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Rivera Deras IY, Frade Pardo L, Arenas Martínez MC, Tejedor López L. [Psychogenic crises in the elderly: a challenge in their diagnosis and treatment, about a case]. Rev Esp Geriatr Gerontol 2023; 58:101372. [PMID: 37263850 DOI: 10.1016/j.regg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Ivon Y Rivera Deras
- Servicio de Geriatría, Hospital Universitario La Paz - Cantoblanco, Madrid, España.
| | - Lucía Frade Pardo
- Servicio de Neurología, Hospital Universitario La Paz - Cantoblanco, Madrid, España
| | | | - Luis Tejedor López
- Servicio de Geriatría, Hospital de Emergencias Enfermera Isabel Zendal, Madrid, España
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Sobregrau P, Baillès E, Carreño M, Donaire A, Boget T, Setoain X, Bargalló N, Rumià J, V Sánchez Vives M, Pintor L. Psychiatric and psychological assessment of patients with drug-resistant epilepsy and psychogenic nonepileptic seizures (PNES) with no response to previous treatments. Epilepsy Behav 2023; 145:109329. [PMID: 37453292 DOI: 10.1016/j.yebeh.2023.109329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNES) are common imitators of epileptic seizures. Refractoriness to antiseizure medication hinders the differential diagnosis between ES and PNES, carrying deleterious consequences in patients with PNES. Psychiatric and psychological characteristics may assist in the differential diagnosis between drug-resistant epilepsy (DRE) and PNES. Nevertheless, current comprehensive psychiatric and psychological descriptive studies on both patient groups are scarce and with several study limitations. This study provides a comprehensive psychiatric and psychological characterization of Spanish patients with DRE and PNES. METHOD A cross-sectional and comparative study was completed with 104 patients with DRE and 21 with PNES. Psychiatric and psychological characteristics were assessed with the HADS, SCL-90-R, NEO-FFI-R, PDQ-4+, COPE, and QOLIE-31 tests. Parametric and non-parametric tests were used, and regression models were fit to further explore factors affecting patients' life quality. RESULTS Patients with PNES had greater levels of somatization and extraversion and were associated with benzodiazepine intake. Patients with DRE showed greater narcissistic personality disorder symptoms than those with PNES. In patients with DRE, difficulty in performing basic needs-related tasks and greater psychological distress severity and seizure frequency were associated with poorer life quality. In contrast, being a woman, having a psychiatric disorder history, and greater psychiatric symptoms' intensity were associated with poorer life quality in patients with PNES. CONCLUSION Patients with DRE and PNES share similar psychiatric and psychological characteristics, with only very few being significantly different.
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Affiliation(s)
- Pau Sobregrau
- Faculty of Psychology, University of Barcelona (UB), Barcelona 08007, Spain; Department of Psychiatry, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain.
| | - Eva Baillès
- Health Psychology Unit, Psychiatry Department, Vall d'Hebron, Barcelona 08035, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Núria Bargalló
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain
| | - María V Sánchez Vives
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain; Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona (UB), Barcelona 08007, Spain
| | - Luís Pintor
- Department of Psychiatry, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
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Roze E, Hingray C, Degos B, Drapier S, Tyvaert L, Garcin B, Carle-Toulemonde G. [Functional neurological disorders: A clinical anthology]. L'ENCEPHALE 2023:S0013-7006(23)00084-2. [PMID: 37400338 DOI: 10.1016/j.encep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorders have a broad phenotypic spectrum and include different clinical syndromes, which are sometimes associated to each other or appear consecutively over the course of the disease. This clinical anthology provides details on the specific and sensitive positive signs that are to be sought in the context of a suspected functional neurological disorder. Beside these positive elements leading to the diagnosis of functional neurological disorder, we should keep in mind the possibility of an associated organic disorder as the combination of both organic and functional disorders is a relatively frequent situation in clinical practice. Here we describe the clinical characteristics of different functional neurological syndromes: motor deficits, abnormal hyperkinetic and hypokinetic movements, voice or speech disorders, sensory disorders, and functional dissociative seizures. The clinical examination and the identification of positive signs play a critical role in the diagnosis of functional neurological disorder. Knowledge of the specific signs associated with each phenotype render possible to make an early diagnosis. For that matter, it contributes to the improvement of patient care management. It allows to a better engagement in an appropriate care pathway, which influence their prognosis. Highlighting and discussing positive signs with patients can also be an interesting step in the process of explaining the disease and its management.
