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Prolonged psychogenic nonepileptic seizures or pseudostatus. Epilepsy Behav 2014; 31:304-6. [PMID: 24262782 DOI: 10.1016/j.yebeh.2013.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine if patients with episodes of prolonged psychogenic nonepileptic seizures or pseudostatus are different from those with psychogenic nonepileptic seizures (PNESs) without prolonged attacks regarding their demographic and clinical characteristics and factors potentially predisposing to PNESs. METHODS In this prospective study, all patients with a clinical diagnosis of PNESs (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2013. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics of patients with PNES-status with those with PNES-only. RESULTS Two hundred and eleven patients were studied. Forty-nine patients (23.2%) reported episodes of PNES-status, and 162 patients (76.8%) did not report PNES-status. There were no significant differences between these two groups of patients regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs. CONCLUSION Psychogenic nonepileptic seizure status (PNES-status) is relatively common among patients with PNESs. It seems that patients with PNES-status are not different from those with PNES-only, at least regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs.
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152
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van der Kruijs SJM, Bodde NMG, Carrette E, Lazeron RHC, Vonck KEJ, Boon PAJM, Langereis GR, Cluitmans PJM, Feijs LMG, Hofman PAM, Backes WH, Jansen JFA, Aldenkamp AP. Neurophysiological correlates of dissociative symptoms. J Neurol Neurosurg Psychiatry 2014; 85:174-9. [PMID: 23175855 DOI: 10.1136/jnnp-2012-302905] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Dissociation is a mental process with psychological and somatoform manifestations, which is closely related to hypnotic suggestibility and essentially shows the ability to obtain distance from reality. An increased tendency to dissociate is a frequently reported characteristic of patients with functional neurological symptoms and syndromes (FNSS), which account for a substantial part of all neurological admissions. This review aims to investigate what heart rate variability (HRV), EEG and neuroimaging data (MRI) reveal about the nature of dissociation and related conditions. METHODS Studies reporting HRV, EEG and neuroimaging data related to hypnosis, dissociation and FNSS were identified by searching the electronic databases Pubmed and ScienceDirect. RESULTS The majority of the identified studies concerned the physiological characteristics of hypnosis; relatively few investigations on dissociation related FNSS were identified. General findings were increased parasympathetic functioning during hypnosis (as measured by HRV), and lower HRV in patients with FNSS. The large variety of EEG and functional MRI investigations with diverse results challenges definite conclusions, but evidence suggests that subcortical as well as (pre)frontal regions serve emotion regulation in dissociative conditions. Functional connectivity analyses suggest the presence of altered brain networks in patients with FNSS, in which limbic areas have an increased influence on motor preparatory regions. CONCLUSIONS HRV, EEG and (functional) MRI are sensitive methods to detect physiological changes related to dissociation and dissociative disorders such as FNSS, and can possibly provide more information about their aetiology. The use of such measures could eventually provide biomarkers for earlier identification of patients at risk and appropriate treatment of dissociative conditions.
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153
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Similar semiology of epileptic and psychogenic nonepileptic seizures recorded during stereo-EEG. Seizure 2013; 22:897-900. [DOI: 10.1016/j.seizure.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 11/21/2022] Open
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154
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Thomas AA, Preston J, Scott RC, Bujarski KA. Diagnosis of probable psychogenic nonepileptic seizures in the outpatient clinic: does gender matter? Epilepsy Behav 2013; 29:295-7. [PMID: 24021495 DOI: 10.1016/j.yebeh.2013.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/01/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
Psychogenic nonepileptic seizures (PNESs) are paroxysmal events of altered behavior that outwardly resemble epilepsy but are caused by psychiatric disease. The diagnosis of probable PNESs can be made in the outpatient clinic prior to video-EEG monitoring by identification of specific PNES predictors and specific elements of seizure semiology from the clinical history. Since psychiatric disease may have distinct mechanisms between women and men, the objective of this study was to determine if gender-specific differences exist in PNES predictors and PNES semiology. Such differences could be used to optimize the accuracy of outpatient diagnosis of probable PNESs. Medical records of male and female patients with video-EEG diagnosis of definite PNESs were retrospectively reviewed for occurrence of PNES predictors. In addition, PNES semiology was analyzed de novo from video-EEG records and categorized into previously established semiology clusters. Eighty-six patients were included in the analysis (59 women and 27 men). We found significantly lower rates of reported physical and sexual abuse, lower rates of previous psychiatric diagnosis, and lower rates of chronic pain in male patients with no significant differences in rates of other PNES predictors. Furthermore, we found no difference in PNES semiology between men and women, with both groups experiencing similar rates of major motor, minor motor, and nonmotor semiology. In conclusion, our results lend support to the idea that distinct risk factor criteria but similar semiology criteria should be used for the diagnosis of probable PNESs in the outpatient clinic in men and women.
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Affiliation(s)
- Alissa A Thomas
- Dartmouth Hitchcock Medical Center, Department of Neurology, One Medical Center Drive, Lebanon, NH 03756, USA.
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155
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Brown RJ, Bouska JF, Frow A, Kirkby A, Baker GA, Kemp S, Burness C, Reuber M. Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures. Epilepsy Behav 2013; 29:178-83. [PMID: 23973643 DOI: 10.1016/j.yebeh.2013.07.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Psychogenic nonepileptic seizures (PNESs) are poorly understood and difficult to treat. Research and theory suggest that problems with recognizing, acknowledging, and regulating emotional states (i.e., emotional dysregulation) may contribute to the development and maintenance of PNESs. However, there is a lack of well-controlled studies using dedicated measures of emotional regulation with patients with PNESs. The current study sought to address this gap. METHODS Forty-three patients with PNESs and 24 with epilepsy completed a postal survey comprising measures of emotional dysregulation (Difficulties in Emotion Regulation Scale), alexithymia (Toronto Alexithymia Scale), attachment (Relationship Scales Questionnaire), and psychopathology (Generalized Anxiety Disorder-7; Patient Health Questionnaire-9; Somatoform Dissociation Questionnaire-20). Cluster analysis was used to identify possible subgroups of patients with PNESs characterized by distinct patterns of emotional dysregulation. RESULTS Two clusters of patients with PNESs were identified. The first (n=11) was characterized by higher levels of psychopathology, somatization, alexithymia, and difficulties with most aspects of emotional regulation (including identifying, accepting, and describing feelings, accessing adaptive regulatory strategies, performing goal-directed behaviors, and controlling feelings and actions) compared with the group with epilepsy. The second (n=32) was characterized by relatively high somatization and depression scores but comparatively normal levels of alexithymia and emotional regulation. CONCLUSIONS The findings suggest that patients with PNESs can be divided into at least two meaningful subgroups characterized by distinct psychological profiles, only one of which is characterized by significant problems with emotional dysregulation. Further research is needed to determine whether the relatively normal emotional dysregulation and high somatization scores of some patients with PNESs are due to emotional avoidance or more basic problems with perceptual and behavioral control.
