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Libbon R, Rothberg B, Baker S, Heru A. Multifamily Group Psychotherapy for Patients With Nonepileptic Seizures and Their Families. Am J Psychother 2023:appipsychotherapy20210060. [PMID: 36794444 DOI: 10.1176/appi.psychotherapy.20210060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Multifamily group (MFG) psychotherapy is widely used for mental and general medical conditions. MFG therapy engages family members in caring for a loved one experiencing illness and helps clarify the impact of illness on family. Use of MFG therapy for patients with nonepileptic seizures (NES) and their families to explore satisfaction with treatment and family functioning is described. METHODS MFG therapy for patients with NES and their participating family members was incorporated into an existing interdisciplinary group-based psychotherapy treatment program. The Family Assessment Device and a novel feedback questionnaire were used to understand the effect of MFG therapy on this population. RESULTS Patients with NES (N=29) and their corresponding family members (N=29) indicated on the feedback questionnaire their satisfaction with having MFG therapy as part of their treatment; satisfaction was also evidenced by a 79% (N=49 of 62) patient participation rate. Patients and family members reported enhanced understanding of the impact of illness on the family and believed MFG therapy would help them communicate about illness and reduce family conflict. Scores on the Family Assessment Device indicated that family members perceived better family functioning than did patients (average scores of 1.84 and 2.99, respectively). CONCLUSIONS The discrepancy in perceived family functioning supports the idea of integrating family members in treatment for patients experiencing NES. The group treatment modality was satisfactory to participants and may prove useful for other kinds of somatic symptom disorders, which are often external manifestations of internal distress. Family members can become treatment allies in psychotherapy when included in treatment.
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Janocko NJ, Morton ML, Groover O, Teagarden DL, Villarreal HK, Merchant S, Ahuruonye N, Rodriguez-Ruiz AA, Drane DL, Karakis I. Translating Phenomenology of Psychogenic Nonepileptic Seizures Into Nosology: Insights From Patients' and Caregivers' Profiles. Neurologist 2022; 27:100-105. [PMID: 34855664 DOI: 10.1097/nrl.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology. METHODS Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables. RESULTS Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures. CONCLUSIONS Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel L Drane
- Departments of Neurology
- Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Neurology, University of Washington, Seattle, WA
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Goldstein LH, Robinson EJ, Pilecka I, Perdue I, Mosweu I, Read J, Jordan H, Wilkinson M, Rawlings G, Feehan SJ, Callaghan H, Day E, Purnell J, Baldellou Lopez M, Brockington A, Burness C, Poole NA, Eastwood C, Moore M, Mellers JD, Stone J, Carson A, Medford N, Reuber M, McCrone P, Murray J, Richardson MP, Landau S, Chalder T. Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT. Health Technol Assess 2021; 25:1-144. [PMID: 34196269 DOI: 10.3310/hta25430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive-behavioural therapy for adults with dissociative seizures. DESIGN This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. SETTING This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive-behavioural therapy services. PARTICIPANTS Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. INTERVENTIONS Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive-behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. MAIN OUTCOME MEASURES The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. RESULTS In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive-behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1-35 dissociative seizures); cognitive-behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0-20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive-behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7-12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect -0.39, 95% confidence interval -0.61 to -0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive-behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval -0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive-behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. LIMITATIONS Unlike outcome assessors, participants and clinicians were not blinded to the interventions. CONCLUSIONS There was no significant additional benefit of dissociative seizure-specific cognitive-behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive-behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive-behavioural therapy. FUTURE WORK Examination of moderators and mediators of outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Izabela Pilecka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain Perdue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Julie Read
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Harriet Jordan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Wilkinson
- Canterbury Christ Church University, Salamons Institute for Applied Psychology, Tunbridge Wells, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregg Rawlings
- School of Clinical Psychology, University of Sheffield, Sheffield, UK
| | - Sarah J Feehan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Callaghan
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Elana Day
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Purnell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Baldellou Lopez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Brockington
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Norman A Poole
- Department of Neuropsychiatry, St George's Hospital, South West London and St George's NHS Mental Health NHS Trust, London, UK
| | - Carole Eastwood
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michele Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK
| | | | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nick Medford
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- Department of Health Services & Population Research, Institute of Psychiatry,Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lanzillotti AI, Sarudiansky M, Lombardi NR, Korman GP, D Alessio L. Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders. Neuropsychiatr Dis Treat 2021; 17:1825-1838. [PMID: 34113112 PMCID: PMC8187153 DOI: 10.2147/ndt.s286710] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/01/2021] [Indexed: 01/22/2023] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES.
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Affiliation(s)
- Alejandra Inés Lanzillotti
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Mercedes Sarudiansky
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | | | - Guido Pablo Korman
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Luciana D Alessio
- Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Buenos Aires, Argentina.,Buenos Aires University, Medicine School, Cell Biology and Neuroscience Institute (IBCN)- National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Wolf P, Lin K, Mameniškiené R, Walz R. Does Epilepsy Have an Impact on Locus of Control? Front Psychol 2020; 11:2251. [PMID: 33013587 PMCID: PMC7509065 DOI: 10.3389/fpsyg.2020.02251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
Many chronic diseases impair patients' quality of life and may also affect their control perceptions. This could particularly happen for patients with epilepsy whose seizures often imply loss of control as a deeply disturbing experience. In 1980, a study on learned helplessness in epilepsy found a highly significant reduction of internal general locus of control (GLOC) and an increase of chance and powerful others health-related LOC (HLOC). In consequence, LOC became a frequent target of investigations relating to depression and anxiety, quality of life, coping, compliance, and other psychosocial aspects of epilepsy. Both GLOC and HLOC were investigated, and special groups like children, elderly, mentally handicapped persons, and those with psychogenic non-epileptic seizures were addressed. Most studies attempted to relate in-group differences of LOC to other parameters. Seizure-free patients were found to have a more internal HLOC, and patients with severe epilepsies have a more external HLOC. Patients with a high external HLOC seem to have more difficulties with coping and to be more anxious. Whereas external GLOC was correlated with learned helplessness, internal GLOC was associated with high self-efficacy and better life quality. An association of external LOC with depression seemed not to be a stable co-relation as clinical improvement following epilepsy surgery dissociated the two. A hypothesis was confirmed that the ability of some patients to counteract seizures at their onset, thus preserving control, was correlated with a higher internal HLOC. Some other theoretically well-founded hypotheses were not supported. Absolute figures as reported in several papers are of limited use because the only normative data for comparison come from a local sample of 1976 from Tennessee, whereas LOC scores may differ largely dependent on cultural and societal conditions. Very few controlled studies exist, and the early finding of a generally externalized LOC in epilepsy was confirmed only in one study performed in a South Indian community known for strong stigma against epilepsy. A recent transcultural investigation conducted in Brazil and Lithuania found no differences from healthy controls and between countries. It seems worthwhile to further investigate relations of LOC with epilepsy stigma.
