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Çikriklar HI, Kotan D, Yücel M, Ceylan M, Çiftçi GG, Bayraktutan ÖF, Çiftçi IH. The role of Orexin-A levels in epileptic seizure. Neurosci Lett 2020; 734:135097. [PMID: 32485288 DOI: 10.1016/j.neulet.2020.135097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/16/2020] [Accepted: 05/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to determine the usefulness of Orexin-A levels in differentiating between epileptic seizures and psychogenic non-epileptic seizures in patients presenting to the emergency service with epileptic seizure-type symptoms. METHODS A total of 80 individuals were included in this study, including 59 who presented to the emergency service within the first four hours of having been diagnosed with generalized tonic-clonic seizures (39 with epileptic seizures (ES) and 20 with pseudoseizures (PNES) and 21 controls. Orexin-A levels were measured in venous blood samples. RESULTS The mean Orexin-A levels were 5.16 ng/mL in the control group, 7.17 ng/mL in the PNES group, and 11.08 ng/mL in the ES group (Table 1). The mean Orexin-A level of the ES group was significantly different from both the control group and the PNES group (Table 1, p < 0.001); the difference between the control group and the PNES group was not significant (p > 0.05). CONCLUSIONS Results of this study suggest that blood Orexin-A may be an effective biomarker in the differential diagnosis of epileptic seizures/psychogenic non-epileptic seizures in patients presenting to the emergency service with an epileptic seizure-type clinical picture.
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Affiliation(s)
| | - Dilcan Kotan
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Murat Yücel
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Mustafa Ceylan
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | - Gönül G Çiftçi
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
| | | | - Ihsan H Çiftçi
- Altinsehir Mahallesi 326. Sokak No:7 Daire:20, NILÜFER, Bursa, Turkey
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Herrero H, Tarrada A, Haffen E, Mignot T, Sense C, Schwan R, El-Hage W, Maillard L, Hingray C. Skin conductance response and emotional response in women with psychogenic non-epileptic seizures. Seizure 2020; 81:123-131. [PMID: 32795943 DOI: 10.1016/j.seizure.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepileptic seizure (PNES). Our purpose was to assess physiological, cognitive, and behavioral emotional responses of PNES patients. METHODS This study compared three types of emotional responses to visual emotional stimuli between 34 female PNES group and 34 matched healthy controls: physiological response measured by skin conductance response (SCR) (rate, amplitude and latency) and heart rate deceleration; cognitive response measured by valence and arousal elicited by the images; and behavioural response measured by latency of ratings. The groups were characterized on psychiatric comorbidities, traumatic history, alexithymia, and dissociation. RESULTS Compared to controls, PNES group displayed lower SCR for all images (p = 0.038), shorter amplitude of heart rate deceleration (p = 0.024) and faster arousal rating for all images (p = 0.019), but no difference on cognitive rating of images. Within-groups analyses showed only in PNES subjects increased rate (+19.35%, p = 0.046) SCR for negative stimuli with strong arousal compared to negative with low arousal. PNES physiological response (SCR and heart rate deceleration) was negatively correlated to dissociation tendency (r=-0.48, p = 0.0083) and alexithymia (r=-0.44, p = 0.012)). For cognitive response, no correlation was found. CONCLUSION These results are in favour of a lower physiological emotional response but with an over-reactivity at behavioral level contrasting with similar cognitive assessment. For strong aversive stimuli, PNES might present a trend to overreact at physiological and behavioural levels. Our results suggest that dissociation and difficulty in describing feelings are associated with an altered physiological response in PNES women only.
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Affiliation(s)
- Hugo Herrero
- Groupe Hospitalier Paul Guiraud, 94800 Villejuif, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | | | - Emmanuel Haffen
- Inserm, EA 481Neurosciences,Department of Clinical Psychiatry, Besançon, France
| | - Thibault Mignot
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Charlotte Sense
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Raymund Schwan
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | | | - Louis Maillard
- Service de Neurologie, CHRU Nancy Nancy, France; CNRS, CRAN - UMR 7039, Nancy F-54000, France
| | - Coraline Hingray
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; Service de Neurologie, CHRU Nancy Nancy, France
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53
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Asadi-Pooya AA, Homayoun M. Psychogenic nonepileptic (functional) seizures: Significance of family history and model learning. Psychiatry Res 2020; 290:113166. [PMID: 32512356 DOI: 10.1016/j.psychres.2020.113166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE If a positive family history of seizures plays a significant role that contributes to the risk for developing psychogenic nonepileptic seizures (PNES) by means of model learning, one would expect that patients with PNES with a family history of seizures show a different semiology than those without such a history. We investigated whether the above hypothesis is valid. METHODS In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, Iran, from 2008 until 2019, were investigated. Demographic and clinical characteristics were compared between patients with a positive family history of seizures and those without such a history RESULTS: During the study period, 274 patients with PNES-only had the inclusion criteria. Seventy-seven (28%) patients had a positive family history of seizures and 197 (72%) patients did not have such a history. There were no significant demographic or clinical differences between the two groups. CONCLUSION It seems that a positive family history of seizures and model learning does not play a significant role in the development of PNES. Investigators should explore other potentially significant contributors and risk factors for developing PNES in future studies.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA.
| | - Maryam Homayoun
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Karakis I, Morton ML, Janocko NJ, Groover O, Teagarden DL, Villarreal HK, Loring DW, Drane DL. Caregiver burden in psychogenic non-epileptic seizures. Seizure 2020; 81:13-17. [PMID: 32683267 DOI: 10.1016/j.seizure.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Caregiver burden in psychogenic non-epileptic seizures (PNES) is an important but understudied reality. The objective of this exploratory study was to quantify caregiver burden in PNES and to identify the patient and caregiver characteristics associated with it. METHODS PNES patients and their identified caregivers completed surveys about demographic, disease related and psychosocial characteristics during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using the Zarit Caregiver Burden Inventory (ZCBI) score as an independent variable and the patient and caregiver related characteristics as dependent variables. RESULTS 43 patients and 28 caregivers were recruited. The patients were on average 36 years old, single women, unemployed, with some college education. They suffered from PNES on average for 8 years, having approximately 20 seizures per month, and were previously maintained on ≥ 2 antiseizure medications. Most caregivers were first degree relatives with a mean age of 43 years, married employed women of higher educational attainment, typically cohabitating with the patients. Caregiver burden was within the mild-moderate range (ZCBI mean score 28). The burden appeared higher in caregivers of male patients. Patient quality of life, depression and medication side effects were associated with that burden. Additionally, caregiver stigma, depression and anxiety emerged as potential contributors. In the multivariate analysis, patient quality of life and caregiver depression stood out as the most robust factors. CONCLUSION There is substantial caregiver burden in PNES. It is associated with both the patient and the caregiver psychosocial well-being in a reciprocal relationship.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Matthew L Morton
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicholas J Janocko
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Groover
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Diane L Teagarden
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hannah K Villarreal
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington, Seattle, WA, USA
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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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McMurtry CM. Managing immunization stress-related response: A contributor to sustaining trust in vaccines. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:210-218. [PMID: 32673376 DOI: 10.4745/ccdr.v46i06a10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adverse events following immunizations (AEFI) are important to identify and manage effectively so as to sustain trust in vaccines and optimize health. The AEFI category related to "anxiety about the immunization" was considered problematic as it did not adequately capture the range of stress responses that can occur. The currently used term for this category, immunization stress-related responses (ISRR), is broader, including the full spectrum of signs and symptoms that can arise in response to stress. ISRR can include vasovagal reactions (fainting), hyperventilation and functional neurological symptoms (e.g. weakness, nonepileptic seizures). It is based on a biopsychosocial framework in which biological (e.g. age, sex), psychological (e.g. preparedness, previous experiences, anxiety) and social factors (e.g. response by others, social media) interact to create an individual's stress response to the immunization process. New guidance is available on prevention, early detection and management of ISRRs which is summarized in the article.