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Affiliation(s)
- Richard J Brown
- School of Psychological Sciences, University of Manchester, UK.
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156
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Scévola L, Teitelbaum J, Oddo S, Centurión E, Loidl CF, Kochen S, D Alessio L. Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: a study of an Argentine population. Epilepsy Behav 2013; 29:155-60. [PMID: 23969203 DOI: 10.1016/j.yebeh.2013.07.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/11/2013] [Accepted: 07/13/2013] [Indexed: 12/01/2022]
Abstract
Epidemiological data show that up to 20-30% of patients with psychogenic nonepileptic seizures (PNESs), resembling drug-resistant epilepsy (DRE), are referred to tertiary epilepsy centers. Furthermore, both disorders present high psychiatric comorbidity, and video-EEG is the gold standard to make differential diagnoses. In this study, we described and compared the clinical presentation and the frequency of psychiatric disorders codified in DSM IV in two groups of patients, one with PNESs and the other with DRE, admitted in a tertiary care epilepsy center of Buenos Aires, Argentina. We included 35 patients with PNESs and 49 with DRE; all were admitted in the video-EEG unit in order to confirm an epilepsy diagnosis and determine surgical treatment possibilities. All patients underwent a neurological and psychiatric assessment, according to standardized protocol (SCID I and II; DSM IV criteria). Student's t test was performed to compare continuous variables and Chi square test to compare qualitative variables. In this study, 33 (67%) patients with DRE and 35 (100%) patients with PNESs met criteria for at least one disorder codified in Axis I of DSM IV (p=0.003). Differences in the frequency of psychiatric disorder presentation were found between groups. Anxiety disorders (16.32% vs 40%; p=0.015), trauma history (24.5% vs 48.57%; p=0.02), posttraumatic stress disorder (4.08% vs 22.85%; p=0.009), and personality cluster B disorders (18.37% vs 42.86%; p=0.02) were more frequent in the group with PNESs. Psychotic disorders were more frequent in the group with DRE (20.4% vs 2.85%; p=0.019). Depression was equally prevalent in both groups. Standardized psychiatric assessment provides information that could be used by the mental health professional who receives the referral in order to improve quality of care and smooth transitions to proper PNES treatment, which should include a multidisciplinary approach including neurology and psychiatry.
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Affiliation(s)
- Laura Scévola
- Epilepsy Center Ramos Mejía Hospital, Cell Biology and Neuroscience Institute (IBCN), Buenos Aires University (UBA)-CONICET, Buenos Aires, Argentina; Psychiatry Division, Ramos Mejía Hospital, Buenos Aires, Argentina.
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157
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Myers L, Fleming M, Lancman M, Perrine K, Lancman M. Stress coping strategies in patients with psychogenic non-epileptic seizures and how they relate to trauma symptoms, alexithymia, anger and mood. Seizure 2013; 22:634-9. [DOI: 10.1016/j.seizure.2013.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 04/19/2013] [Accepted: 04/20/2013] [Indexed: 11/28/2022] Open
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158
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Reilly C, Menlove L, Fenton V, Das KB. Psychogenic nonepileptic seizures in children: A review. Epilepsia 2013; 54:1715-24. [DOI: 10.1111/epi.12336] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Colin Reilly
- Research Department; Young Epilepsy; Surrey; United Kingdom
| | - Leanne Menlove
- Research Department; Young Epilepsy; Surrey; United Kingdom
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159
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Tannemaat MR, van Niekerk J, Reijntjes RH, Thijs RD, Sutton R, van Dijk JG. The semiology of tilt-induced psychogenic pseudosyncope. Neurology 2013; 81:752-8. [PMID: 23873974 DOI: 10.1212/wnl.0b013e3182a1aa88] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. METHODS We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS). RESULTS Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p < 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p < 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p < 0.01), but jerking movements occurred more frequently in VVS (p < 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p < 0.0001). CONCLUSIONS PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis.
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Affiliation(s)
- Martijn R Tannemaat
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Amsterdam, the Netherlands
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160
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Myers L, Perrine K, Lancman M, Fleming M, Lancman M. Psychological trauma in patients with psychogenic nonepileptic seizures: trauma characteristics and those who develop PTSD. Epilepsy Behav 2013; 28:121-6. [PMID: 23708490 DOI: 10.1016/j.yebeh.2013.03.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The first objective of this study was to examine and describe the demographic, psychiatric, and trauma characteristics of our sample with PNESs as a whole. Subsequently, a comparison between traumatized and nontraumatized patients with PNESs was performed with regard to descriptive and trauma characteristics and general psychopathology symptoms. Lastly, we analyzed the predictive value in distinguishing patients with "likely" vs. "not likely" PTSD utilizing a model derived from our patients' psychometric test results. METHODS We collected and tallied demographic and psychiatric information and trauma characteristics on 61 patients with PNESs who had confirmed or denied having experienced trauma in their lifetime. We then studied this group with the Trauma Symptom Inventory-2 (TSI-2) and the Minnesota Multiphasic Personality Inventory-2RF (MMPI-2RF). Traumatized patients were subsequently classified as "PTSD likely" and "PTSD not likely" based on TSI-2 criteria and compared on demographic, psychiatric, and trauma characteristics and MMPI-2RF scores. RESULTS Our study revealed that 45 out of 61 (73.8%) patients reported experiencing at least one traumatic event in their lifetime. Approximately 40% reported physical or sexual abuse followed in percentage size by loss of a significant other, psychological abuse, witnessing the abuse of others, and medical trauma. Traumatized vs. nontraumatized and "PTSD likely" and "PTSD not likely" patients differed significantly on several clinical variables, as well as MMPI-2RF scores. Scores from TSI-2 produced a model that accurately predicted "no PTSD" in 21/26 (80.77%) subjects who denied a history of PTSD and "PTSD" in 5/6 subjects (83.33%) who endorsed a history of PTSD. CONCLUSION This study showed that overall exposure to psychological trauma is much more prevalent in patients with PNESs than in the general population with an inordinately high exposure to sexual and physical abuse as well as a variety of other types of abuse. Psychopathology was identified in the group with PNESs as a whole with discrete distinctions in clinical symptoms and characteristics of the traumatized as well as the "PTSD likely" subgroups. These findings contribute useful information in understanding intragroup differences in what is increasingly appearing to be a heterogeneous psychiatric condition composed of distinguishable subgroups.
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Affiliation(s)
- Lorna Myers
- Northeast Regional Epilepsy Group, 820 Second Avenue, Suite 6C, New York, NY 10017, USA.