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Katia Lin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Rüta Mameniškiené
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania
| | - Roger Walz
- Center for Applied Neuroscience, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Center for Epilepsy Surgery of Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Department of Internal Medicine, Neurology Service, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Teagarden DL, Morton ML, Janocko NJ, Groover O, Villarreal HK, Evans L, Drane DL, Karakis I. Socioeconomic disparities in patients with psychogenic nonepileptic seizures and their caregivers. Epilepsy Behav 2020; 110:107160. [PMID: 32493610 DOI: 10.1016/j.yebeh.2020.107160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is no information on disparities of patients with psychogenic nonepileptic seizures (PNES) and their caregivers. The objective of this exploratory study is to compare patients with PNES and caregivers with low socioeconomic status (SES) with those of high SES for disparities in healthcare use, seizures, medication adverse effects, psychosocial impact, and knowledge about epilepsy. METHODS Patients with PNES and caregivers completed surveys about the aforementioned outcomes during their Epilepsy Monitoring Unit (EMU) admission. Associations were evaluated using SES as a binary independent variable and the patient- and caregiver-related outcomes as dependent variables. RESULTS Forty-three patients and 28 caregivers were recruited. The majority of patients were on average 36 years old, single women, unemployed, with some college education. The majority had PNES for 8 years averaging 20 seizures per month and were maintained on ≥2 antiepileptic drugs (AEDs) prior to their EMU admission. 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. Low SES patients showed poorer knowledge about epilepsy (p < 0.0001) and higher anxiety levels (p = 0.03). Conversely, high SES patients demonstrated poorer social functioning (p = 0.04). High SES caregivers showed higher caregiving burden (p = 0.01). CONCLUSION There are noteworthy disparities in patients with PNES of different SES and their caregivers. Identification of those disparities is a critical step in the creation of appropriate interventions to address them.
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Affiliation(s)
- Diane L Teagarden
- 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
| | - Hannah K Villarreal
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Latasha Evans
- 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
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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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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GOZUBATİK-CELİK R, NALBANTOGLU M, KOSEOGLU M. The Frequency of Non-Epileptic Seizures in Epileptic Patients, the Relationship with Anxiety and Depression. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Wardrope A, Wong S, McLaughlan J, Wolfe M, Oto M, Reuber M. Peri‐ictal responsiveness to the social environment is greater in psychogenic nonepileptic than epileptic seizures. Epilepsia 2020; 61:758-765. [DOI: 10.1111/epi.16471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Alistair Wardrope
- Sheffield Teaching Hospitals National Health Service Foundation Trust Royal Hallamshire Hospital Sheffield UK
| | - Siew Wong
- Sheffield Teaching Hospitals National Health Service Foundation Trust Royal Hallamshire Hospital Sheffield UK
| | | | - Maytal Wolfe
- William Quarrier Scottish Epilepsy Centre Glasgow UK
| | - Maria Oto
- William Quarrier Scottish Epilepsy Centre Glasgow UK
| | - Markus Reuber
- Sheffield Teaching Hospitals National Health Service Foundation Trust Royal Hallamshire Hospital Sheffield UK
- Academic Neurology Unit University of Sheffield Royal Hallamshire Hospital Sheffield UK
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Nemade D, Shivkumar V, Ferguson P, Singh J, Shah S. Psychosocial and Physiologic Characteristics of Patients with Non-epileptic Events: A Retrospective Study. Cureus 2020; 12:e6767. [PMID: 32140334 PMCID: PMC7039355 DOI: 10.7759/cureus.6767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The main focus of this study is to aid early identification of psychogenic non-epileptic seizure (PNES) patients by identifying physical and psychosocial characteristics to reduce the health care burden, to reduce the unnecessary use of anti-epileptic medications and their side effects, and maximizing cost-effective use of video electroencephalography (VEEG). Methods We analyzed PNES subject data from VEEG monitoring performed at the Epilepsy Center at the Marshall University School of Medicine. We reviewed more than 360 episodes in 54 subjects older than 18 years (mean age ± standard deviation (SD): 48 ± 12.97 years; 83% female). Results We found that most of our PNES patients were older than 45 years of age (66.7%), females (83.3%); obese (66.6%) or overweight (18.5%); either single (33.3%), separated (7.4%), divorced (22.2%), or widowed (14.8%); of low education, unemployed (either received government assistance (83.3%) or disability benefits (57.4%)) with associated physical illness (85.2%) and psychiatric illness (96.3%). Conclusion Our study adds to the current knowledge of the sociodemographic and sociocultural variability of PNES. It might enable early diagnosis and management of patients with PNES.
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Affiliation(s)
- Dipali Nemade
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Vikram Shivkumar
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Paul Ferguson
- Neurology, Marshall University School of Medicine, Huntington, USA
| | | | - Sona Shah
- Neurology, Marshall University School of Medicine, Huntington, USA
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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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Moritz JLW, Mameniškienė R, Rimšienė J, Budriūnienė A, de Almeida Calado G, Rigon IB, Cantú PLM, Meneguzzi C, Walz R, Lin K, Wolf P. Control perceptions in epilepsy: A transcultural case-control study with focus on auras. Epilepsy Behav 2018; 88:130-138. [PMID: 30269031 DOI: 10.1016/j.yebeh.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. METHODS A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). RESULTS Patient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. CONCLUSIONS General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.
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Affiliation(s)
- Jorge Luís Wollstein Moritz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rūta Mameniškienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Justė Rimšienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Atėnė Budriūnienė
- Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Isadora Barazzetti Rigon
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Caroline Meneguzzi
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roger Walz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Kátia Lin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Peter Wolf
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark.