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Affiliation(s)
- C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON.,Pediatric Chronic Pain Program, McMaster University, Hamilton, ON.,Adjunct Research Professor, Department of Paediatrics, Western University, London, ON.,Associate Scientist, Children's Health Research Institute, London, ON
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57
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Gerhardt C, Hamouda K, Irorutola F, Rose M, Hinkelmann K, Buchheim A, Senf-Beckenbach P. Insecure and Unresolved/Disorganized Attachment in Patients With Psychogenic Nonepileptic Seizures. J Acad Consult Liaison Psychiatry 2020; 62:337-344. [PMID: 33358452 DOI: 10.1016/j.psym.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. OBJECTIVE The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. METHODS A cross-sectional design was chosen to compare patients with confirmed PNES (n = 44) and healthy controls (n = 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. RESULTS We found significantly less secure (P = 0.006) and more unresolved/disorganized (P = 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview for DSM-IV axis II disorders, Patient Questionnaire (P = 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P = 0.007) than patients with other attachment classifications. CONCLUSIONS Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.
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Affiliation(s)
- Carola Gerhardt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany.
| | - Karim Hamouda
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Freddy Irorutola
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Kim Hinkelmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Anna Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - Philine Senf-Beckenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
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Beghi M, Cornaggia CM, Beghi E. A brief update on psychogenic non-epileptic seizures: a challenge to overcome. JOURNAL OF EPILEPTOLOGY 2020. [DOI: 10.21307/jepil-2020-003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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59
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Gold MS, MacDonald NE, McMurtry CM, Balakrishnan MR, Heininger U, Menning L, Benes O, Pless R, Zuber PLF. Immunization stress-related response - Redefining immunization anxiety-related reaction as an adverse event following immunization. Vaccine 2020; 38:3015-3020. [PMID: 32131975 DOI: 10.1016/j.vaccine.2020.02.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
The Council for the International Organizations of Medical Sciences (CIOMS) and WHO working group on pharmacovigilance defines five cause specific AEFI which includes an immunization anxiety-related reaction. Historically this term has been used to describe a range of symptoms and signs that may arise after immunization that are related to "anxiety" about the immunization. However, the term "anxiety" does not adequately capture all the elements of this cause specific AEFI. In 2015, the Global Advisory Committee for Vaccine Safety convened an expert working group with the purpose of redefining, preventing and managing this particular AEFI. The term "Immunization Stress-Related Response" is proposed to replace the former terminology. We present a manual that redefines this AEFI and present a framework for prevention, diagnosis and management in both an individual and also when such events occur as clusters and affect multiple individuals. Since such mass events can result in cessation of immunization programmes and/or a loss of public confidence, a communication response is essential.
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Affiliation(s)
- Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Australia.
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Madhava Ram Balakrishnan
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Lisa Menning
- Expanded Programme on Immunization, World Health Organisation, Geneva, Switzerland
| | - Oleg Benes
- Regional Office Europe, World Health Organisation, Denmark
| | - Robert Pless
- Clinical Evaluation Division, Vaccines/Blood Biologics and Genetic Therapies Directorate, Health Canada, Canada
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
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Terminology for psychogenic nonepileptic seizures: Making the case for "functional seizures". Epilepsy Behav 2020; 104:106895. [PMID: 31986440 DOI: 10.1016/j.yebeh.2019.106895] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study was to review the literature on the terminologies for psychogenic nonepileptic seizures (PNES) and make a proposal on the terminology of this condition. This proposal reflects the authors' own opinions. METHODS We systematically searched MEDLINE (accessed from PubMed) and EMBASE from inception to October 10, 2019 for articles written in English with a main focus on PNES (with or without discussion of other functional neurological disorders) and which either proposed or discussed the accuracy or appropriateness of PNES terminologies. RESULTS The search strategy reported above yielded 757 articles; 30 articles were eventually included, which were generally of low quality. "Functional seizures" (FS) appeared to be an acceptable terminology to name this condition from the perspective of patients. In addition, FS is a term that is relatively popular with clinicians. CONCLUSION From the available evidence, FS meets more of the criteria proposed for an acceptable label than other popular terms in the field. While the term FS is neutral with regard to etiology and pathology (particularly regarding whether psychological or not), other terms such as "dissociative", "conversion", or "psychogenic" seizures are not. In addition, FS can potentially facilitate multidisciplinary (physical and psychological) management more than other terms. Adopting a universally accepted terminology to describe this disorder could standardize our approach to the illness and facilitate communication between healthcare professionals, patients, their families, carers, and the wider public.
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Varone G, Gasparini S, Ferlazzo E, Ascoli M, Tripodi GG, Zucco C, Calabrese B, Cannataro M, Aguglia U. A Comprehensive Machine-Learning-Based Software Pipeline to Classify EEG Signals: A Case Study on PNES vs. Control Subjects. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1235. [PMID: 32102437 PMCID: PMC7071461 DOI: 10.3390/s20041235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 11/17/2022]
Abstract
The diagnosis of psychogenic nonepileptic seizures (PNES) by means of electroencephalography (EEG) is not a trivial task during clinical practice for neurologists. No clear PNES electrophysiological biomarker has yet been found, and the only tool available for diagnosis is video EEG monitoring with recording of a typical episode and clinical history of the subject. In this paper, a data-driven machine learning (ML) pipeline for classifying EEG segments (i.e., epochs) of PNES and healthy controls (CNT) is introduced. This software pipeline consists of a semiautomatic signal processing technique and a supervised ML classifier to aid clinical discriminative diagnosis of PNES by means of an EEG time series. In our ML pipeline, statistical features like the mean, standard deviation, kurtosis, and skewness are extracted in a power spectral density (PSD) map split up in five conventional EEG rhythms (delta, theta, alpha, beta, and the whole band, i.e., 1-32 Hz). Then, the feature vector is fed into three different supervised ML algorithms, namely, the support vector machine (SVM), linear discriminant analysis (LDA), and Bayesian network (BN), to perform EEG segment classification tasks for CNT vs. PNES. The performance of the pipeline algorithm was evaluated on a dataset of 20 EEG signals (10 PNES and 10 CNT) that was recorded in eyes-closed resting condition at the Regional Epilepsy Centre, Great Metropolitan Hospital of Reggio Calabria, University of Catanzaro, Italy. The experimental results showed that PNES vs. CNT discrimination tasks performed via the ML algorithm and validated with random split (RS) achieved an average accuracy of 0.97 ± 0.013 (RS-SVM), 0.99 ± 0.02 (RS-LDA), and 0.82 ± 0.109 (RS-BN). Meanwhile, with leave-one-out (LOO) validation, an average accuracy of 0.98 ± 0.0233 (LOO-SVM), 0.98 ± 0.124 (LOO-LDA), and 0.81 ± 0.109 (LOO-BN) was achieved. Our findings showed that BN was outperformed by SVM and LDA. The promising results of the proposed software pipeline suggest that it may be a valuable tool to support existing clinical diagnosis.
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Affiliation(s)
- Giuseppe Varone
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
- Regional Epilepsy Centre, Great Metropolitan Hospital, 89100 Reggio Calabria, Italy;
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
- Regional Epilepsy Centre, Great Metropolitan Hospital, 89100 Reggio Calabria, Italy;
| | - Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
- Regional Epilepsy Centre, Great Metropolitan Hospital, 89100 Reggio Calabria, Italy;
| | | | - Chiara Zucco
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
| | - Barbara Calabrese
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
| | - Mario Cannataro
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (G.V.); (S.G.); (E.F.); (M.A.); (C.Z.); (B.C.); (M.C.)