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161
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Asadi-Pooya AA, Emami M, Emami Y. Gender differences in manifestations of psychogenic non-epileptic seizures in Iran. J Neurol Sci 2013; 332:66-8. [PMID: 23820124 DOI: 10.1016/j.jns.2013.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Psychogenic non-epileptic seizures (PNES) are more prevalent among women. We investigated the potential differences in demographic and clinical characteristics of PNES between women and men. METHODS In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2012. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics and seizure semiology of PNES between women and men. RESULTS Two hundred and twenty-two patients were diagnosed as having PNES. One hundred and eighty-eight patients had video-EEG recordings available and included in the study. One hundred and twenty-nine (69%) were female and 59 (31%) were male. There were no significant differences between women and men with PNES with regard to demographic, clinical and semiological characteristics. CONCLUSION We did not observe any significant demographic differences between women and men with PNES. Likewise, seizure characteristics and semiology were very similar in both genders. It appears that an Islamic lifestyle (in Iran) has little influence on the sex ratio and clinical manifestations of PNES compared with the Western studies.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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162
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Sarkar P, Ibitoye RT, Sturman S, Sarkar PK. First seizure in the adult: management in the emergency department. Br J Hosp Med (Lond) 2013; 74:18-23. [PMID: 23593669 DOI: 10.12968/hmed.2013.74.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela Sarkar
- Department of Infectious Diseases/Genito-Urinary Medicine, St George's Hospital NHS Trust, London SW17 0QT.
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163
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Asadi-Pooya AA, Emami M. Juvenile and adult-onset psychogenic non-epileptic seizures. Clin Neurol Neurosurg 2013; 115:1697-700. [PMID: 23602431 DOI: 10.1016/j.clineuro.2013.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/25/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Psychogenic non-epileptic seizures (PNES) tend to begin in adolescence and young adulthood, although the seizures can occur in a wide range of ages. In the current study, we investigated the age of onset in patients with PNES and tried to determine the correlation between the age of onset and the demographic and clinical characteristics and factors potentially predisposing to PNES. METHODS In this cross-sectional study, all patients with a clinical diagnosis of PNES were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2012. We dichotomized the patients into two groups; those with age of onset below 18 years (juvenile), and those with age of onset at 18-55 years (adult-onset). We studied the demographic and clinical characteristics and factors potentially predisposing to PNES between these two groups. Statistical analyses were performed using Chi square and Fisher's Exact tests and Mann-Whitney U test. RESULTS Fifty-seven patients with juvenile and 129 people with adult-onset PNES were studied. Demographic characteristics of these two groups were not different significantly. Seizure characteristics and semiology in these two groups were not significantly different either. However, factors potentially predisposing to PNES were significantly different between these two groups. History of being abused, academic failure, epilepsy or family history of epilepsy were more frequently observed in juvenile PNES, while medical comorbidities were more frequent among patients with adult-onset PNES. CONCLUSION Age of onset of PNES is not correlated with the clinical manifestations; however, factors potentially predisposing to PNES are significantly different in patients with juvenile compared to those with adult-onset PNES.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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164
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Asadi-Pooya AA, Emami M. Demographic and clinical manifestations of psychogenic non-epileptic seizures: the impact of co-existing epilepsy in patients or their family members. Epilepsy Behav 2013; 27:1-3. [PMID: 23352998 DOI: 10.1016/j.yebeh.2012.12.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the current study was to clarify the impact of co-existing epileptic seizures (either in patients themselves or in their family members) on the demographic and clinical characteristics and manifestations of psychogenic non-epileptic seizures (PNES). METHODS In this prospective study, all patients with a definite diagnosis of PNES were recruited at the epilepsy center at Shiraz University of Medical Sciences from September 2008 through May 2012. We subdivided the patients into three groups: those with PNES but without either epilepsy or a family history of epilepsy (group 1); those with PNES and concomitant epilepsy but without a family history of epilepsy (group 2); and those with PNES and a family history of epilepsy but without concomitant epilepsy (group 3). We studied the demographic and clinical findings and associated risk factors among these three groups. RESULTS One hundred and eighty-eight patients had confirmed diagnosis of PNES at our center, of whom 32 patients (17%) had confirmed epilepsy. In total, 176 patients met our inclusion criteria and were studied: 103 patients in group 1, 19 patients in group 2, and 54 patients in group 3. Demographic characteristics, seizure characteristics, and semiology in these three groups of patients with PNES were similar. They reported similar associated factors for PNES. CONCLUSION Epilepsy is relatively common among patients with PNES. The demographic and clinical characteristics of patients with PNES are similar in those with or without co-existing epilepsy (in themselves or among their family members).
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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165
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Yılmaz Ü, Serdaroğlu A, Gürkaş E, Hirfanoğlu T, Cansu A. Childhood paroxysmal nonepileptic events. Epilepsy Behav 2013; 27:124-9. [PMID: 23416282 DOI: 10.1016/j.yebeh.2012.12.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
We aimed to determine the types and clinical characteristics of paroxysmal nonepileptic events (PNEs) in children. During a 13-year period, 765 patients underwent long-term video-EEG monitoring, and 95 (12.4%) of them were identified to have PNEs. The most common diagnoses were conversion disorder, parasomnias, staring spells, movement disorders, and hypnic jerks. Paroxysmal nonepileptic events originated from physiologic or organic (43.2%) and psychogenic (56.8%) causes. Mean delay in diagnosis was 3.1 years. Mean ages at diagnosis were 8.8 and 13.8 years in physiologic or organic and psychogenic groups, respectively. A marked female predominance was seen in the psychogenic group, whereas males slightly predominated in the physiologic or organic group. In the physiologic or organic group, events were less frequent, longer in duration, and commonly manifested as subtle motor activity, whereas subtle and prominent motor activities were encountered equally in both groups. Concomitant epilepsy was present in 10.5% of the patients. Differences in clinical characteristics may be helpful in differentiating physiologic or organic PNEs in children from psychogenic PNEs.
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166
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Bodde NMG, van der Kruijs SJM, Ijff DM, Lazeron RHC, Vonck KEJ, Boon PAJM, Aldenkamp AP. Subgroup classification in patients with psychogenic non-epileptic seizures. Epilepsy Behav 2013. [PMID: 23200772 DOI: 10.1016/j.yebeh.2012.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In this open non-controlled clinical cohort study, the applicability of a theoretical model for the diagnosis of psychogenic non-epileptic seizures (PNES) was studied in order to define a general psychological profile and to specify possible subgroups. METHODS Forty PNES patients were assessed with a PNES "test battery" consisting of eleven psychological instruments, e.g., a trauma checklist, the global cognitive level, mental flexibility, speed of information processing, personality factors, dissociation, daily hassles and stress and coping factors. RESULTS The total PNES group was characterized by multiple trauma, personality vulnerability (in a lesser extent, neuropsychological vulnerabilities), no increased dissociation, many complaints about daily hassles that may trigger seizures and negative coping strategies that may contribute to prolongation of the seizures. Using factor analysis, specific subgroups were revealed: a 'psychotrauma subgroup', a 'high vulnerability somatizing subgroup' (with high and low cognitive levels) and a 'high vulnerability sensitive personality problem subgroup'. CONCLUSION Using a theoretical model in PNES diagnosis, PNES seem to be a symptom of distinct underlying etiological factors with different accents in the model. Hence, describing a general profile seems to conceal specific subgroups with subsequent treatment implications. This study identified three factors, representing two dimensions of the model, that are essential for subgroup classification: psychological etiology (psychotrauma or not), vulnerability, e.g., the somatization tendency, and sensitive personality problems/characteristics ('novelty seeking'). For treatment, this means that interventions could be tailored to the main underlying etiological problem. Also, further research could focus on differentiating subgroups with subsequent treatment indications and possible different prognoses.