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Walsh S, Levita L, Reuber M. Comorbid depression and associated factors in PNES versus epilepsy: Systematic review and meta-analysis. Seizure 2018; 60:44-56. [DOI: 10.1016/j.seizure.2018.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/17/2018] [Accepted: 05/19/2018] [Indexed: 10/16/2022] Open
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Powell S, Hagen K, Korn T. Treating Pseudoseizures and Related Behaviors in an Adult Male with an Intractable Seizure Disorder. Clin Case Stud 2016. [DOI: 10.1177/1534650102239090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AD, a 42-year-old male diagnosed with an intractable seizure disorder, profound mental retardation, and numerous medical diagnoses, manifested pseudoseizures and related behaviors. To reduce the frequency of these behaviors, treatment procedures were developed and implemented. In conjunction with direct care staff members, target behaviors were identified and defined: pseudoseizures, falling, and sliding from chair. The behavioral treatment applied combined antecedent control and a progressive intervention approach using verbal cueing, visually checking, tactile attention, and edible reinforcement. Data collection occurred over an 18-month period. Results show an increase in the number of days occurring without charted behaviors within consecutive 28-day reporting periods. Data collection consisted of 7,068 observations of AD's behaviors. This allowed correlations to be conducted with significant correlations existing between pseudoseizures and falling ( r = .59) and chair sliding and positive observations ( r = —.63). t tests were computed resulting in significant differences between AD's target behaviors and pseudoseizures.
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Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review. Clin Psychol Rev 2016; 45:157-82. [PMID: 27084446 DOI: 10.1016/j.cpr.2016.01.003] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
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Affiliation(s)
- Richard J Brown
- 2nd Floor Zochonis Building, Brunswick Street, School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Pick S, Mellers JDC, Goldstein LH. Emotion and dissociative seizures: A phenomenological analysis of patients' perspectives. Epilepsy Behav 2016; 56:5-14. [PMID: 26799918 DOI: 10.1016/j.yebeh.2015.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings, and to provide a phenomenological insight into patients' perspectives on these issues. Semistructured interviews were carried out with 15 patients with DS, and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; iv) relating to others; and v) resilience, protective factors, and coping mechanisms. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- Susannah Pick
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| | - John D C Mellers
- Neuropsychiatry Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Laura H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
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Dimaro LV, Roberts NA, Moghaddam NG, Dawson DL, Brown I, Reuber M. Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures. Epilepsy Behav 2015; 46:109-17. [PMID: 25922151 DOI: 10.1016/j.yebeh.2015.03.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/22/2015] [Accepted: 03/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. METHODS Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered. RESULTS We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization. CONCLUSION Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.
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Affiliation(s)
- Lian V Dimaro
- University of Nottingham, Institute of Work, Health & Organisations, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK.
| | - Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, 4701 W. Thunderbird Road, MC 3051, Glendale, AZ 85306, USA.
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Ian Brown
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Valente KD, Rzezak P, LaFrance WC. Standard medical care for psychogenic nonepileptic seizures in Brazil. Epilepsy Behav 2015; 45:128-35. [PMID: 25800126 DOI: 10.1016/j.yebeh.2015.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/03/2015] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
Abstract
Knowledge about health systems can promote implementation of more specific and strategic health practices for patients with psychogenic nonepileptic seizures (PNES). For this purpose, we surveyed the current management of PNES (standard medical care [SMC]) by Brazilian League Against Epilepsy members. Respondents reported diagnosing PNES with a mean frequency of 3patients/month. Video-EEG (vEEG) was considered the best method for the diagnosis. Respondents who have vEEG in their facilities refer to vEEG significantly more often than those who have no vEEG (p<0.001). Therefore, South and Southeast Brazil regions referred patients more frequently to vEEG than other regions (p=0.004). Psychotherapy was considered the most effective (92.2%) treatment option, followed by education (75%) and psychopharmacology (70.3%). There were no regional differences considering treatment. The study identified current national diagnostic and treatment practices across the country and identified relevant Brazilian regional differences.
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Affiliation(s)
- Kette D Valente
- Laboratory of Neuroimaging in Neuroscience (LIM 21), University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil.
| | - Patricia Rzezak
- Laboratory of Neuroimaging in Neuroscience (LIM 21), University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil; Laboratory of Clinical Neurophysiology, Psychiatry Department, University of São Paulo (USP) School of Medicine, São Paulo, SP, Brazil
| | - W Curt LaFrance
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
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Agrawal N, Gaynor D, Lomax A, Mula M. Multimodular psychotherapy intervention for nonepileptic attack disorder: an individualized pragmatic approach. Epilepsy Behav 2014; 41:144-8. [PMID: 25461207 DOI: 10.1016/j.yebeh.2014.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 11/17/2022]
Abstract
Nonepileptic attack disorder (NEAD) is a highly distressing and costly condition commonly seen in specialist epilepsy clinics. Consistently effective treatments for NEAD remain elusive, and findings from research indicate that there is no one form of psychological therapy that will be effective in such a heterogeneous group of patients. In this paper, we propose a multimodular approach to psychological therapy in NEAD, which allows the clinician to tailor an individualized management program for the patient appropriate to his/her needs.
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Affiliation(s)
- Niruj Agrawal
- Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK; St George's, University of London, London, UK; South West London & St George's MH NHS Trust, London, UK; Department of Neuropsychiatry, St George's Hospital, London, UK
| | - Danielle Gaynor
- Department of Neuropsychiatry, St George's Hospital, London, UK
| | - Alice Lomax
- St George's, University of London, London, UK; Charing Cross Hospital, London, UK; Hammersmith Hospital, London, UK.
| | - Marco Mula
- Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK; St George's, University of London, London, UK
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Reuber M, Howlett S, Kemp S. Psychologic treatment of patients with psychogenic nonepileptic seizures. Expert Rev Neurother 2014; 5:737-52. [PMID: 16274332 DOI: 10.1586/14737175.5.6.737] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychogenic nonepileptic seizures are relatively common, often disabling and costly to patients and society. Most authorities consider psychologic treatment as the therapeutic intervention of choice. This review is intended primarily for psychologists and therapists who treat patients with psychogenic nonepileptic seizures, and for neurologists who make the diagnosis and wish to find out more about psychologic treatment options. The first section describes the nature and etiology of psychogenic nonepileptic seizures. General questions regarding the psychologic treatment of patients with psychogenic nonepileptic seizures are addressed, before discussing specific therapeutic approaches. The final part summarizes the authors' views on optimal treatment and the direction of future research.