- Regional Epilepsy Centre, Great Metropolitan Hospital, 89100 Reggio Calabria, Italy;
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Kholi H, Bellier A, Vercueil L. PNESSE 1: Psychogenic status and status epilepticus: Could they be distinguished retrospectively? A survey among neurologists. Epilepsy Behav 2020; 102:106665. [PMID: 31760202 DOI: 10.1016/j.yebeh.2019.106665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate neurologists' reliability in recognizing retrospectively a diagnosis of psychogenic status and status epilepticus (SE) based solely on clinical semiology, as reported in medical charts. METHODS This is a retrospective analysis of medical records of patients with suspected SE, diagnosed with psychogenic status and SE, proven by video-electroencephalography (EEG) monitoring, over a two-year period, from January 1st 2012 to December 31st 2013. Eight additional patients outside this time frame were included in this series because they had video-EEG proven psychogenic status, and they met all the inclusion criteria. The group with SE was divided into symptomatic SE (SSE) if a precipitating factor was identified, and undetermined SE (USE) if none were identified. Twenty-two neurologists from the CHU de Grenoble-Alpes were asked to fill out a survey where they were asked to score, for each patient, their agreement, using Likert scales, for the respective diagnoses of psychogenic status and SE. Their opinions were based on a provided written sheet summarizing the clinical description of the event and patients' clinical context. Neurologists were blinded to video-EEG monitoring results and final diagnosis. The level of agreement, disagreement, and the homogeneity of neurologist's responses according to the final diagnosis were then calculated. Finally, clinical data, as provided in the event's clinical description and context, considered as highly relevant by neurologists to establish an accurate diagnosis were gathered. RESULTS Eighteen neurologists completed the survey for 48 patients, including 11 diagnosed with psychogenic status and 37 with SE (30 with SSE and 7 with USE). For patients diagnosed with SE, the presence of a precipitating factor increased the likelihood and the homogeneity among neurologists of a diagnosis of SE (77%), with a specificity (Sp) of 96% and a positive predictive value of 95%. The lack of a precipitating factor significantly decreased the diagnosis likelihood of SE (55%) with a predictive value of 82%. For patients diagnosed with psychogenic status, most of neurologists agreed with the diagnosis of psychogenic status (69%) with a predictive value of 82%, although heterogeneity in the diagnosis was found. According to neurologists participating in this study, most significant terms, found in the medical charts, helping to distinguish SE from psychogenic status were "stereotypical movements", "limb myoclonus", "epilepsy", and "vigilance alteration". To differentiate psychogenic status from SE, most relevant terms used by neurologists were "resistance to eyes opening", "anarchic movements", "prolonged motor manifestations", "limb tremor" and "opisthotonus". However, analysis of the distribution of the terms among the different groups (SSE, USE, and psychogenic status) showed no significant difference. SIGNIFICANCE This study is in line with previous literature highlighting the difficulty in retrospectively differentiating SE from psychogenic status based on clinical events description recorded in the medical chart.
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Affiliation(s)
- Hélène Kholi
- EFSN, CHU Grenoble Alpes, 38043 Grenoble, France.
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Viarasilpa T, Panyavachiraporn N, Osman G, Akioyamen NO, Wasade VS, Barkley G, Mayer SA. Intubation for Psychogenic Non-Epileptic Attacks: Frequency, Risk Factors, and Impact on Outcome. Seizure 2019; 76:17-21. [PMID: 31958705 DOI: 10.1016/j.seizure.2019.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Patients with psychogenic non-epileptic attacks (PNEA) sometimes receive aggressive treatment leading to endotracheal intubation. We sought to identify the frequency, risk factors, and impact on outcome of intubation for PNEA. METHODS We retrospectively reviewed all PNEA patients admitted via the emergency department (ED) who had an episode of PNEA documented by continuous video electroencephalography (vEEG) at Henry Ford Hospital between January 2012 and October 2017. Patients with comorbid epilepsy were excluded. Clinical features, treatments, and vEEG reports were compared between intubated and non-intubated patients. RESULTS Of 80 patients who were admitted via the ED and had PNEA documented by vEEG, 12 (15%) were intubated. Compared with non-intubated PNEA patients, intubated patients had longer duration of convulsive symptoms (25 [IQR 7-53] vs 2 [IQR 1-9] minutes, P = 0.01), were less likely to have a normal Glasgow Coma Scale score of 15 (33% vs 94%, P < 0.001), received higher doses of benzodiazepines (30 [IQR 16-45] vs 10 [IQR 5-20] mg of diazepam equivalents, P = 0.004), and were treated with more antiepileptic drugs (AEDs, 2 [IQR 1-3] vs 1 [IQR 1-2], P = 0.01). Hospital length of stay was longer (3 [IQR 3-5] vs 2 [IQR 2-3], P = 0.001), and the rate of complications (25% vs 4%, P = 0.04) and re-hospitalization from a recurrent episode of PNEA within 30 days was higher among intubated PNEA patients (17% vs 0%, P = 0.02). CONCLUSION Fifteen percent of patients hospitalized for vEEG-documented PNEA were intubated. Intubated patients had longer length of stay, more in-hospital complications, and a high rate of re-hospitalization from recurrent PNEA symptoms. Prolonged duration of convulsive symptoms, depressed level of consciousness, and aggressive treatment with benzodiazepines were associated with intubation for PNEA.
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Affiliation(s)
- Tanuwong Viarasilpa
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Nicha Panyavachiraporn
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Gamaleldin Osman
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Noel O Akioyamen
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Vibhangini S Wasade
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Gregory Barkley
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Hospital (TV, NP, GO, NOA, VSW, GB, SAM), Detroit, MI, USA; Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University (TV, NP), Bangkok, Thailand.
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Psychogenic nonepileptic seizures: Comparing what South African healthcare providers communicate to patients at the point of diagnosis against international guidelines. Epilepsy Behav 2019; 101:106399. [PMID: 31698264 DOI: 10.1016/j.yebeh.2019.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022]
Abstract
The process of communicating a diagnosis of psychogenic nonepileptic seizures (PNES) has been widely studied internationally and found to be an important factor in the reduction of symptoms as well as promoting the uptake of treatment. To date, no research has focused on diagnosis communication in the South African context. This study used applied thematic analysis to explore the content addressed by a sample of 11 South African healthcare providers (HCPs) when presenting a diagnosis of PNES to a patient. The purpose was to investigate the areas of alignment between the international guidelines and what is done in practice and to identify other elements communicated by South African HCPs that were not addressed in the guidelines. The key communication elements described in five international guidelines were grouped into nine main themes, and coding frequencies were used to identify areas of alignment. In general, the practices of the participants aligned closely to the international guidelines. There was close alignment between the guidelines and the practices of HCPs in respect of six themes, namely: that the diagnosis was not epilepsy; how the diagnosis was made; that PNES was a real, debilitating condition; an explanation of possible causes and maintaining factors; that antiepileptic drugs are not effective in treating PNES; and a description of appropriate treatment. Participants suggested four additional subthemes that may be included when presenting a diagnosis: what to do in the event of future seizures; that further investigations are not helpful; enquiry into the link between stressors and seizures; and a discussion about comorbid conditions. Participants noted the value of utilizing a guideline as a means to ensure that all HCPs involved with a patient communicate a consistent message. They emphasized that diagnosis presentation must be relevant to the South African population and discussed the need to tailor explanations for the patient's home language and level of education. Cross-cultural barriers and different cultural health beliefs may require a specially tailored communication approach grounded in a clear cultural understanding.
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Operto FF, Coppola G, Mazza R, Pastorino GMG, Campanozzi S, Margari L, Roccella M, Marotta R, Carotenuto M. Psychogenic nonepileptic seizures in pediatric population: A review. Brain Behav 2019; 9:e01406. [PMID: 31568694 PMCID: PMC6908892 DOI: 10.1002/brb3.1406] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Psychogenic nonepileptic seizures (PNES) are observable abrupt paroxysmal changes in behavior or consciousness that resemble epileptic seizures, but without concurrent electroencephalographic abnormalities. METHODS In this manuscript, we reviewed literature concerning pediatric PNES and focused on those articles published in the last 10 years, in order to try to understand what the state of the art is at the moment, particularly as regards relationship and differential diagnosis with epilepsy. RESULTS Psychogenic nonepileptic seizures have been extensively described in literature mainly in adults and less frequently in children. Despite the potential negative impact of a misdiagnosis (unnecessary investigations and antiepileptic drugs, structured pathological behavioral patterns), in literature there is little information regarding the real prevalence, clinical features, treatment, and outcome of PNES in children and adolescents. CONCLUSION Psychogenic nonepileptic seizures are common but frequently missed entity in pediatric population. Diagnosis could be difficult, especially in those children who have both epileptic and nonepileptic seizures; video EEG and home video can help clinicians in diagnosis. More studies are needed to better classify PNES in children and facilitate diagnosis and treatment.