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Affiliation(s)
- N M G Bodde
- Department of Behavioral Research and Psychological Services, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
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167
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Mula M. Are psychogenic non-epileptic seizures and psychogenic movement disorders two different entities? When even neurologists stop talking to each other. Epilepsy Behav 2013. [PMID: 23182885 DOI: 10.1016/j.yebeh.2012.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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168
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Alessi R, Valente KD. Psychogenic non-epileptic seizures at a tertiary care center in Brazil. Epilepsy Behav 2013; 26:91-5. [PMID: 23247270 DOI: 10.1016/j.yebeh.2012.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/06/2012] [Accepted: 10/20/2012] [Indexed: 11/16/2022]
Abstract
Although psychogenic non-epileptic seizures (PNES) are a worldwide phenomenon, most of our knowledge addressing clinical characteristics is based on studies conducted in the USA, Europe, and Australia. There are scarce data about PNES in South American countries. This study provided a detailed analysis of the demographic, clinical, and psychosocial characteristics of 102 Brazilian patients with PNES. Seventy-eight patients (76.4%) were female with mean age of 35.27 years. Mean age at onset was 27.85 years; mean time to diagnosis was 7.89 years; 87.25% lived with their families; 56.89% were single; and only 33 (39.75%) worked on a regular basis. Depression was diagnosed in 48.03%. Thirty-three patients misdiagnosed as having epilepsy were using antiepileptic drugs. Stress factors were identified in 57.84%. This is the first Brazilian study that involves a large sample of patients with video-EEG-documented PNES and corroborates the idea that PNES are a worldwide phenomenon sharing several similarities, despite cultural and socioeconomic differences.
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Affiliation(s)
- Rudá Alessi
- Laboratory of Clinical Neurophysiology, Institute of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
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169
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Diagnosis, Costs, and Utilization for Psychogenic Non-Epileptic Seizures in a US Health Care Setting. PSYCHOSOMATICS 2013. [DOI: 10.1016/j.psym.2012.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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170
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Purdom CL, Kirlin KA, Hoerth MT, Noe KH, Drazkowski JF, Sirven JI, Locke DEC. The influence of impression management scales on the Personality Assessment Inventory in the epilepsy monitoring unit. Epilepsy Behav 2012; 25:534-8. [PMID: 23159377 DOI: 10.1016/j.yebeh.2012.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/11/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
The Somatic Complaints scale (SOM) and Conversion subscale (SOM-C) of the Personality Assessment Inventory perform best in classifying psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES); however, the impact of positive impression management (PIM) and negative impression management (NIM) scales on SOM and SOM-C classification has not been examined. We studied 187 patients from an epilepsy monitoring unit with confirmed PNES or ES. On SOM, the best cut score was 72.5 T when PIM was elevated and 69.5 T when there was no bias. On SOM-C, when PIM was elevated, the best cut score was 67.5 T and 76.5 T when there was no bias. Negative impression management elevations (n=9) were too infrequent to analyze separately. Despite similarities in classification accuracy, there were differences in sensitivity and specificity with and without PIM, impacting positive and negative predictive values. The presence of PIM bias generally increases positive predictive power of SOM and SOM-C but decreases negative predictive power.
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171
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Sahaya K, Dholakia SA, Lardizabal D, Sahota PK. Opinion survey of health care providers towards psychogenic non epileptic seizures. Clin Neurol Neurosurg 2012; 114:1304-7. [DOI: 10.1016/j.clineuro.2012.03.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 12/18/2011] [Accepted: 03/24/2012] [Indexed: 11/24/2022]
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172
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Raghavendra S, Nooraine J, Mirsattari SM. Role of electroencephalography in presurgical evaluation of temporal lobe epilepsy. EPILEPSY RESEARCH AND TREATMENT 2012; 2012:204693. [PMID: 23198144 PMCID: PMC3503287 DOI: 10.1155/2012/204693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/18/2012] [Accepted: 06/28/2012] [Indexed: 11/17/2022]
Abstract
Surgery remains a therapeutic option for patients with medically refractory epilepsy. Comprehensive presurgical evaluation includes electroencephalography (EEG) and video EEG in identifying patients who are likely to benefit from surgery. Here, we discuss in detail the utility of EEG in presurgical evaluation of patients with temporal lobe epilepsy along with illustrative cases.
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Affiliation(s)
| | - Javeria Nooraine
- Department of Neurology, Vikram Hospital, Bangalore 560052, India
| | - Seyed M. Mirsattari
- Departments of Clinical Neurological Sciences, Medical Imaging, Medical Biophysics, and Psychology, University of Western Ontario, London, ON, Canada N6A 5A5
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173
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Atkinson M, Shah A, Hari K, Schaefer K, Bhattacharya P, Shah A. Safety considerations in the epilepsy monitoring unit for psychogenic nonepileptic seizures. Epilepsy Behav 2012; 25:176-80. [PMID: 23032127 DOI: 10.1016/j.yebeh.2012.07.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/20/2012] [Accepted: 07/29/2012] [Indexed: 10/27/2022]
Abstract
Injury occurs in epilepsy monitoring units (EMUs) to patients with epileptic seizures (ES); however, there are limited data regarding the safety concerns of patients with psychogenic nonepileptic seizures (PNES) being monitored in EMUs. We reviewed EMU records from 116 PNES and compared them to 170 ES. Three falls (2.6%) occurred in PNES without injury compared to 6 falls (3.5%) in ES with 1 injury, a facial hematoma. Of the 9 total falls, 8 patients were ambulatory during their events. Several adverse incidents occurred for both groups. Of the PNES without staff response, 30 of 39 were due to PNES being less than 60s in duration, and 16 of 39 involved lack of push-button activation to alert the staff. For the ES group, 57 of 101 were due to electrographic seizures without seizure detection software or push-button activation. Similar safety protocols should be administered while monitoring these patients regardless of seizure type.
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Affiliation(s)
- Marie Atkinson
- Department of Neurology, Wayne State University School of Medicine, 4201 St. Antoine, 8A UHC, Detroit, MI 48201, USA.
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174
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Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events. Epilepsy Behav 2012; 24:439-44. [PMID: 22683287 DOI: 10.1016/j.yebeh.2012.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/04/2012] [Accepted: 05/05/2012] [Indexed: 11/23/2022]
Abstract
The Structured Interview of Malingered Symptomatology (SIMS) is a self-report instrument that asks patients whether they experience atypical or implausible symptoms. The instrument has not been evaluated in an epilepsy population, and the potential for it to accurately distinguish between patients with psychogenic non-epileptic events (PNEE) and epileptic event groups has not been established. The SIMS was administered to patients in long-term video-EEG monitoring of these patients, 91 with PNEE and 29 with epilepsy were included in this study. Structured Interview of Malingered Symptomatology total scores as well as neurological and affective subscales were found to be predictors of group membership. Sensitivity and specificity across several different base rates of PNEE as well as maximum level likelihood ratios are presented. The findings not only demonstrate the utility of marked score elevations in differentiating PNEE from epilepsy but also point to considerable caution in interpreting mild elevations. Implications for the utility of this instrument in epilepsy evaluations are discussed.