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Affiliation(s)
- Markus Reuber
- Academic Neurology Unit, University of Sheffield, Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Duncan R. Psychogenic nonepileptic seizures: diagnosis and initial management. Expert Rev Neurother 2014; 10:1803-9. [DOI: 10.1586/ern.10.171] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia 2013; 54 Suppl 1:53-67. [DOI: 10.1111/epi.12106] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- W. Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division; Rhode Island Hospital; Brown University, Alpert Medical School; Providence; Rhode Island; U.S.A
| | - Markus Reuber
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield; United Kingdom
| | - Laura H. Goldstein
- Department of Psychology; Institute of Psychiatry; King's College London; London; United Kingdom
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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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Cianci V, Ferlazzo E, Condino F, Mauvais HS, Farnarier G, Labate A, Latella MA, Gasparini S, Branca D, Pucci F, Vazzana F, Gambardella A, Aguglia U. Rating scale for psychogenic nonepileptic seizures: scale development and clinimetric testing. Epilepsy Behav 2011; 21:128-31. [PMID: 21543260 DOI: 10.1016/j.yebeh.2011.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/18/2011] [Accepted: 03/19/2011] [Indexed: 11/18/2022]
Abstract
Our aim was to develop a clinimetric scale evaluating motor phenomena, associated features, and severity of psychogenic nonepileptic seizures (PNES). Sixty video/EEG-recorded PNES induced by suggestion maneuvers were evaluated. We examined the relationship between results from this scale and results from the Clinical Global Impression (CGI) scale to validate this technique. Interrater reliabilities of the PNES scale for three raters were analyzed using the AC1 statistic, Kendall's coefficient of concordance (KCC), and intraclass correlation coefficients (ICCs). The relationship between the CGI and PNES scales was evaluated with Spearman correlations. The AC1 statistic demonstrated good interrater reliability for each phenomenon analyzed (tremor/oscillation, tonic; clonic/jerking, hypermotor/agitation, atonic/akinetic, automatisms, associated features). KCC and the ICC showed moderate interrater agreement for phenomenology, associated phenomena, and total PNES scores. Spearman's correlation of mean CGI score with mean total PNES score was 0.69 (P<0.001). The scale described here accurately evaluates the phenomenology of PNES and could be used to assess and compare subgroups of patients with PNES.
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Affiliation(s)
- Vittoria Cianci
- Institute of Neurology, Magna Græcia University, Catanzaro, Italy
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LaFrance WC, Alosco ML, Davis JD, Tremont G, Ryan CE, Keitner GI, Miller IW, Blum AS. Impact of family functioning on quality of life in patients with psychogenic nonepileptic seizures versus epilepsy. Epilepsia 2011; 52:292-300. [PMID: 21299547 DOI: 10.1111/j.1528-1167.2010.02765.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate different contributions of aspects of family functioning (FF) on health-related quality of life (HRQOL) in patients with psychogenic nonepileptic seizures (PNES) versus epileptic seizures (ES). METHODS Forty-five participants with PNES and 32 with ES completed self-report measures of FF (Family Assessment Device; FAD), HRQOL (Quality of Life in Epilepsy-31), and depression (Beck Depression Inventory-II; BDI-II). The FAD is a self-report questionnaire that assesses FF along six dimensions and general functioning. Regression analyses were used to evaluate the contribution of FF to HRQOL above and beyond the effects of disease severity and depression. KEY FINDINGS Mean Family General Functioning fell in the unhealthy range in participants with ES or PNES. On further analysis, male participants in each group endorsed unhealthy levels of FF compared to female participants. Patients with PNES reported poorer HRQOL and greater depressive symptoms compared to ES participants; there were no gender differences in HRQOL. Regression analyses indicated that the FAD Roles subscale predicted reduced HRQOL in patients with PNES after controlling for illness duration, seizure frequency, and depression. After controlling for the same factors, Communication and Affective Involvement subscales scores predicted HRQOL in ES participants. SIGNIFICANCE Family dysfunction was reported in both ES and PNES participants, but greater family dysfunction was experienced by male participants in both groups. Aspects of FF predicted HRQOL in patients with PNES and ES differentially. FF may be an important treatment target to enhance coping in these groups, although the treatments may need to target different aspects of FF in PNES versus ES.
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Affiliation(s)
- W Curt LaFrance
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
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Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 2008; 12:622-35. [PMID: 18164250 DOI: 10.1016/j.yebeh.2007.11.006] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 11/18/2007] [Indexed: 10/22/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient. Emphasizing the clinical picture throughout, the first part of this article is intended to "look and look again" at what we know about the epidemiology, semiology, clinical context, treatment, and prognosis of PNES. The second part is dedicated to the questions that remain to be answered. It argues that the most important reason our understanding of PNES remains limited is the focus on the visible manifestations of PNES or the seizures themselves. In contrast, subjective seizure manifestations and the biographic or clinical context in which they occur have been relatively neglected.
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Affiliation(s)
- Markus Reuber
- Academic Neurology Unit, University of Sheffield/Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK.
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Adult attachment style and childhood interpersonal trauma in non-epileptic attack disorder. Epilepsy Res 2008; 79:84-9. [DOI: 10.1016/j.eplepsyres.2007.12.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/12/2007] [Accepted: 12/29/2007] [Indexed: 11/19/2022]
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Sharpe D, Faye C. Non-epileptic seizures and child sexual abuse: A critical review of the literature. Clin Psychol Rev 2006; 26:1020-40. [PMID: 16472897 DOI: 10.1016/j.cpr.2005.11.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 10/25/2022]
Abstract
Non-epileptic seizures have received a substantial amount of attention in the psychiatric and medical literature, but comparatively little attention from psychologists. Non-epileptic seizures resemble epileptic seizures but lack the physiological symptoms of genuine epilepsy and are psychological in origin. Many authors have emphasized the role that child sexual abuse may play in the etiology of this disorder. In the present paper, we provide a review of 34 studies examining this relationship, followed by a meta-analysis of 19 effect sizes. While our statistical results support the professed link between child sexual abuse and non-epileptic seizures, we suggest that because of research design limitations, it is premature to draw any definitive conclusions regarding a relationship. Eight of these research design limitations are identified and discussed (e.g., the absence of comparison groups; an explicit and public definition of child sexual abuse). Alternatives to a traditional psychoanalytic perspective that emphasizes the role of child sexual abuse in the etiology of NES are presented. Specific recommendations for future research are made and psychologists are strongly encouraged to play a more active role in both researching and treating non-epileptic seizures.
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Affiliation(s)
- Donald Sharpe
- Psychology Department, University of Regina, Regina, SK, Canada S4S 0A2.