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Affiliation(s)
- Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giangennaro Coppola
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Roberta Mazza
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Grazia Maria Giovanna Pastorino
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy
| | - Rosa Marotta
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Ganos C, Martino D, Espay AJ, Lang AE, Bhatia KP, Edwards MJ. Tics and functional tic-like movements: Can we tell them apart? Neurology 2019; 93:750-758. [PMID: 31551261 DOI: 10.1212/wnl.0000000000008372] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/31/2019] [Indexed: 11/15/2022] Open
Abstract
Within the broad spectrum of movement disorders, tics and functional tic-like movements belong to a particular clinical category. Both types of movements are within the range of normal movement kinematics and muscle synergies, but appear repetitive and without appropriate context embedment. Historically, there have been many attempts to separate the 2 types of movements, but because of their phenomenological overlap, clinical distinction may be prone to error, and misdiagnoses may often occur. Most importantly, the 2 types of movement may coexist. Here, we review the available literature on the 2 types of motor phenomena and demonstrate some of the difficulties in distinguishing tics from functional tic-like movements on clinical grounds. We also highlight similarities and differences in pathophysiologic characteristics, documenting the significance of action monitoring, attentional allocation, and behavioral reinforcement in both types of movements, as well as in their risk factors. We discuss the overlap of current behavioral treatments for tics and functional tic-like movements and emphasize implications of diagnostic mislabeling. Such implications include the need to tailor behavioral treatment approaches to individual phenomenological profiles and guiding decision making for severe patients requiring invasive interventions, such as deep brain stimulation. A deeper insight from clinicians with respect to persisting challenges in classifying and differentiating these motor phenomena could accelerate the development of reliable clinical and physiologic markers (i.e., next generation phenotyping) and a neurobiology-driven therapeutic approach for these motor phenomena.
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Affiliation(s)
- Christos Ganos
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London.
| | - Davide Martino
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London
| | - Alberto J Espay
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London
| | - Anthony E Lang
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London
| | - Kailash P Bhatia
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London
| | - Mark J Edwards
- From the Department of Neurology (C.G.), Charité University Medicine Berlin, Germany; Department of Clinical Neurosciences (D.M.), Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, AB, Canada; Department of Neurology (A.J.E.), James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; Division of Neurology (A.E.L.), Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, University of Toronto, ON, Canada; Department of Clinical and Movement Neurosciences (K.P.B.), Queen Square Institute of Neurology, University College London; and Neurosciences Research Centre (M.E.), Molecular and Clinical Sciences Institute, St George's University of London
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Personality traits, illness behaviors, and psychiatric comorbidity in individuals with psychogenic nonepileptic seizures (PNES), epilepsy, and other nonepileptic seizures (oNES): Differentiating between the conditions. Epilepsy Behav 2019; 98:210-219. [PMID: 31382179 DOI: 10.1016/j.yebeh.2019.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The study aimed to investigate if South African individuals with psychogenic nonepileptic seizures (PNES) differ from individuals with epileptic seizures (ES) and other nonepileptic seizures (oNES) in terms of demographic and seizure characteristics, personality traits, illness behaviors, and depression, anxiety, and posttraumatic stress disorder (PTSD) comorbidity in statistically significant ways; and if so, to test if these differences can be utilized in raising suspicion of PNES as the differential diagnosis to epilepsy and oNES in practice. METHODS Data were analyzed from 29 adults with seizure complaints recruited using convenience sampling from a private and a government hospital with video-electroencephalography (vEEG) technology. A quantitative double-blind convenient sampling comparative design was used. A demographic and seizure questionnaire, the NEO Five Factor Inventory-3 (NEO-FFI-3), an abbreviated version of Illness Behavior Questionnaire (IBQ), and the Beck Anxiety Inventory - Primary Care (BAI-PC) were administered. Cronbach's alphas, analysis of variance (ANOVA), cross-tabulation, Fisher exact test, and receiver operating characteristic (ROC) analyses were performed on the dataset. RESULTS The total sample consisted of 29 participants, of which 5 had PNES (17%), 21 ES (73%), and 3 oNES (10%). The final sample was comprised of 24 participants from the private hospital and 5 from the government hospital. The group with PNES was found to be significantly more male, to experience significantly more monthly seizures, and chronic pain when comparing the PNES with the ES group, and the PNES with the combined ES and oNES group in both private only sample, as well as the private and government hospital combined sample. Patients with PNES also had a higher level of education compared with the group with ES in the combined private and government hospital sample, something that was not evident in the private hospital only sample. No significant differences between groups were found in either sample in terms of age, population group, language, age at first seizure, and the NEO-FFI-3 subscales. All three groups scored above the cutoff point of 5 exhibiting depression, anxiety, and PTSD symptoms on the BAI-PC in both samples. However, the group with PNES tended to score significantly higher than the group with ES and the combined ES and oNES group in the private hospital sample. A cutoff point of 12 on the BAI-PC was found to predict PNES in this seizure population with 80% sensitivity and 89% specificity. However, once the analysis was repeated on the combined private and government hospital sample, significance in BAI-PC scores between groups was lost. All scales showed good reliability in our study, with the exception of the "Openness to Experience" subscale of the NEO-FFI-3 once reliability analysis was carried out on the combined private and government hospital group. CONCLUSIONS This study provides an important stepping stone in the understanding of demographic and seizure factors, personality domains, abnormal illness behaviors, and psychiatric comorbidity in the South African population with PNES. The study also reported on a cutoff score of 12 on the BAI-PC predicting PNES with 80% sensitivity and 89% specificity in a private hospital sample.
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68
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Fouché M, Hartwig L, Pretorius C. Management of uncertainty in the diagnosis communication of psychogenic nonepileptic seizures in a South African context. Epilepsy Behav 2019; 98:45-52. [PMID: 31299532 DOI: 10.1016/j.yebeh.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
The process of communicating a diagnosis of psychogenic nonepileptic seizures (PNES) is an integral part of the treatment process. Many international studies have therefore focused on the PNES diagnosis communication process, but to date, none with a specific focus on the South African context. This current study considered the factors that influence the patient's experience of uncertainty and the strategies employed to manage that uncertainty within the provider-patient communication. This was considered from the healthcare provider's point of view, within the specific context of diagnosis communication. We conducted 13 semi-structured interviews with providers, eliciting their perceptions related to the communication of a PNES diagnosis to patients. Data were analyzed using thematic analysis, and themes were grouped according to the main tenets of the interpersonal health communication theory of uncertainty management, which included, the experience, appraisal, and management of uncertainty. The results revealed medical, personal, and social forms of uncertainty. The social sources of uncertainty, which include challenges related to the South African healthcare system, cultural, and language variability within the South African context, as well as possible stigmatization, seemed to have the biggest influence not only on the other areas of uncertainty, but was also indicated as a barrier to effective uncertainty management by providers. Providers in this study identified the importance of building the provider-patient relationship and ensuring patient understanding, as the main strategies used to reduce uncertainty. There was some evidence to suggest varied emotional appraisals of uncertainty by patients, but because of the subjective nature of this information, further research would be needed to confirm these findings. These findings suggest that as providers, one cannot apply a one-size-fits-all approach when aiding in uncertainty management. Furthermore, it is pertinent to remain cognizant of the social realities of the South African context and its impact on the patient's uncertainty experience. More research is needed to understand patients' perceptions of uncertainty management within the context of PNES diagnosis communication, and how they align with the perceptions of the providers provided here.
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Affiliation(s)
- Melinda Fouché
- Department of Psychology, University of Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch 7600, South Africa
| | - Louise Hartwig
- Department of Psychology, University of Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch 7600, South Africa
| | - Chrisma Pretorius
- Department of Psychology, University of Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch 7600, South Africa.
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Nie J, Song Z, Liu X. A case of dissociative convulsions presented as frequent epilepsy-like seizures. Gen Psychiatr 2019; 32:e100055. [PMID: 31552382 PMCID: PMC6738664 DOI: 10.1136/gpsych-2019-100055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 11/23/2022] Open
Abstract
Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. Here, we present a case with dissociative convulsions in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.