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175
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Nguyen ML, Shapiro MA, Demetree JM, White KA. When non-epileptic seizures fool the experts. Int J Psychiatry Med 2012; 42:331-8. [PMID: 22439300 DOI: 10.2190/pm.42.3.g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Even when non-epileptic seizures are correctly diagnosed, appropriate treatment recommendations may not be fully or correctly implemented. We present a case of a 17-year-old girl with frequent non-epileptic seizures who presented for frequent trips to the emergency room (ER) and was admitted to an inpatient Child and Adolescent Psychiatric Facility. Despite being informed that episodes were non-epileptic seizures, various staff and healthcare providers at the psychiatric hospital continued to send the patient to the ER to treat suspected epileptic seizures. We discuss possible reasons why this may have occurred, including psychosocial and emotional reactions of staff members to the episodes. This discussion may also help to explain the persistence of the patient's episodes. We also present options for minimizing the potential for future mismanagement of non-epileptic seizures.
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176
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Testa SM, Krauss GL, Lesser RP, Brandt J. Stressful life event appraisal and coping in patients with psychogenic seizures and those with epilepsy. Seizure 2012; 21:282-7. [DOI: 10.1016/j.seizure.2012.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 02/09/2012] [Accepted: 02/11/2012] [Indexed: 10/28/2022] Open
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177
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Szabó L, Siegler Z, Zubek L, Liptai Z, Körhegyi I, Bánsági B, Fogarasi A. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia 2012; 53:565-70. [PMID: 22332748 DOI: 10.1111/j.1528-1167.2012.03404.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Psychogenic nonepileptic seizure (PNES) is an important differential diagnostic problem in patients with or without epilepsy. There are many studies that have analyzed PNES in adults; currently, however, there is no systematic assessment of purely childhood PNES semiology. Our study based on a large pediatric video-electroencephalography (EEG) monitoring (VEM) cohort, provides a detailed analysis of childhood PNES and assesses the usability of the current classification system described in adults. METHODS Medical and video-EEG records of 568 consecutive children (younger than 18 years) who underwent video-EEG monitoring (VEM) at our hospital were reviewed. Aura, type of movement, anatomic distribution, synchrony, symmetry, eye movement, responsiveness, vocalization, hyperventilation, vegetative and emotional signs, presence of eyewitness, and duration of the event were recorded among children with the diagnosis of PNES. We also compared our data with those of earlier adult studies. KEY FINDINGS Seventy-five archived PNES of 27 children (21 girls; age 8-18 years) were reanalyzed. Nine children (33%) had the diagnosis of epilepsy currently or in the past. Mean age at the time of PNES onset was 11.6 (standard deviation 3.2) years. Mean duration of PNES was longer (269 s) compared to seizures of the epileptic group (83 s; p = 0.002). Eyewitnesses (mostly parents) were present in 89% of cases. Eighty percent of PNES had an abrupt start, with 68% also ending abruptly. In only 15% of events were the patients eyes closed at the beginning of the attack. Patients were unresponsive in 34%. The most frequent motor sign was tremor (25%) with the upper, rather than lower limbs more frequently involved. Pelvic thrusting was seen in only two attacks. Emotional-mostly negative-signs were observed during 32 PNES (43%). Based on Seneviratne et al.'s classification, 18 events (24%) were classified as rhythmic motor PNES, only half the frequency of that previously described in adults. No hypermotor PNES was found. The frequency of complex motor PNES (13%) and mixed PNES (4%) showed similar frequency in children as in adults. Dialeptic PNES was found more frequently among younger children. All PNES belonged to the same semiologic type in 23 patients (85%). SIGNIFICANCE Because homogeneity of PNES within a patient was high in the pediatric population, we found it useful to classify PNES into different semiologic categories. Dialeptic PNES seems to be more frequent among younger children. Tremor is the most frequent motor sign and usually accompanied by preserved responsiveness in childhood. Negative emotion is commonly seen in pediatric PNES, but pelvic thrusting is a rare phenomenon. We, therefore, suggest a modification of the present classification system in which PNES with motor activity is divided into minor and major motor PNES, and the latter group is subdivided into synchron rhythmic motor and asynchron motor PNES. We believe that our study, a detailed analysis on the semiology and classification of purely childhood PNES might assist the early and precise diagnosis of nonepileptic paroxysmal events.
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Affiliation(s)
- Léna Szabó
- Department of Neurology, Bethesda Children's Hospital, Budapest, Hungary.
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178
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Using personality disorders to distinguish between patients with psychogenic nonepileptic seizures and those with epileptic seizures. Epilepsy Behav 2012; 23:138-41. [PMID: 22236571 DOI: 10.1016/j.yebeh.2011.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/26/2011] [Accepted: 11/03/2011] [Indexed: 11/23/2022]
Abstract
Identifying psychiatric disorders rather than psychiatric symptoms might help to distinguish patients with psychogenic nonepileptic seizures (PNES) from those with epileptic seizures (ES). Patients with PNES (n=35), patients with ES (n=35), and healthy controls (n=37) were compared with respect to the prevalence of psychiatric disorders in this study. We tested the predictive power of having axis I psychiatric disorders, as well as personality disorders, in distinguishing ES from PNES. There was no significant difference between the patient groups in the prevalence of axis I psychiatric disorders. Personality disorders were more prevalent in the PNES group than in the ES group (P<0.05). Having a personality disorder was the only predictor for the PNES group. Having a personality disorder seems to be a more significant predictor for PNES than having an axis I psychiatric disorder. Greater attention should be paid to personality disorders in the differentiation of PNES and ES and the provision of effective treatment.
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179
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Abstract
The differential diagnoses of epileptic seizures depend on the different semiologies of the respective seizures. Patient history and history of witnesses are of foremost importance in the differentiation. When seizures recur, they are more easily distinguished than single seizures. Diagnostic methods like EEG and eventually EEG video monitoring will help in the differentiation when clinical information and patient history do not allow a clear diagnosis. We present the most common differential diagnoses and their differences compared to epileptic seizures.
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Affiliation(s)
- J Rémi
- Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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180
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Widdess-Walsh P, Mostacci B, Tinuper P, Devinsky O. Psychogenic nonepileptic seizures. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:277-295. [PMID: 22938977 DOI: 10.1016/b978-0-444-52898-8.00017-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Treatment for PNES must be individualized. A combination of approaches is probably the most beneficial for improvement. Treatment should not simply emphasize removing maladaptive PNES behaviour, but should also focus on learning new coping skills and removing secondary gains. If PNES persist, therapy should be re-evaluated.