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Goldstein LH, Mellers JDC. Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. J Neurol Neurosurg Psychiatry 2006; 77:616-21. [PMID: 16614021 PMCID: PMC2117432 DOI: 10.1136/jnnp.2005.066878] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine anxiety related seizure symptoms and avoidance behaviour in adults with dissociative (psychogenic non-epileptic) seizures (DS) in comparison with a group suffering from partial epilepsy. METHODS 25 DS and 19 epilepsy patients completed an attack symptom measure, the hospital anxiety and depression scale, the dissociative experiences scale, and the fear questionnaire. RESULTS DS patients reported the presence of significantly greater numbers of somatic symptoms of anxiety during their attacks than the epilepsy group, despite not reporting subjectively higher levels of anxiety. The DS patients also reported higher levels of agoraphobic-type avoidance behaviour than the epilepsy group. Measures of dissociation were higher in the DS group, who also reported greater symptoms of depression. CONCLUSIONS The findings support a model whereby DS occur as a paroxysmal, dissociative response to heightened arousal in the absence of raised general anxiety levels. The model has practical implications for clinical assessment and treatment: in clinical practice, inquiry about these symptoms may help in the diagnosis of DS; with respect to treatment, the anxiety related symptoms and avoidance behaviour prevalent in DS are a potential focus for a cognitive behavioural approach analogous to that used in the treatment of other anxiety disorders.
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Affiliation(s)
- L H Goldstein
- Institute of Psychiatry, Department of Psychology, King's College London, and Neuropsychiatry Department, Maudsley Hospital, SE5 8AF, UK.
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30
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Abstract
Up to one fifth of patients who present to specialist clinics with seizures do not have epilepsy. The majority of such patients suffer from psychologically mediated episodes; dissociative seizures, often referred to as "non-epileptic seizures". This paper describes the diagnostic evaluation of seizure disorders, including clinical assessment and the role of special investigations. The organic and psychiatric imitators of epilepsy are outlined and findings on psychiatric assessment are reviewed. This group of patients often proves difficult to engage in appropriate treatment and an approach to explaining the diagnosis is described. As yet there are no controlled trials of treatment in this disorder but preliminary evidence suggests cognitive behavioural therapy is both a rational and promising way forward.
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Affiliation(s)
- J D C Mellers
- Department of Neuropsychiatry, Maudsley Hospital, Room 32, Denmark Hill, London SE5 8AZ, UK
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31
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Bewley J, Murphy PN, Mallows J, Baker GA. Does alexithymia differentiate between patients with nonepileptic seizures, patients with epilepsy, and nonpatient controls? Epilepsy Behav 2005; 7:430-7. [PMID: 16095976 DOI: 10.1016/j.yebeh.2005.06.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 06/04/2005] [Accepted: 06/04/2005] [Indexed: 11/30/2022]
Abstract
Considering the evidence of an association between alexithymia and somatization, this study aimed to discover whether alexithymia could distinguish patients with psychogenic nonepileptic seizures (NES) from those with epilepsy (ES) and nonpatient controls (C). Toronto Alexithymia Scale (TAS-20) scores were obtained from 21 matched participants from each of these groups, together with measures of anxiety and depression. Overall TAS-20 scores did not differentiate the three groups after controlling for anxiety and depression, but scores on certain subscales of the TAS-20 differed significantly between the patient groups and the controls. Although alexithymia could not discriminate individuals with NES from those with organic manifestations, whether the etiology of alexithymia may differ according to patient group was discussed. Given that 90.5% of NES patients were identified as alexithymic, treatment approaches used for individuals with alexithymia may be usefully applied to those with NES.
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Affiliation(s)
- Jane Bewley
- Department of Social & Psychological Sciences, Edge Hill College of Higher Education, Ormskirk, UK
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32
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Hilty DM, Bourgeois JA, Sugden SG, Chang CH, Servis ME, Alsaadi TM. An integrated neuropsychiatric approach to diagnosis and management of patients with epileptic seizures. Curr Treat Options Neurol 2005; 7:389-402. [PMID: 16079043 DOI: 10.1007/s11940-005-0031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In patients who present to neurology settings with history of epileptic seizures, psychiatric disorders may be the sole manifestation of apparent neurologic symptoms, or they may coexist. Current challenges for clinicians include distinguishing between two disorders and making the correct diagnoses, interpreting test results, and (co-) managing the disorder(s). Our goal is to provide the clinician with an integrated neuropsychiatric approach for the triage, assessment (history, screening tools, examination, diagnostic tests), and treatment (neurologic and/or psychiatric) of these challenging patients. In particular, use of schemata, tables, and algorithms will offer step-by-step approaches and guidelines for the clinician. Recommendations are made for the indications for psychiatric consultation, and co-management is recommended for patients with emergencies, those who fail routine psychiatric treatments, and those with complex presentations or multiple comorbid conditions.
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Affiliation(s)
- Donald M Hilty
- University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.
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33
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Green A, Payne S, Barnitt R. Illness representations among people with non-epileptic seizures attending a neuropsychiatry clinic: a qualitative study based on the self-regulation model. Seizure 2004; 13:331-9. [PMID: 15158705 DOI: 10.1016/j.seizure.2003.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A qualitative study was carried out in order to investigate illness representations of people with non-epileptic seizures (NES) in relation to Leventhal's self-regulation or common sense model. Nine participants with NES took part in semi-structured interviews and transcripts were analysed using an approach from interpretative phenomenological analysis. Data were coded according to the five elements of the self-regulation model (identity, cause, time-line, consequences, controllability) and two additional themes. Particularly evident was participants' confusion about their experience, what to call their condition, and its cause. It was therefore difficult for participants to express clear ideas about the time-line of their illness and its control or cure. Also evident was a tendency to categorise illness in dualistic terms as either organic or psychological. There was some dissatisfaction with doctors where ideas about the nature of the illness did not match. It is concluded that a clear idea of illness identity and cause may be necessary for successful management.
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Affiliation(s)
- Andrew Green
- The Burden Centre for Neuropsychiatry, Neuropsychology and Epileptology, Frenchay Hospital, Frenchay, Bristol BS16 1JB, UK.