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Affiliation(s)
- Jing Nie
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhua Song
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Liu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cullingham T, Kirkby A, Sellwood W, Eccles FJR. Avoidance in nonepileptic attack disorder: A systematic review and meta-analyses. Epilepsy Behav 2019; 95:100-111. [PMID: 31030077 DOI: 10.1016/j.yebeh.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Avoidance is the active process of trying to escape from or not experience situations, places, thoughts, or feelings. This can be done through behavioral or cognitive strategies, or more broadly, a combination of both, utilized in an attempt to disengage from private experiences referred to as experiential avoidance (EA). Avoidance is considered important in the development and maintenance of nonepileptic attack disorder (NEAD). This review aimed to understand avoidance in NEAD and evaluate its role as a contributory factor. METHODS Fourteen articles were identified by searching Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE Complete, PsycINFO, and EMBASE and were combined in a narrative synthesis. Six of these articles were included in a meta-analysis comparing levels of EA for individuals with NEAD and healthy controls (HC), and four were included in a meta-analysis comparing EA in NEAD to epilepsy comparisons (EC). CONCLUSIONS Experiential avoidance appears to be a strategy that is used by a high proportion of the population with NEAD. The group with NEAD utilized significantly more avoidance compared with both the HC and EC. However, further research is needed to understand the extent and types of avoidance that are relevant.
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Affiliation(s)
- Tasha Cullingham
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK.
| | - Antonia Kirkby
- Department of Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - William Sellwood
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK
| | - Fiona J R Eccles
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK
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Pick S, Goldstein LH, Perez DL, Nicholson TR. Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. J Neurol Neurosurg Psychiatry 2019; 90:704-711. [PMID: 30455406 PMCID: PMC6525039 DOI: 10.1136/jnnp-2018-319201] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/20/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.
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Affiliation(s)
- Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioural Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Abstract
Functional non-epileptic attacks (FNEA) are seizure-like events occurring in the absence of epilepsy. Having had many different names over the years including dissociative convulsions and pseudo-seizures, they now fall in the borderland between neurology and psychiatry, often not accepted by either specialty. However, there is evidence that there is a high rate of psychiatric comorbidity in these patients and therefore it is likely that psychiatrists will come across patients with FNEA and they should know the broad principles of assessment and management. We have provided a clinically based overview of the evidence regarding epidemiology, risk factors, clinical features, differentiation from epilepsy, prognosis, assessment and treatment. By the end of this article, readers should be able to understand the difference between epileptic seizures and FNEA, know how to manage acute FNEA, and understand the principles of neuropsychiatric assessment and management of these patients, based on knowledge of the evidence base.
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Walther K, Volbers B, Erdmann L, Dogan Onugoren M, Gollwitzer S, Kasper BS, Kurzbuch K, Lang J, Schwab S, Schwarz M, Hamer HM. Psychological long‐term outcome in patients with psychogenic nonepileptic seizures. Epilepsia 2019; 60:669-678. [DOI: 10.1111/epi.14682] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Katrin Walther
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Bastian Volbers
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
- Department of NeurologyInselspitalUniversity Hospital Bern Bern Switzerland
| | - Laura Erdmann
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | | | - Stephanie Gollwitzer
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Burkhard S. Kasper
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Katrin Kurzbuch
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Johannes Lang
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Stefan Schwab
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Michael Schwarz
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Hajo M. Hamer
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
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Indranada AM, Mullen SA, Wong MJ, D'Souza WJ, Kanaan RAA. Preictal autonomic dynamics in psychogenic nonepileptic seizures. Epilepsy Behav 2019; 92:206-212. [PMID: 30684800 DOI: 10.1016/j.yebeh.2018.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Psychogenic nonepileptic seizures (PNES) resemble seizures but are psychological in origin. The etiology of PNES remains poorly understood, yet several theories argue for the importance of autonomic dysregulation in its pathophysiology. We therefore conducted a retrospective study to investigate autonomic dynamics leading up to a seizure to inform their mechanistic relevance. METHODS One hundred one patients with PNES and 45 patients with epileptic seizure (ES) were analyzed for preictal heart rate (HR) and respiratory rate (RR) at baseline and at minute intervals from 5 min to onset. RESULTS Patients with PNES showed rising HR (p < 0.001, repeated-measures analysis of variance (ANOVA)) and rising RR (p = 0.012, repeated-measures ANOVA) from baseline to the onset of their seizures. Patients with ES did not exhibit significant preictal HR or RR increase. Patients with PNES had nonsignificantly higher preictal HR and RR than patients with ES. SIGNIFICANCE Patients with PNES exhibit increasing autonomic arousal prior to seizure events unlike patients with epilepsy. This may reflect increasing levels of preictal anxiety, and future studies could study patients' subjective experiences of the preictal period, and more definitive measures of ventilation to see if this supported a model of PNES as "panic without panic".
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Affiliation(s)
- Alaric M Indranada
- The University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia
| | - Saul A Mullen
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia
| | - Melanie J Wong
- The University of Melbourne, Department of Clinical Neurosciences, St Vincent's Health, VIC 3065, Australia
| | - Wendyl J D'Souza
- The University of Melbourne, Department of Clinical Neurosciences, St Vincent's Health, VIC 3065, Australia
| | - Richard A A Kanaan
- The University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK.
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Diagnostic utility of the Minnesota Multiphasic Personality Inventory-2 Restructured Form in the epilepsy monitoring unit: Considering sex differences. Epilepsy Behav 2018; 88:117-122. [PMID: 30261450 DOI: 10.1016/j.yebeh.2018.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022]
Abstract
Psychological assessment measures are frequently used to evaluate patients in epilepsy monitoring units. One goal of that assessment is to contribute information that may help with differential diagnosis between epilepsy and psychogenic nonepileptic seizures (PNES). The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is one such measure. Del Bene et al. (2017) recently published an analysis that was the first to compare MMPI-2-RF scale elevations between diagnostic groups stratified by sex. The purpose of the present study was to replicate that analysis in a larger sample. Similar to previous work, we found that both men and women with PNES were more likely than men and women with epilepsy to report high levels of somatic complaints (2 to 5 times greater odds of somatic symptom reporting) and a variety of types of complaints. Mood disturbance scales were not significantly elevated in our PNES sample. Results contribute to the small body of research on sex differences in patients with PNES and suggest that somatization is a key characterization across sexes.
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The effectiveness and acceptability of a guided self-help Acceptance and Commitment Therapy (ACT) intervention for psychogenic nonepileptic seizures. Epilepsy Behav 2018; 88:332-340. [PMID: 30342877 DOI: 10.1016/j.yebeh.2018.09.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/15/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
This study utilized a nonconcurrent case-series design to examine the effectiveness and acceptability of a guided self-help Acceptance and Commitment Therapy (ACT) intervention for people with psychogenic nonepileptic seizures. A key aim of the study was to investigate the relationship between psychological flexibility (a key process within ACT), psychological health, quality of life, and seizure frequency. Six participants completed the study, with reliable and clinically significant changes in psychological flexibility, quality of life, and psychological health observed in the majority of participants. Notable reductions in self-reported seizure frequency were also observed. The implications of these findings for clinical practice are discussed and recommendations for future research suggested.
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77
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Serum NT-pro CNP levels in epileptic seizure, psychogenic non-epileptic seizure, and healthy subjects. Neurol Sci 2018; 39:2135-2139. [PMID: 30232670 DOI: 10.1007/s10072-018-3562-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/07/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Epileptic seizure is the result of uncontrollable neural excitation in the brain. The C-type natriuretic peptide is a member of natriuretic peptide hormone family and is synthesized by brain and blood vessels in CNS. NT-pro CNP is an amino-terminal fragment of C-type natriuretic peptide and is more stable compared to its predecessor. In this study, we aimed to evaluate the role of NT-pro CNP in psychogenic non-epileptic seizures, epileptic seizures, and normal subjects. METHODS Thirty-three patients with epilepsy and 43 patients with psychogenic non-epileptic seizures were enrolled in this study. The control group consisted of 28 healthy subjects. Post-ictal serum levels of NT-pro CNP were acquired from all participants. Statistically significant differences between patient groups and controls regarding serum levels of NT-pro CNP were sought. RESULTS NT-pro CNP levels were significantly lower in the epilepsy group than the psychogenic non-epileptic seizure group and control group with no significant difference between the psychogenic non-epileptic seizure and control group (p < 0.05). CONCLUSION Post-ictal serum NT-pro CNP levels were lower in epileptic seizures compared to psychogenic non-epileptic seizures as well as healthy controls. We think that such a difference is associated with C-type natriuretic peptide-related neural mechanisms such as altered microcirculation, increased brain-blood barrier permeability, and synaptic stabilization.
