESULTS

The discriminative power of serum BG for the diagnosis of PCP in this group of patients was very high. Using a cutoff of 300 pg/mL, the sensitivity, specificity, positive predictive value(PPV) and negative predictive value (NPV) were 91%, 92%, 89% and 93% respectively. A model for ROC with just serum BG (N = 108) had an AUC of 0.95. Serum procalcitonin (PCT) and BAL BG were not as accurate for the diagnosis of PCP. For BAL BG using a cutoff of 783 pg/mL, the sensitivity,specificity, positive predictive value (PPV) and negative predictive value (NPV) were 72%, 79%,72% and 79% respectively. The differences between the medians for serum PCT between the group with a without PCP did not reach statistical significance (p = 0.6137).

CONCLUSION

The measurement of serum BG should be incorporated in the diagnostic work up of HIV positive patients with dyspnea and infiltrates on chest X X-ray. Our study confirms the diagnostic value of serum BG previously reported by others but we add a cutoff value that we believe is more accurate for patients with AIDS and suspicion of PCP.

Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD

OBJECTIVES

The objective of this study was to examine cognitive and clinical differences among three groups of patients diagnosed with psychogenic nonepileptic seizures (PNESs): those with posttraumatic stress disorder (PTSD), those with a history of trauma but no PTSD, and those without a history of trauma.

METHODS

Seventeen patients who were confirmed to have PTSD based on the Trauma Symptom Inventory-2 (TSI-2) and clinical interview were compared with 29 patients without PTSD who had experienced trauma and 17 patients who denied experiencing trauma. We analyzed demographic data, psychiatric information, trauma characteristics, and neuropsychological variables in these groups.

RESULTS

Our study revealed that patients with PNESs with comorbid PTSD performed significantly worse on episodic verbal memory (narrative memory); had greater self-reported Total, Verbal, and Visual Memory impairments; and had higher substance abuse history and use of psychopharmacological agents compared with patients without PTSD regardless of a history of trauma.

CONCLUSION

The present study showed that patients with PNESs diagnosed with PTSD exhibited memory functions that were significantly different from those in patients with PNESs who do not carry a diagnosis of PTSD (regardless of history of trauma). Furthermore, these specific cognitive findings in narrative memory are consistent with those reported in patients with PTSD alone. The present findings contribute to further identifying discrete intragroup differences within PNESs. Identifying a specific psychopathological subgroup such as PTSD will allow clinicians to accurately select treatment.