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34
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Goldstein LH, Deale AC, Mitchell-O'Malley SJ, Toone BK, Mellers JDC. An Evaluation of Cognitive Behavioral Therapy as a Treatment for Dissociative Seizures. Cogn Behav Neurol 2004; 17:41-9. [PMID: 15209224 DOI: 10.1097/00146965-200403000-00005] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate in an open trial the effectiveness of cognitive behavioral therapy as a treatment of adults with dissociative seizures (i.e., "pseudoseizures"). BACKGROUND Although suggestions have been made concerning the management of patients with dissociative seizures, no studies have previously evaluated the systematic use of cognitive behavioral therapy in the treatment of this disorder. METHOD Twenty patients diagnosed with dissociative seizures were offered treatment comprising 12 sessions of cognitive behavioral therapy. Principal outcome measures were dissociative seizure frequency and psychosocial functioning, including improvement in employment status and mood. Measures were administered before treatment, at the end of treatment, and at a 6-month follow-up. RESULTS Treatment was completed by 16 patients (questionnaire measures were not available for 4 patients who discontinued treatment). Following treatment, there was a highly significant reduction in seizure frequency and an improvement in self-rated psychosocial functioning. These improvements were maintained at the 6-month follow-up. There was also a tendency for patients to have improved their employment status between the start of treatment and the 6-month follow-up period. CONCLUSIONS In this open prospective trial, cognitive behavioral therapy was associated with a reduction in dissociative seizure frequency and an improvement in psychosocial functioning in adults with dissociative seizures.
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Affiliation(s)
- Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, De Crespigny Park, London.
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35
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Abstract
Disease and mood states are important determinants of quality of life (QOL). Low QOL, due to mood states, can be expected especially in psychiatric disorders such as depression. However, patients with seizure disorders may be even more affected because of the combined burden of physical episodes, psychiatric comorbidities, and psychosocial factors (e.g., stigma). In this study, we compare the quality of life in seizure disorders and clinical depression. Based on our earlier findings, we hypothesize that epilepsy patients fare better than patients with psychogenic, nonepileptic seizures (PNES), and we speculate that QOL in PNES is also lower relative to clinical depression. We estimate the relationships between type of seizures (epilepsy vs PNES), depression, and QOL (SF-36) using multiple regression, and we compare the SF-36 scores of patients with epilepsy and PNES (n=194) with the normative data for clinical depression using one-sample t tests. Our findings indicate that depression contributes to the poor QOL in both epilepsy and PNES, but the patients with PNES, even those without depression, have worse QOL compared with both the epilepsy patients and the depression norms. We conclude that evaluating and treating mood states is as important as treating PNES itself when caring for patients with PNES, and it might be the first step toward improving their QOL.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology and Cincinnati Epilepsy Center, University of Cincinnati Medical Center, Cincinnati, OH 45267-0525, USA.
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36
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Bushnik T, Englander J, Duong T. Medical and Social Issues Related to Posttraumatic Seizures in Persons With Traumatic Brain Injury. J Head Trauma Rehabil 2004; 19:296-304. [PMID: 15263857 DOI: 10.1097/00001199-200407000-00004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of late posttraumatic seizures (LPTS) in individuals with traumatic brain injury (TBI) ranges anywhere from 5% to 18.9% in civilian populations up to 32% to 50% in military personnel. OBJECTIVE This article reviews the current knowledge about the incidence and prevalence of LPTS following a TBI, the risk factors for developing LPTS, and the options available for preventing the development of LPTS. METHODS The psychosocial ramifications of LPTS following a TBI have not been well explored. As a result, the psychosocial findings from the current literature on epilepsy will be reviewed with the hope that the need for future TBI outcomes research to investigate the impact of LPTS following a TBI or, at least, to include LPTS as a potential contributing factor will be recognized.
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Affiliation(s)
- Tamara Bushnik
- Northern California TBI Model System of Care, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
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37
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Abstract
Psychogenic nonepileptic seizures (PNES) are a significant public health problem, occurring in perhaps 25% of patients admitted to epilepsy monitoring units. Additional distinguishing characteristics for these patients would be helpful from both a clinical and a scientific standpoint. This study examines sleep structure by polysomnography in patients with PNES compared with patients with epileptic seizures (ES). ES and PNES were verified by video-EEG monitoring. All patients with PNES were evaluated by a psychiatrist. Eight female patients with PNES were compared with 10 female ES patients in the same age group. Percentage REM sleep was significantly greater for women with PNES (23+/-1%) than for those with ES (18+/-1%). There were no differences in other sleep stages, total sleep time, or sleep efficiency. REM latency was less in PNES patients although not significantly. The study suggests that patients with PNES have a sleep architecture similar to that found in major depression, known to be associated with increased REM sleep.
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Affiliation(s)
- Carl W Bazil
- Comprehensive Epilepsy Center, The Neurological Institute, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
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38
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Stanhope N, Goldstein LH, Kuipers E. Expressed emotion in the relatives of people with epileptic or nonepileptic seizures. Epilepsia 2003; 44:1094-102. [PMID: 12887443 DOI: 10.1046/j.1528-1157.2003.09503.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This study investigated Expressed Emotion (EE) in relatives of people with epileptic or nonepileptic seizures (NES). METHODS In a cross-sectional study, we used the Five-Minute Speech Sample to explore EE in the key relative of people with epilepsy (n = 36) and those with NESs (n = 21), as well as levels of anxiety and depression and use of coping strategies. RESULTS A significantly greater proportion of relatives of NES than epilepsy patients were rated as high EE. Hostility was evident in more high-EE epilepsy than high-EE NES relatives, whereas emotional overinvolvement and positive relationship ratings tended to be more common in high-EE NES relatives. High- and low-EE epilepsy relatives used problem-focused as opposed to emotion-focused coping strategies significantly more than half the time. High EE and seizure frequency were not associated. Age at onset of the disorder was higher in epilepsy patients with high- than with low-EE relatives. CONCLUSIONS Irrespective of etiology, carers for people with seizure disorders may find it hard to adjust to the difficulties these disorders create. Interventions that encourage problem-solving, reappraisals of "loss" and education regarding the causes of some of the patients' behavioral and mood problems seem likely to be beneficial.
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39
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Salmon P, Al-Marzooqi SM, Baker G, Reilly J. Childhood family dysfunction and associated abuse in patients with nonepileptic seizures: towards a causal model. Psychosom Med 2003; 65:695-700. [PMID: 12883124 DOI: 10.1097/01.psy.0000075976.20244.d8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A history of childhood sexual abuse is thought to characterize patients with nonepileptic seizures (NES). We tested the hypotheses: 1) that history of sexual abuse is more prevalent in patients with NES than in controls with epilepsy; 2) that such abuse is associated with NES, not directly but because it is a marker of family dysfunction; and 3) that family dysfunction and abuse are, in turn, linked to NES because they increase a general tendency to somatize. METHODS We compared 81 patients with NES with 81 case-matched epilepsy patients, using questionnaires to elicit recollections of sexual, physical, and psychological abuse and family atmosphere and to quantify current somatization. RESULTS Although each form of abuse was more prevalent in NES patients, only child psychological abuse uniquely distinguished NES from epilepsy. However, its association with NES was explained by family dysfunction. A general tendency to somatize explained part of the relationship of abuse to NES. CONCLUSIONS Abuse therefore seems to be a marker for aspects of family dysfunction that are associated with--and may therefore cause--somatization and, specifically, NES.