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78
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Nielsen ES, Wichaidit BT, Østergaard JR, Rask CU. Paediatricians' attitudes to and management of functional seizures in children. Eur J Paediatr Neurol 2018; 22:774-781. [PMID: 29871800 DOI: 10.1016/j.ejpn.2018.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore paediatricians' attitudes to and treatment practice for children with functional seizures (FS). METHODS In a nationwide survey, all 64 Danish neuro-paediatricians and social paediatricians were invited to complete a structured questionnaire encompassing FS-related issues that included beliefs and attitudes about aetiology and diagnostic assessment, current strategies for management, experienced need for clinical guidelines and better treatment options. RESULTS A total of 61 paediatricians (95%) participated in the study. Nearly half (46%) had seen more than 30 children with FS during their career. Most (65%) believed in a primarily psychogenic aetiology. More than half (57%) stated that they could make the diagnosis by solely observing a seizure, and 18% indicated the children faked their symptoms. The paediatricians' responses to these issues did not significantly vary according to their level of clinical experience. Furthermore, the majority (78%) expressed a need for clinical guidelines, and only 13% rated existing treatment options as sufficient. Collaborative care between different specialties or management in a child and adolescent mental health services (CAMHS) setting was seen as the best model for treatment. However, only 23% reported often referring these children to CAMHS after making the diagnosis. CONCLUSION The findings suggest that introduction of clinical guidelines in this area is highly needed. Such guidelines could promote more formal training of paediatricians in understanding and assessing FS and increased collaboration between paediatrics and CAMHS regarding care for children with this challenging and potentially costly and disabling disorder.
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Affiliation(s)
| | - Bianca Taaning Wichaidit
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | | | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Child and Adolescent Psychiatric Centre, Aarhus University Hospital, Risskov, Denmark
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Simani L, Elmi M, Asadollahi M. Serum GFAP level: A novel adjunctive diagnostic test in differentiate epileptic seizures from psychogenic attacks. Seizure 2018; 61:41-44. [PMID: 30077862 DOI: 10.1016/j.seizure.2018.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE There has been increasing interest in the use of different biomarkers to help distinguish psychogenic from epileptic seizures, in patients presenting acutely with seizure-like events. In the present study, we measured serum glial fibrillary astrocytic protein (GFAP) levels in patients presenting with such events who were subsequently diagnosed as epileptic seizures (ESs) or psychogenic non-epileptic seizures (PNESs) and compared GFAP levels obtained with those found in healthy subjects. METHODS Sixty-three patients with seizures (43 with ES and 20 with PNES), and 19 healthy subjects participated in the study. Venous blood samples were obtained within the first 6 h after seizures and serum GFAP levels were measured by protein quantification (ELIZA kit) with an electrochemical luminescence immunoassay. RESULTS Serum GFAP levels were significantly higher in patients with ES compared to PNES or healthy controls. A cut-off point of 2.71 ng/ml was found optimally to differentiate ES from PNES (sensitivity 72%, specificity 59%). CONCLUSION Our study suggests that post-seizure serum GFAP levels could be used in future studies better to understand the underlying mechanism of seizures and may offer as an adjunctive diagnostic test in differentiating ES from PNES.
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Affiliation(s)
- Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Elmi
- Department of epilepsy, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, South Kargar Ave., Kamali St., Tehran, Iran
| | - Marjan Asadollahi
- Department of epilepsy, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, South Kargar Ave., Kamali St., Tehran, Iran.
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Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area. Seizure 2018; 59:67-71. [DOI: 10.1016/j.seizure.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 11/23/2022] Open
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Diagnostic and treatment practices for psychogenic nonepileptic and epileptic seizures in Namibia. Epilepsy Behav 2018; 83:92-102. [PMID: 29665572 DOI: 10.1016/j.yebeh.2018.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/04/2018] [Accepted: 03/04/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Information about existing healthcare resources for the management of seizures in developing countries is lacking. These countries are often poorly equipped to deal with the immense burden of costs, mortality, stigma, seizure-related disability, and comorbidities presented by seizure disorders. This study aimed to contribute to the goals of the International League Against Epilepsy (ILAE) by investigating the resources available for patients with seizure in Namibia. METHODS Two separate surveys on the diagnostic and treatment practices for epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) were administered to private healthcare practitioners (HCPs) in Namibia. RESULTS The findings are based on 50 responses from HCPs involved in the management of seizures. The responses indicate that HCPs have less confidence in their ability to manage PNES than ES. Psychological/psychiatric assessments are seldom utilized. Although HCPs engage in face-to-face communication of diagnoses, they seldom refer patients to additional sources of information. Healthcare practitioners follow up patients with ES more regularly than those with PNES. Healthcare practitioners indicated their willingness to collaborate and recognize the role of traditional health practitioners (THPs) in a supportive capacity when it comes to the management of seizures. Financial constraints, limited availability of specialized equipment, and lack of knowledge and awareness regarding seizure disorders among both HCPs and patients were mentioned as major obstacles in accessing healthcare services. CONCLUSION The findings of this study add to the current literature by demonstrating some of the particular characteristics of HCPs from a lower middle-income African country regarding the diagnosis and treatment of PNES and ES.
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82
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[Psychogenic non epileptic seizures : Differential diagnostic features]. Herzschrittmacherther Elektrophysiol 2018; 29:155-160. [PMID: 29761337 DOI: 10.1007/s00399-018-0557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/03/2018] [Indexed: 10/16/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are to be considered in the differential diagnosis of a transient loss of consciousness. Their discrimination from syncope, epileptic seizures or vascular events can be difficult and requires profound knowledge about the semiology and clinical presentation of PNES and their differential diagnoses. Erroneous diagnoses and the resulting therapies lead to elevated morbidity, elevated costs and a poorer outcome. The aim of the present article is to provide an overview on PNES and their delineation from the clinical pictures of epilepsy and syncope.
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83
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Tong X, An D, Reuber M, Zhang Q, Zhou D. Diagnostic and treatment services for patients with Psychogenic Nonepileptic Seizures (PNES): A survey of health professionals in urban China. Seizure 2018; 56:78-87. [PMID: 29454194 DOI: 10.1016/j.seizure.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study is intended to provide an overview of diagnostic and treatment services for patients with psychogenic nonepileptic seizures (PNES) across China. METHODS Using a questionnaire devised by the PNES Task Force of Neuropsychiatry Commission of the International League Against Epilepsy (ILAE), we conducted a survey among Chinese health professionals at the Sixth Advanced International Course: Clinical Epileptology. Descriptive analyses were performed. RESULTS Responses from 102 eligible clinicians were analysed. Responses were received from urban areas in 20 provinces/municipalities around China. Most respondents were neurologists. The results showed that hospitals in urban China were mostly well-equipped, and that health professionals' understanding of PNES largely reflected current international expert opinion. However, many of the participants would not actually make the diagnosis, and most provided neither follow-up nor treatment (especially psychotherapy) for patients with PNES. Only about one third of the patients diagnosed with PNES were estimated to receive at least one appointment for psychological treatment. In the opinion of the respondents, tacit trauma (neglect and stress) play an important role in the development of PNES. The main obstacles to patients with PNES accessing health services for their condition were thought to be lack of knowledge or awareness among health professionals, patients and society. CONCLUSION Despite good access to equipment, diagnostic and treatment services for patients with PNES in China are currently deficient. Education programs about PNES with different target groups, and more effective referral and social security systems emerge as particular development needs from this survey.