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181
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Epilepsy, mental health disorder, or both? EPILEPSY RESEARCH AND TREATMENT 2011; 2012:163731. [PMID: 22934158 PMCID: PMC3420407 DOI: 10.1155/2012/163731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/02/2011] [Indexed: 01/28/2023]
Abstract
Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.
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182
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Abstract
Multiple triggers have been shown to provoke seizures in reflex epilepsy. Among these are external stimuli (flickering light, hot water), actions (chewing, reading), and even mental tasks. We present a 9-year-old girl whose seizures were provoked mainly by emotional stress. In most cases of emotional stress-related seizures, especially when a specific confrontational incidence preceded the seizure, the suspicion for a nonepileptic event is high. In our patient we were able to show that the seizures were epileptic. Further investigation to clarify the pathophysiology of stress-related seizures is needed.
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Affiliation(s)
- Tal Gilboa
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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183
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Krishnan B, Faith A, Vlachos I, Roth A, Williams K, Noe K, Drazkowski J, Tapsell L, Sirven J, Iasemidis L. Resetting of brain dynamics: epileptic versus psychogenic nonepileptic seizures. Epilepsy Behav 2011; 22 Suppl 1:S74-81. [PMID: 22078523 PMCID: PMC3237405 DOI: 10.1016/j.yebeh.2011.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 08/27/2011] [Indexed: 10/15/2022]
Abstract
We investigated the possibility of differential diagnosis of patients with epileptic seizures (ES) and patients with psychogenic nonepileptic seizures (PNES) through an advanced analysis of the dynamics of the patients' scalp EEGs. The underlying principle was the presence of resetting of brain's preictal spatiotemporal entrainment following onset of ES and the absence of resetting following PNES. Long-term (days) scalp EEGs recorded from five patients with ES and six patients with PNES were analyzed. It was found that: (1) Preictal entrainment of brain sites was reset at ES (P<0.05) in four of the five patients with ES, and not reset (P=0.28) in the fifth patient. (2) Resetting did not occur (p>0.1) in any of the six patients with PNES. These preliminary results in patients with ES are in agreement with our previous findings from intracranial EEG recordings on resetting of brain dynamics by ES and are expected to constitute the basis for the development of a reliable and supporting tool in the differential diagnosis between ES and PNES. Finally, we believe that these results shed light on the electrophysiology of PNES by showing that occurrence of PNES does not assist patients in overcoming a pathological entrainment of brain dynamics. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction.
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Affiliation(s)
- Balu Krishnan
- Department of Electrical Engineering, Ira Fulton Schools of Engineering, Arizona State University, Tempe, AZ, USA
| | - Aaron Faith
- Harrington Department of Biomedical Engineering, School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Ioannis Vlachos
- Harrington Department of Biomedical Engineering, School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Austin Roth
- Harrington Department of Biomedical Engineering, School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Korwyn Williams
- Phoenix Children's Hospital, Pediatric Neurology/Epilepsy, Phoenix, AZ, USA
| | - Katie Noe
- Mayo Clinic, Neurology/Epilepsy, Scottsdale, AZ, USA
| | | | - Lisa Tapsell
- Mayo Clinic, Neurology/Epilepsy, Scottsdale, AZ, USA
| | - Joseph Sirven
- Mayo Clinic, Neurology/Epilepsy, Scottsdale, AZ, USA
| | - Leon Iasemidis
- Department of Electrical Engineering, Ira Fulton Schools of Engineering, Arizona State University, Tempe, AZ, USA,Harrington Department of Biomedical Engineering, School of Biological & Health Systems Engineering, Arizona State University, Tempe, AZ, USA,Mayo Clinic, Neurology/Epilepsy, Scottsdale, AZ, USA
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184
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Nežádal T, Hovorka J, Herman E, Němcová I, Bajaček M, Stichová E. Psychogenic non-epileptic seizures: our video-EEG experience. Neurol Res 2011; 33:694-700. [PMID: 21756548 DOI: 10.1179/1743132811y.0000000003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of our study was to assess the number of psychogenic non-epileptic seizures (PNES) in our patients with a refractory seizure disorder, to determine the 'typical' PNES semiology using video-EEG monitoring and describe other PNES parameters. METHODS We evaluated prospectively 596 patients with pharmacoresistant seizures. All these patients underwent continuous video-EEG monitoring. In consenting patients, we used suggestive seizure provocation. We assessed seizure semiology, interictal EEG, brain MRI, psychiatric co-morbidities, personality profiles, and seizure outcome. RESULTS In the sample of 596 monitored patients, we detected 111 (19.3%) patients with PNES. Of the 111 patients with PNES, 86.5% had spontaneous and 76.5% had provoked seizures. The five most typical symptoms were: initially closed eyelids (67.6%), rapid tremor (47.7%), asynchronous limb movement (37.8%), preictal pseudosleep (33.3%), and side-to-side head movement (32.4%). Interictal EEG was rated as abnormal in 46.2% and with epileptiform abnormality in 9%. Brain MRI was abnormal in 32 (28.8%) patients. Personality disorders (46.8%), anxiety (39.6%), and depression (12.6%) were the most frequent additional psychiatric co-morbidities. PNES outcome after at least 2 years is reported; 22.5% patients was seizure-free; one-third had markedly reduced seizure frequency. We have not seen any negative impact of the provocative testing on the seizure outcome. DISCUSSION Video-EEG monitoring with suggestive seizure provocation supported by clinical psychiatric and psychological evaluation significantly contributes to the correct PNES diagnosis, while interictal EEG and brain MRI are frequently abnormal. Symptoms typical for PNES, as opposed to epileptic seizures, could be distinguished.
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Affiliation(s)
- Tomáš Nežádal
- Department of Neurology, Epileptology and Neuropsychiatry, Na Františku Hospital, Prague, Czech Republic
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185
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Patients with psychogenic non-epileptic seizures referred to a tertiary epilepsy centre: patient characteristics in relation to diagnostic delay. Clin Neurol Neurosurg 2011; 114:217-22. [PMID: 22071205 DOI: 10.1016/j.clineuro.2011.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 10/11/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This clinical study examines patient and seizure characteristics of patients with psychogenic non-epileptic seizures (PNES) in a tertiary epilepsy centre. The main focus was whether a new subgroup of PNES patients emerged with a relatively short referral time and possible specific characteristics. METHODS All PNES patients referred to a specialist program in our centre between mid 2007 and mid 2009 were consecutively included. This yielded a study cohort of 90 patients. RESULTS The majority of the patients have a patient history with many medical symptoms and they were or had been in treatment by a medical specialist. Furthermore diffuse psychological/psychiatric symptoms and subsequent treatments are also remarkably common, in general without a clear psychological diagnosis. The average time between seizure onset and referral to an epilepsy centre is remarkably low (4.29 years). About 50% of the patients were referred within 2 years of seizure onset. This 'active high speed referral group' had significantly more previous psychological complaints, significantly more previous psychological/psychiatric treatments and a trend towards more previous medical investigations. CONCLUSION There seems to be a new subgroup of PNES patients with a short referral time, characterized by a more active attitude towards examination of the symptoms in combination with an active attitude to apply for treatment. However, the PNES cohort as a whole is characterized by having somatoform symptoms based on a process of somatization.