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Affiliation(s)
- Peter Salmon
- Department of Clinical Psychology, University of Liverpool, Liverpool, England.
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40
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Carton S, Thompson PJ, Duncan JS. Non-epileptic seizures: patients' understanding and reaction to the diagnosis and impact on outcome. Seizure 2003; 12:287-94. [PMID: 12810341 DOI: 10.1016/s1059-1311(02)00290-x] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE The study aim was to assess patients' understanding of and reaction to a diagnosis of non-epileptic attack disorder and to explore whether these factors contribute to outcome. METHOD Eighty-four patients diagnosed with non-epileptic attack disorder participated in the study. Participants answered questions about their seizures and understanding and reaction to the diagnosis. Data were collected by semi-structured telephone interview. Questionnaires were sent to the patients' general practitioners (GPs) to gather information regarding the patient's seizure status, prescription of anti-epileptic drugs and opinion regarding the diagnosis. RESULTS At the time of follow-up, a third of participants reported being seizure free. A total of 63% did not have a good understanding of the diagnosis, most were unclear about the precipitating factors and the most common reaction to the diagnosis was confusion. Many reported a negative impact of NES on everyday life. Sixty-five percent reported receiving psychological follow-up but the number of sessions attended was few (median 2). There was evidence that the reaction to the diagnosis contributed to the outcome in particular an angry outcome was associated with a poor prognosis. Ten GPs did not agree with the diagnosis. CONCLUSION Patients understanding and reactions to a diagnosis of non-epileptic attacks are important factors that should contribute to the development of more tailored treatment approaches.
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Affiliation(s)
- Simone Carton
- Department of Psychology, National Rehabilitation Hospital, County, Dublin, Ireland
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41
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Iriarte J, Parra J, Urrestarazu E, Kuyk J. Controversies in the diagnosis and management of psychogenic pseudoseizures. Epilepsy Behav 2003; 4:354-9. [PMID: 12791342 DOI: 10.1016/s1525-5050(03)00113-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the advent of video-EEG telemetry studies (V-EEG) neurologists have become increasingly aware of psychogenic pseudoseizures (PPS) given the relatively high prevalence of these events among patients seen in epilepsy centers. The use of V-EEG has been accepted as the gold standard study in establishing this diagnosis; some clinicians, however, have suggested that the clinical phenomena of PPS are so obvious in many patients that V-EEG may not be necessary. This is one of many controversial points that clinicians face when evaluating patients suspected of having PPS. In this article, we review some of these controversies, specifically the need for a video-EEG monitoring study in all patients suspected of having PPS and the role of induction protocols in the evaluation of PPS, the question of whether patients have any control over their events, and finally some of the therapeutic strategies for PPS including the need to limit these patients' driving privileges.
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Affiliation(s)
- Jorge Iriarte
- Department of Neurology, Clínica Universitaria, University of Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
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42
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Abstract
The population incidence of psychogenic nonepileptic seizures (PNES) may be only 4% that of epilepsy, but many patients with PNES have a tendency to seek medical attention, and PNES make up a larger share of the workload of neurologists and emergency and general physicians. Although a great number of publications describe how PNES can be distinguished from epileptic seizures, it usually takes several years to arrive at this diagnosis, and three-quarters of patients (with no additional epilepsy) are treated with anticonvulsants initially. However, the management of PNES as epileptic seizures can lead to significant iatrogenic harm. Moreover, the failure to recognize the psychological cause of the disorder detracts from addressing associated psychopathology and enhances secondary somatization processes. This review provides an overview of studies of the diagnosis, etiology, treatment, and prognosis of PNES. Physicians should always consider PNES in the differential diagnosis of a seizure disorder. If a diagnosis of PNES is possible, or a diagnosis of epilepsy in doubt, a clear diagnostic categorization should be sought. This should involve the assessment of the patient by a physician versed in the diagnosis of seizure disorders and, in many cases, the documentation of a typical seizure by video-EEG. Outcome may be improved if the diagnosis is more actively sought, made earlier, and communicated more convincingly.
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Affiliation(s)
- Markus Reuber
- Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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43
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Abstract
Pseudostatus epilepticus in childhood has not been well reported in the literature. We describe the clinical presentation and management of a 9-year-old child with well-controlled epilepsy who presented in a prolonged period of pseudoseizures. Intensive care management over a number of weeks with multiple high-dose antiepileptic drugs, anesthesia, and ventilation at a tertiary care pediatric center was performed before the diagnosis of pseudostatus epilepticus was made. Initiation of family counseling and behavior therapy after diagnosis of the nonepileptic nature of the protracted paroxysmal events with video telemetry in our pediatric epilepsy unit was followed by remission. The patient reported herein illustrates the risks of iatrogenic morbidity that may result from a delay in the diagnosis of pseudoseizures and pseudostatus epilepticus in childhood.
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Affiliation(s)
- Ingrid E B Tuxhorn
- Section of Pediatric Epilepsy, Klinik Mara-Kidron, Epilepsy Center Bethel, Bielefeld, Germany
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44
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Abstract
While the diagnostic features of psychogenic non-epileptic seizures have been better characterized in recent years, comparatively little is written about management. This review provides guidance to clinicians involved in the treatment of patients with psychogenic non-epileptic seizures and generates ideas for future research. It summarizes the recent literature specifically dealing with the treatment of such seizures and draws on the wider psychiatric literature on effective treatments for patients with other medically unexplained symptoms.
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Affiliation(s)
- Markus Reuber
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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45
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Silva W, Giagante B, Saizar R, D'Alessio L, Oddo S, Consalvo D, Saidón P, Kochen S. Clinical features and prognosis of nonepileptic seizures in a developing country. Epilepsia 2001; 42:398-401. [PMID: 11442159 DOI: 10.1046/j.1528-1157.2001.45299.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs). METHODS One hundred sixty-one consecutive ictal video-EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during video-EEC without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatment, and correlation with outcome on follow-up were examined. RESULTS The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features were tonic-clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy-three percent of patients with pure NESs received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty-nine percent of the patients received psychological/psychiatric therapy. At follow-up, 23.5% were free of NESs. CONCLUSIONS All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NESs.