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Affiliation(s)
- Xin Tong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Qin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Information Theoretic-Based Interpretation of a Deep Neural Network Approach in Diagnosing Psychogenic Non-Epileptic Seizures. ENTROPY 2018; 20:e20020043. [PMID: 33265170 PMCID: PMC7512641 DOI: 10.3390/e20020043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 11/17/2022]
Abstract
The use of a deep neural network scheme is proposed to help clinicians solve a difficult diagnosis problem in neurology. The proposed multilayer architecture includes a feature engineering step (from time-frequency transformation), a double compressing stage trained by unsupervised learning, and a classification stage trained by supervised learning. After fine-tuning, the deep network is able to discriminate well the class of patients from controls with around 90% sensitivity and specificity. This deep model gives better classification performance than some other standard discriminative learning algorithms. As in clinical problems there is a need for explaining decisions, an effort has been carried out to qualitatively justify the classification results. The main novelty of this paper is indeed to give an entropic interpretation of how the deep scheme works and reach the final decision.
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85
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An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management. Can J Neurol Sci 2018; 45:130-136. [DOI: 10.1017/cjn.2017.283] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractThe purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity.
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86
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Oto M, Reuber M. Psychogenic non-epileptic seizures: aetiology, diagnosis and management. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.113.011171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryPsychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient's history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.
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87
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Spitzer C, Eckhardt-Henn A. Dissoziative Anfälle. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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88
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Rao SR, Slater JD, Kalamangalam GP. A simple clinical score for prediction of nonepileptic seizures. Epilepsy Behav 2017; 77:50-52. [PMID: 29111502 DOI: 10.1016/j.yebeh.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/21/2017] [Accepted: 09/10/2017] [Indexed: 11/26/2022]
Abstract
Psychogenic nonepileptic seizures (PNES), often mistaken for epilepsy in community practice, require inpatient video-EEG (VEEG) monitoring for diagnostic confirmation. We developed a simple score designed for use in an outpatient setting to predict the subsequent VEEG diagnosis of PNES. We retrospectively compared fifty-five consecutive patients with VEEG-proven PNES (N1=55) with a group of randomly selected patients with VEEG-proven epilepsy (N2=55). Patients were divided into two groups: I) a 'truly retrospective' group of 27 patients with PNES and 27 patients with epilepsy whose data served to develop the score, and II) a 'pseudoprospective' group of 28 patients each with PNES and epilepsy to whom the score was applied. Six features in the history of the Group I cohort appeared more prominent in patients with PNES than patients with epilepsy and were assigned escalating numerical values as follows: number of declared drug allergies (0, 0.5, 1), number of declared comorbidities (0, 0.5, 1), number of previous invasive medical interventions of any type (0, 0.5, 1), and a history of significant psychological or physical trauma (0 or 1). In addition, a score was assigned to verbal description of the seizures themselves as being consistent (=0), atypical (=1), or indeterminate (=0.5) for epilepsy. The values were added to yield an omnibus score ranging from 0 to 6. Scoring of Group II subjects in a blinded fashion revealed that in general patients with PNES had higher scores, and the majority obtained a score >2; most patients with epilepsy scored <1.5. Group difference in the mean between the PNES and epilepsy cohort was highly significant (p<0.0001, Wilcoxon rank-sum test). Our score is a simple clinical instrument based on the patient history that may find use in the triage of patients awaiting hospitalization for VEEG and in pre-VEEG counseling.
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Affiliation(s)
- Sindhu R Rao
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA
| | - Jeremy D Slater
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA
| | - Giridhar P Kalamangalam
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA.
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Engaging psychiatrists in the diagnosis of psychogenic nonepileptic seizures. What can they contribute? Seizure 2017; 52:182-187. [DOI: 10.1016/j.seizure.2017.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022] Open
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Doğan EA, Ünal A, Ünal A, Erdoğan Ç. Clinical utility of serum lactate levels for differential diagnosis of generalized tonic-clonic seizures from psychogenic nonepileptic seizures and syncope. Epilepsy Behav 2017; 75:13-17. [PMID: 28806632 DOI: 10.1016/j.yebeh.2017.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/01/2017] [Accepted: 07/04/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The differential diagnosis of generalized tonic-clonic seizures (GTCS), psychogenic nonepileptic seizures (PNES), and syncope constitutes a major challenge. Misdiagnosis rates up to 20 to 30% are reported in the literature. PURPOSE To assess the clinical utility of serum lactate levels for differentiation of GTCS, PNES, and syncope based on gender differences. METHODS Data from 270 patients were evaluated retrospectively. Only patients ≥18 years old with the final diagnosis of GTCS, PNES, or syncope in their chart were recruited. Serum lactate levels were measured in the first 2h of the index event. RESULTS Serum lactate levels in patients with GTCS (n=157) were significantly higher than in the patients with PNES (n=25) (p<0.001) and syncope (n=88) (p<0.001). When compared with the females, serum lactate levels in patients with GTCS were significantly higher in the male subgroup (p=0.004). In male patients the ROC analysis yielded a serum lactate value of 2.43mmol/l with a sensitivity of 0.85 and a specificity of 0.88 as the optimal cut-off value to distinguish GTCS from other events. The ROC analysis for the AUC yielded a high estimate of 0.94 (95% confidence interval: 0.91-0.98). When a cut-off value of 2.43mmol/l was chosen for the females, which was an optimal value for male patients, the specificity was 0.85, however, the sensitivity was 0.64. CONCLUSION We propose that serum lactate level when measured in the first 2h after the index event has a high clinical utility in the differential diagnosis of GTCS, PNES, and syncope. With concomitant clinical signs and physical examination findings besides neuroimaging and EEG, elevated levels of lactate should be taken into account when evaluating a patient with impaired consciousness. On the other hand, the suggested cut-off value 2.43mmol/l might not have a discriminative effect between GTCS, PNES, and syncope in female patients. This finding should be verified in a prospectively designed study with a larger patient population.
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Affiliation(s)
- Ebru Apaydın Doğan
- Akdeniz University School of Medicine, Neurology Department, Antalya, Turkey.
| | - Ali Ünal
- Akdeniz University School of Medicine, Neurology Department, Antalya, Turkey
| | - Aslıhan Ünal
- Akdeniz University School of Medicine, Emergency Department, Antalya, Turkey
| | - Çağla Erdoğan
- Akdeniz University School of Medicine, Neurology Department, Antalya, Turkey
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91
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Abstract
The present study explored how seizure clusters may be defined for those with psychogenic nonepileptic seizures (PNES), a topic for which there is a paucity of literature. The sample was drawn from a multisite randomized clinical trial for PNES; seizure data are from participants' seizure diaries. Three possible cluster definitions were examined: 1) common clinical definition, where ≥3 seizures in a day is considered a cluster, along with two novel statistical definitions, where ≥3 seizures in a day are considered a cluster if the observed number of seizures statistically exceeds what would be expected relative to a patient's: 1) average seizure rate prior to the trial, 2) observed seizure rate for the previous seven days. Prevalence of clusters was 62-68% depending on cluster definition used, and occurrence rate of clusters was 6-19% depending on cluster definition. Based on these data, clusters seem to be common in patients with PNES, and more research is needed to identify if clusters are related to triggers and outcomes.
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92
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Baird GL, Harlow LL, Machan JT, LaFrance WC. Cluster reduction in patients in a pilot treatment trial for psychogenic nonepileptic seizures. Epilepsy Behav 2017. [PMID: 28624511 DOI: 10.1016/j.yebeh.2017.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The present study examined seizure clusters as a primary outcome in patients receiving treatment for PNES. Cluster reduction is examined longitudinally using frequency threshold and statistical definitions of seizure cluster for patients. Possible risk factors for clustering will be examined along with clustering as a risk factor for poorer secondary outcomes. METHODS Participants were from a pilot randomized treatment trial for PNES where they received cognitive behavioral therapy-informed psychotherapy (CBT-ip), sertraline, combination therapy, or treatment as usual. Seizure data are from patients' seizure dairies. RESULTS Cluster reduction was observed for those receiving CBT-ip or combination treatment using all definitions of daily clusters and weekly clusters. No risk factors of clustering were observed. Those who were identified as having clusters during the trial had poorer secondary outcomes on several measures at baseline relative to those who were not identified as having clusters. DISCUSSION This is the first study known to the authors to not only examined seizure clusters as a primary outcome for those with PNES, but also the first study to suggest that CBT-ip and combination therapy may be effective in reducing the frequency of clusters.