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186
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Patients with epilepsy and patients with psychogenic non-epileptic seizures: Video-EEG, clinical and neuropsychological evaluation. Seizure 2011; 20:706-10. [DOI: 10.1016/j.seizure.2011.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/30/2011] [Accepted: 07/02/2011] [Indexed: 11/22/2022] Open
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187
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Hingray C, Maillard L, Hubsch C, Vignal JP, Bourgognon F, Laprevote V, Lerond J, Vespignani H, Schwan R. Psychogenic nonepileptic seizures: characterization of two distinct patient profiles on the basis of trauma history. Epilepsy Behav 2011; 22:532-6. [PMID: 21962755 DOI: 10.1016/j.yebeh.2011.08.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/10/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. The "trauma" group comprised 19 patients (76%) and the "no-trauma" group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P<0.001) and a higher median score of dissociation (P<0.001). Patients without trauma had more frequent "frustration situations" as a factor triggering PNES and subsequent sick leaves as perpetuating factors (P=0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.
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Affiliation(s)
- C Hingray
- CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), University Hospital of Nancy, Nancy, France.
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188
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[Assessment and treatment of patients with nonepileptic dissociative seizures in a department of epileptology]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2011; 57:288-94. [PMID: 21971696 DOI: 10.13109/zptm.2011.57.3.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We examined the frequency of dissociative seizures in inpatients of a specialized ward for epilepsy as well as their diagnostic and therapeutic course. The basic principle of the latter is the therapeutic triad of value-free communication of the diagnosis, training of techniques for seizure interruption and problem solving of inner conflicts. METHODS All inpatients in a department of epileptology with a diagnosis of dissociative seizures were examined retrospectively for the year 2009. RESULTS 65 patients (11 %) were diagnosed with dissociative seizures, 23 patients with a primary diagnosis of epilepsy and 42 with a secondary diagnosis, epilepsy being the primary diagnosis. Symptoms occurred in the 23 patients with dissociative seizures as primary diagnosis between 2 weeks and 40 years. Possible predisposing factors and psychological comorbidities for the development of dissociative seizures were manifold. A psychopharmacological medication was established in 9 patients (39 %), and psychotherapy was recommended explicitly in all patients. CONCLUSIONS There is a great heterogeneity in patients with dissociative seizures with a sometimes long course of the disorder.
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189
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Magaudda A, Gugliotta SC, Tallarico R, Buccheri T, Alfa R, Laganà A. Identification of three distinct groups of patients with both epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 2011; 22:318-23. [PMID: 21840769 DOI: 10.1016/j.yebeh.2011.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 06/27/2011] [Accepted: 07/05/2011] [Indexed: 10/15/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) can be observed in patients with or without epilepsy (mixed and pure PNES). Patients with mixed PNES are usually considered to be a homogeneous group characterized by the coexistent epilepsy. Our study found that patients with mixed PNES were not homogeneous, but could be divided into three groups based on epilepsy type, mental level, comorbid psychiatric disorders, and history of traumatic experiences. Group 1 patients have pharmacoresistant epilepsy, normal cognition, and comorbid anxiety and/or depressive disorders. Here, PNES etiology is the epilepsy-related problems. In group 2 patients, the epilepsy is associated with mental retardation and dependent personality traits. PNES etiology is represented by the reduction or cessation of seizures. The PNES allow patients to continue receiving attention from caregivers. Group 3 patients have epilepsy, normal cognition, comorbid cluster B personality disorders and anxiety disorders, and psychic trauma. Here, PNES etiology is not related to the epilepsy, but to the psychic trauma.
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Affiliation(s)
- A Magaudda
- Epilepsy Center, Neuroscience Department, University of Messina, Messina, Italy.
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190
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Bodde NMG, Bartelet DCJ, Ploegmakers M, Lazeron RHC, Aldenkamp AP, Boon PAJM. MMPI-II personality profiles of patients with psychogenic nonepileptic seizures. Epilepsy Behav 2011; 20:674-80. [PMID: 21450531 DOI: 10.1016/j.yebeh.2011.01.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/20/2011] [Accepted: 01/30/2011] [Indexed: 11/28/2022]
Abstract
This comparative study explored whether psychogenic nonepileptic seizures (PNES) are a unique disorder with distinctive personality characteristics or (seen from the personality profile) PNES are allied with the domain of a general functional somatic symptom and syndrome (FSSS). We compared the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) results for 41 patients with newly diagnosed PNES and 43 patients with newly diagnosed insomnia. There were no statistically significant quantitative scoring differences on the main clinical scales, indicating that there is no substantial difference in "personality makeup" between the two groups with a FSSS. Additional subscale analysis indicated that patients with PNES reported significantly more somatic complaints (Hysteria 4) and bizarre sensory experiences (Schizophrenia 6). Further profile analysis revealed that the personality pattern of patients with PNES was characterized by a strong tendency toward "conversion V, a lack of control pattern and less excessive worries" as compared with patients with insomnia. Patients with PNES are characterized by a stronger tendency toward somatization and externalization, which has treatment implications.
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191
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Morrison I, Razvi SS. Driving regulations and psychogenic non-epileptic seizures: Perspectives from the United Kingdom. Seizure 2011; 20:177-80. [DOI: 10.1016/j.seizure.2010.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 09/21/2010] [Accepted: 11/01/2010] [Indexed: 11/28/2022] Open
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192
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Durrant J, Rickards H, Cavanna AE. Prognosis and outcome predictors in psychogenic nonepileptic seizures. EPILEPSY RESEARCH AND TREATMENT 2011; 2011:274736. [PMID: 22937230 PMCID: PMC3428611 DOI: 10.1155/2011/274736] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/11/2011] [Indexed: 11/23/2022]
Abstract
It is estimated that one in five patients referred to specialist epilepsy clinics for refractory seizures have psychogenic nonepileptic seizures (PNES). Despite the high prevalence, little is known about the prognosis of patients with PNES. In this paper we set out to systematically assess published original studies on the prognosis and outcome predictors of patients with PNES. Our literature search across the databases Medline, PsycINFO, and EMBASE generated 18 original studies meeting the search criteria. Prognosis was found to be poor in adults, but good in children. Predictors of poor outcome included the presence of coexisting epilepsy or psychiatric comorbidities, violent seizure phenomenology, dependent lifestyle, and poor relationships. Overall, too much reliance is placed on seizure remission as an outcome measurement for patients with PNES, and the impact of many of the outcome predictors requires evaluation using larger studies with longer followup.