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Affiliation(s)
- W Silva
- Municipal Epilepsy Center, Department of Neurology, Ramos Mejía Hospital, and CONICET, Buenos Aires, Argentina.
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46
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Abstract
This report outlines a unique case of pseudoseizures associated with doll phobia in a young adult. Early recognition and treatment directed at the aetiological factors led to the effective treatment of the pseudoseizures and doll phobia.
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Affiliation(s)
- S P Chand
- Sultan Qaboos University, Sultanate of Omen
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47
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Krawetz P, Fleisher W, Pillay N, Staley D, Arnett J, Maher J. Family functioning in subjects with pseudoseizures and epilepsy. J Nerv Ment Dis 2001; 189:38-43. [PMID: 11206663 DOI: 10.1097/00005053-200101000-00007] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to identify differences in family functioning between subjects with pseudoseizures and their families, and control subjects with epilepsy. Thirty-one adult subjects with pseudoseizures and 31 controls with intractable epilepsy, whose diagnoses were confirmed using video-EEG, were recruited from the epilepsy unit of a tertiary care hospital over a 4-year period. Each study participant and their first-degree adult family members completed two standardized questionnaires designed to measure family functioning: the McMaster Family Assessment Device (FAD) and the Beavers Self-Report Family Inventory (SFI). Individuals with pseudoseizures, when compared with epileptic subjects, exhibited significantly elevated scores in three scales of the FAD and in one scale of the SFI, indicating greater psychopathology within the family, as perceived by the individual. Statistically significant differences with the FAD were on measures of affective involvement (p = .044), communication (p = .004), and general functioning (p = .013). The SFI revealed significantly greater difficulty with conflict (p = .050). No differences were noted between subjects with both pseudoseizures and epilepsy and subjects with pseudoseizures alone. In comparison with the families of the epileptic group, the families of subjects with pseudoseizures displayed statistically significant elevations in their responses on the roles scale (p = .003) of the FAD. The responses of the family members did not differ in regard to the role they assumed within the family unit (i.e., spouse, parent). In summary, individuals with pseudoseizures view their families as being more dysfunctional, particularly in the area of communication, whereas their family members perceived difficulties in defining roles. This suggests that family education and interventions focusing on these areas, may be an important aspect of the treatment of patients with pseudoseizures.
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Affiliation(s)
- P Krawetz
- Selkirk Mental Health Centre, Manitoba, Canada
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48
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Tojek TM, Lumley M, Barkley G, Mahr G, Thomas A. Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures. PSYCHOSOMATICS 2000; 41:221-6. [PMID: 10849454 DOI: 10.1176/appi.psy.41.3.221] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research on psychogenic nonepileptic seizures (PNES) has focused on childhood abuse, but less is known about other stressors and psychosocial risk factors. The authors compared 25 patients with PNES with 33 control subjects with epilepsy on stressful life events and other risk factors for somatoform disorders. Compared with control subjects, patients with PNES reported significantly more prevalent and stressful negative life events (including adulthood abuse) and more current rumination, stress-related diseases, somatic symptoms, bodily awareness, and marginally more anxiety and depression. However, the relationship of many of these variables to PNES was accounted for by life stress. Groups did not differ on illness worry, alexithymia, or psychotic symptoms. The results suggest that PNES are part of a larger pattern of somatic symptoms responses to a wide range of negative events, including stress in adulthood.
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Affiliation(s)
- T M Tojek
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
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49
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Abstract
Twenty women and 10 men with Pseudoseizures were matched by age and gender with an epilepsy- and a healthy-control group. In response to clinical and research evidence of a relationship between Pseudoseizures and the experience of stress, it was hypothesised that people with Pseudoseizures would perceive their ongoing lives as more stressful, and use more avoidant and distancing coping, and less problem-focused coping, than people in the two control groups. Using the Perceived Stress Scale (Cohen et al., J. Health Soc. Behav. 24, 1983, 385-396) and the Ways of Coping, revised version (Folkman and Lazarus, Manual for Ways of Coping Questionnaire, Consulting Psychologist Press, Paola Alto, CA, 1988) the study found that people with Pseudoseizures: (1) perceived their ongoing lives as significantly more stressful; (2) were significantly more likely to use a maladaptive (escape-avoidant) coping strategy; and (3) were significantly less likely to use an adaptive (planful problem solving) approach to coping than healthy controls. The study findings indicate that people with Pseudoseizures experience lives as stressful as do people with epilepsy, and are likely to employ maladaptive coping responses. Implications for diagnosis, intervention and future research are discussed.
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Affiliation(s)
- P L Frances
- Department of Clinical Psychology, University of Wales, Bangor, UK
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50
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Wood BL, McDaniel S, Burchfiel K, Erba G. Factors distinguishing families of patients with psychogenic seizures from families of patients with epilepsy. Epilepsia 1998; 39:432-7. [PMID: 9578034 DOI: 10.1111/j.1528-1157.1998.tb01396.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Psychogenic seizures (PS) (emotionally based nonelectrical seizures) have been explained by psychodynamics and trauma. However, the family health literature suggests that somatization, of which psychogenic seizures are a form, may run in families and be determined by family patterns of response to distress. This study compared families of patients with PS and those of patients with epilepsy on variables of distress (anxiety and depression) and somatization. METHODS Eighteen patients (9 with PS and 9 with epilepsy) matched for age and education, and their families answered the Health Status Questionnaire (HSQ), the Weinberger Adjustment Inventory (WAI), the Family Emotional Involvement and Criticism Scale (FEICS), Barsky's Somatization Symptom Inventory (SS), and the Dissociation Experience Scale (DES). Family members' scores were averaged to obtain "family scores." RESULTS Patients with PS and those with epilepsy did not differ in any of the measures. However, families of patients with PS reported more health problems, distress, and criticism than did families of patients with epilepsy (p < 0.05). Families of patients with PS had increased criticism and somatic problem scores comparable to those of both types of patients. CONCLUSIONS Although epilepsy causes patients physical and emotional problems, their families are relatively healthy. In contrast, families of patients with PS are more troubled and may unwittingly contribute to PS through family distress, criticism, and tendencies to somatize.
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Affiliation(s)
- B L Wood
- Department of Psychiatry, SUNY, Buffalo, School of Medicine and Biomedical Sciences, New York, USA.
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