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Affiliation(s)
- Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; Diagnostic Imaging, The Warren Alpert Medical School of Brown University, United States; University of Rhode Island, Department of Psychology, United States.
| | - Lisa L Harlow
- Lifespan Biostatistics Core, Rhode Island Hospital, United States
| | - Jason T Machan
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; University of Rhode Island, Department of Psychology, United States
| | - W C LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital and Brown University, United States
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93
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Cope SR, Poole N, Agrawal N. Treating functional non-epileptic attacks - Should we consider acceptance and commitment therapy? Epilepsy Behav 2017. [PMID: 28648970 DOI: 10.1016/j.yebeh.2017.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients who experience functional non-epileptic attacks (FNEA) are frequently seen in Neurology clinics. Diagnosis alone can result in cessation of attacks for some patients, but many patients require further treatment. There is evidence that certain psychological therapies, like cognitive-behavioral therapy (CBT) and psychodynamic interpersonal therapy (PIT) can be beneficial. Acceptance and commitment therapy (ACT) is a type of CBT that has been found to be effective at treating other somatic disorders, like epilepsy and chronic pain. In this paper, we explain what ACT is, the current evidence-base for its use, and the rationale for why it may be a beneficial treatment for patients who experience FNEA. We conclude that ACT is a potential treatment option for FNEA, and further research is required.
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Affiliation(s)
- Sarah R Cope
- Neuropsychiatry Service, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | - Norman Poole
- Neuropsychiatry Service, St George's Hospital, Blackshaw Road, London SW17 0QT, UK; Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
| | - Niruj Agrawal
- Neuropsychiatry Service, St George's Hospital, Blackshaw Road, London SW17 0QT, UK; Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
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94
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du Toit A, Pretorius C. Psychogenic nonepileptic seizures: Namibian healthcare providers’ perceptions and frustrations. Seizure 2017; 50:43-52. [DOI: 10.1016/j.seizure.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/28/2022] Open
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95
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Sarudiansky M, Lanzillotti AI, Areco Pico MM, Tenreyro C, Scévola L, Kochen S, D'Alessio L, Korman GP. What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach. Seizure 2017; 51:14-21. [PMID: 28755568 DOI: 10.1016/j.seizure.2017.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To analyse the methods of reasoning with regard to patients' experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Explanatory models and prototypes were identified from the patients' narratives. Four patients related their suffering regarding psychosocial causes -family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people's "attacks" (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy. CONCLUSION Patients' psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services.
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Affiliation(s)
- Mercedes Sarudiansky
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | - Alejandra Inés Lanzillotti
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | - María Marta Areco Pico
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | | | - Laura Scévola
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Mental Health Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Silvia Kochen
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Luciana D'Alessio
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Guido Pablo Korman
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
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96
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Sansevere AJ, Avalone J, Strauss LD, Patel AA, Pinto A, Ramachandran M, Fernandez IS, Bergin AM, Kimia A, Pearl PL, Loddenkemper T. Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy. J Child Neurol 2017; 32:774-788. [PMID: 28503985 DOI: 10.1177/0883073817706028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.
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Affiliation(s)
- Arnold J Sansevere
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer Avalone
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Doyle Strauss
- 2 Department of Neurology, Wake Forest Baptist Health, Wake Forest Medical School, Winston Salem, NC, USA
| | - Archana A Patel
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Pinto
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ann M Bergin
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir Kimia
- 4 Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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97
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Yalçın M, Tellioğlu E, Gündüz A, Özmen M, Yeni N, Özkara Ç, Kiziltan ME. Orienting reaction may help recognition of patients with psychogenic nonepileptic seizures. Neurophysiol Clin 2017; 47:231-237. [DOI: 10.1016/j.neucli.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022] Open
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98
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Novakova B, Harris PR, Reuber M. Diurnal patterns and relationships between physiological and self-reported stress in patients with epilepsy and psychogenic non-epileptic seizures. Epilepsy Behav 2017; 70:204-211. [PMID: 28432961 DOI: 10.1016/j.yebeh.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE Patients with epilepsy and those with psychogenic non-epileptic seizures (PNES) experience high levels of stress and stress is one of the most frequently self-identified seizure precipitants. Although stress is a multifaceted phenomenon, few studies have systematically examined its different components in patients with seizures. The aim of this study was therefore to describe diurnal patterns of psychological and physiological measures of stress in patients with epilepsy and patients with PNES, and explore their relationships to each other in order to improve our understanding of the mechanisms underlying stress and seizure occurrence in these patients. METHOD A range of stress markers including self-reported stress, salivary cortisol, and heart rate variability (HRV) were explored in adult patients with refractory epilepsy (N=22) and those with PNES (N=23) undergoing three- to five-day video-telemetry. RESULTS A diurnal pattern was observed in the physiological measures, characterized by higher levels of physiological arousal in the mornings and lower levels at night in both patients with epilepsy and PNES. The physiological measures (cortisol and HRV) were associated with each other in patients with epilepsy; no close relationship was found with self-reported stress in either of the two patient groups. CONCLUSION The findings contribute to and expand on previous studies of the patterns of stress in patients with seizures. The results also indicate a discrepancy between patients' physiological responses and their subjective stress perceptions, suggesting that simple self-reports cannot be used as a proxy of physiological arousal in patients with seizures and stress. Stress in these patient groups should be studied using a combination of complementary measures.
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Affiliation(s)
- Barbora Novakova
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - Peter R Harris
- School of Psychology, University of Sussex, Sussex House, Falmer, Brighton BN1 9RH, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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99
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Cope SR, Smith JG, King T, Agrawal N. Evaluation of a pilot innovative cognitive-behavioral therapy-based psychoeducation group treatment for functional non-epileptic attacks. Epilepsy Behav 2017; 70:238-244. [PMID: 28454061 DOI: 10.1016/j.yebeh.2017.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/26/2022]
Abstract
A high proportion of patients presenting at epilepsy clinics experience functional non-epileptic attacks (FNEA), and while psychological treatment is generally thought to be the required intervention, evidence regarding psychological treatment of FNEA is limited. A small number of psychoeducation treatments have been evaluated, with promising results. As part of routine care within a neuropsychiatry service, a 3-session cognitive-behavior therapy- (CBT-) informed psychoeducation group was developed. Patients with comorbid epilepsy were included. The group's effectiveness was evaluated in terms of attack frequency, mood, illness perception, dissociative experiences, and patient feedback. Pre- and post-treatment data were obtained for 19 patients. The proportion of patients experiencing attacks significantly decreased, with almost 40% of treatment completers reporting being attack-free at the end of treatment. Significant improvements were also found on level of psychological distress, illness beliefs, and understanding of the condition. No significant changes in mood or general functioning were observed. High satisfaction was reported by almost all patients. Treatment outcome was not significantly affected by the level of dissociative experiences. The results suggest that CBT-based psychoeducation group treatment can be a beneficial part of treatment for those with FNEA, even for those experiencing high levels of dissociation. Further controlled studies with larger sample sizes are required.
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Affiliation(s)
- Sarah R Cope
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Tara King
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Niruj Agrawal
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK; Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
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100
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Psychogenic nonepileptic seizures: a concise review. Neurol Sci 2017; 38:935-940. [PMID: 28275874 DOI: 10.1007/s10072-017-2887-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are commonly diagnosed and treated at epilepsy centers; however, their neurobiology is still poorly understood. Diagnosis relies on a multidisciplinary evaluation and is usually based on different combinations of data. They are diagnosed most reliably by recording a seizure while under video-EEG monitoring. Treatment includes multiple phases. Fewer than 40% of adults with PNES are expected to become seizure-free within 5 years after diagnosis. This article presents a concise review of the current literature about the definition, diagnosis, epidemiology, clinical characteristics, treatment, and prognosis of PNES.
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