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Affiliation(s)
- Joseph Durrant
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Barberry Building, 25 Vincent Drive, Birmingham B152FG, UK
| | - Hugh Rickards
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Barberry Building, 25 Vincent Drive, Birmingham B152FG, UK
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Barberry Building, 25 Vincent Drive, Birmingham B152FG, UK
- Department of Neuropsychiatry, UCL Institute of Neurology, London WC1N 3BG, UK
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193
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Siket MS, Merchant RC. Psychogenic seizures: A review and description of pitfalls in their acute diagnosis and management in the emergency department. Emerg Med Clin North Am 2010; 29:73-81. [PMID: 21109104 DOI: 10.1016/j.emc.2010.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients with psychogenic (nonepileptic) seizures (PS) are frequently encountered by clinicians in the emergency medicine setting. Despite the tendency for these patients to seek frequent medical attention, the time between onset of symptoms and diagnosis is often more than 7 years. The cause of PS is multifactorial, but most patients are thought to have an underlying dissociative condition. The diagnostic evaluation in the emergency department is challenging and relies heavily on clinical suspicion, based on historical and physical features. Laboratory testing and therapeutic maneuvers are of limited utility; prolonged video electroencephalography is the diagnostic gold standard. Once the diagnosis has been secured, the mainstay of treatment involves addressing the underlying psychological distress.
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Affiliation(s)
- Matthew S Siket
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI 02903, USA
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194
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Schachter SC. What needs to change: Goals for clinical and social management and research in the next 60 years. Seizure 2010; 19:686-9. [DOI: 10.1016/j.seizure.2010.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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195
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Baslet G. Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. Seizure 2010; 20:1-13. [PMID: 21106406 DOI: 10.1016/j.seizure.2010.10.032] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/22/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) consist of paroxystic events facilitated by a dysfunction in emotion processing. Models explaining the pathogenic mechanisms leading to these seizure-like episodes are limited. In this article, evidence that supports dysfunction at the level of arousal tolerance, cognitive-emotional information processing and volitional control is reviewed. A hypothetical pathophysiological mechanism is discussed based on functional neuroimaging evidence from PNES-related conditions and traits. This pathophysiological model suggests an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes. Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system. During the episodes, sensorimotor and cognitive processes are modified or not properly integrated, allowing the deployment of autonomous prewired behavioral tendencies. Finally, I elaborate on how therapeutic applications could be modified based on the proposed hypothetical model, potentially improving clinical outcomes.
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Affiliation(s)
- Gaston Baslet
- Department of Psychiatry, University of Illinois at Chicago, 912 South Wood Street, M/C 913, Chicago, IL 60612, USA.
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196
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Schramke CJ, Kay KA, Valeriano JP, Kelly KM. Using patient history to distinguish between patients with non-epileptic and patients with epileptic events. Epilepsy Behav 2010; 19:478-82. [PMID: 20850387 DOI: 10.1016/j.yebeh.2010.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/02/2010] [Accepted: 08/03/2010] [Indexed: 11/18/2022]
Abstract
Information obtained during psychological evaluations of 93 patients with epileptic events (EEs) and 63 with nonepileptic events (NEEs) was used to test the relative contributions of multiple risk factors to prediction of NEEs during video/EEG monitoring. The best group of independent predictors of NEEs comprised: (1) age at first spell, (2) symptoms of a psychiatric diagnosis other than anxiety or depression, (3) marital instability, (4) symptoms of an anxiety disorder other than panic disorder, and (5) years of education. Report of childhood abuse or neglect and taking psychotropic medication correlated with most of the other risk factors for NEEs. It may not be necessary to gather data on all of the variables shown to be associated with NEEs. Although there is a high prevalence of risk factors for psychopathology in patients with EEs, it is lower compared with that of patients with NEEs, and patients with EEs are less likely to report multiple risk factors.
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Affiliation(s)
- Carol J Schramke
- Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, USA.
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197
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Testa SM, Brandt J. Do patients with psychogenic nonepileptic seizures have positive covert attitudes toward sickness? Epilepsy Behav 2010; 19:323-7. [PMID: 20934917 DOI: 10.1016/j.yebeh.2010.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 07/08/2010] [Accepted: 07/18/2010] [Indexed: 11/27/2022]
Abstract
Some individuals with psychogenic nonepileptic seizures (PNES) are seen as having adopted a "sick role" that relinquishes them of responsibility for meeting stressful life demands. Thus, patients with PNES may have positive, albeit unrecognized, attitudes toward seizures, or perhaps illness in general. Because such covert attitudes may not be amendable to self-report, the current study used the Implicit Association Test (IAT), a methodology by which attitudes toward illness and disability can be inferred from performance on an ostensibly neutral task. Individuals with PNES did not have a reduced interference effect when responding to sickness-related and pleasant words on the same response key. Exploratory analyses revealed that a pronounced somatic focus and higher extraversion were associated with more neutral attitudes toward illness among patients with PNES. This IAT methodology found little support for the notion that patients with PNES harbor positive attitudes toward illness. Limitations of the IAT methodology are reviewed and recommendations are provided.
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Affiliation(s)
- S Marc Testa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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198
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Perrin MW, Sahoo SK, Goodkin HP. Latency to first psychogenic nonepileptic seizure upon admission to inpatient EEG monitoring: evidence for semiological differences. Epilepsy Behav 2010; 19:32-5. [PMID: 20675198 PMCID: PMC2942987 DOI: 10.1016/j.yebeh.2010.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/04/2010] [Accepted: 06/05/2010] [Indexed: 10/19/2022]
Abstract
Two hundred sixteen consecutive patients diagnosed with psychogenic nonepileptic seizures (PNES) admitted to the epilepsy monitoring unit at our institution over a 4.5-year period were retrospectively identified. PNES were classified into four semiological subcategories: major motor (n=123), minor motor (n=38), akinetic (n=32), and subjective/experiential (n=23). The median latency to first PNES for the entire population was 7 hours (range: <1 to 207 hours), confirming previous observations that the latency to first PNES on admission is often <24 hours. The novel observation is that latency to first PNES was dependent on type. The median latency to first PNES was significantly prolonged in both the minor motor (median=21 hours) and subjective/experiential (median=22 hours) groups as compared with the major motor (median=5 hours) and akinetic (median=4 hours) groups. Thus, patients with one of these two subtypes may require longer admissions to capture the event of interest and confirm the diagnosis.
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Affiliation(s)
- Margaret W. Perrin
- Department of Neurology, University of Virginia Healthsystem, Charlottesville, VA, USA
| | - Sanjiv K Sahoo
- Department of Neurology, University of Virginia Healthsystem, Charlottesville, VA, USA
| | - Howard P. Goodkin
- Department of Neurology, University of Virginia Healthsystem, Charlottesville, VA, USA, Department of Pediatrics, University of Virginia Healthsystem, Charlottesville, VA, USA
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199
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Young JL, Rund D. Psychiatric Considerations in Patients with Decreased Levels of Consciousness. Emerg Med Clin North Am 2010; 28:595-609. [DOI: 10.1016/j.emc.2010.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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