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Affiliation(s)
- Emmanuel Roze
- Hôpital Salpêtrière, DMU neurosciences, Assistance publique des Hôpitaux de Paris, Paris, France; Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France
| | | | - Bertrand Degos
- Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France; Centre de recherche interdisciplinaire en biologie (CIRB), Collège de France, CNRS UMR7241/Inserm U1050, Université PSL, Paris, France
| | - Sophie Drapier
- Département de neurologie, CHU de Rennes, CIC Inserm 1414, Rennes, France
| | - Louise Tyvaert
- Centre de psychothérapie du CHRU de Nancy, Nancy, France
| | - Béatrice Garcin
- Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France; Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, 29, rue Émile-Lecrivain, 31400 Toulouse, France.
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Asadi-Pooya AA, Mishra M, Farazdaghi M, Fox J. The clinical characteristics of childhood-onset and late-onset functional seizures: How do they differ? Epilepsy Behav 2023; 145:109336. [PMID: 37385121 DOI: 10.1016/j.yebeh.2023.109336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND We investigated childhood-onset functional seizures (FS) and late-onset FS and hypothesized that there are differences in their characteristics. METHODS In this retrospective study, we investigated all patients with confirmed FS with an age at onset of 14 years or younger and those with an age at onset of 50 years or older, who were admitted to the epilepsy monitoring units at one center in Iran (Shiraz Comprehensive Epilepsy Center, from 2008 until 2022) and one center in the USA (Vanderbilt University Medical Center, from 2011 until 2022). RESULTS One-hundred and forty patients were included. They included 80 patients with childhood-onset FS and 60 with late-onset FS. Those with late-onset FS were more likely to have medical comorbidities compared with the patients with childhood-onset FS (OR = 13.9). Those with late-onset FS more likely had a history of head injury compared with the patients with childhood-onset FS (OR = 5.97). Duration of illness was significantly longer in patients with childhood-onset FS compared with the patients with late-onset FS (6 years vs. 2 years). CONCLUSION Our study identified several similarities and differences in the clinical characteristics and predisposing factors of patients with childhood-onset and late-onset FS. In addition, we found that childhood-onset FS is more likely to remain undiagnosed and thus untreated for many years. These findings provide additional evidence that FS is a heterogenous condition and we propose that a proportion of the differences between patients may be accounted for by age-associated factors.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Murli Mishra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Trainor D, Foster E, Rychkova M, Lloyd M, Leong M, Wang AD, Velakoulis D, O'Brien TJ, Kwan P, Loi SM, Malpas CB. Development and validation of a screening questionnaire for psychogenic nonepileptic seizures. Epilepsy Behav 2020; 112:107482. [PMID: 33181887 DOI: 10.1016/j.yebeh.2020.107482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Epilepsy and psychogenic nonepileptic seizures (PNES) are serious conditions, associated with substantial morbidity and mortality. Although prompt diagnosis is essential, these conditions are frequently misdiagnosed, delaying appropriate treatment. We developed and validated the Anxiety, Abuse, and Somatization Questionnaire (AASQ), a quick and clinically practical tool to differentiate PNES from epilepsy. METHOD We retrospectively identified psychological variables that differentiated epilepsy from PNES in a discovery cohort of patients admitted to a video-electroencephalography monitoring (VEM) unit from 2002 to 2017. From these findings, we developed the AASQ and prospectively validated it in an independent cohort of patients with gold-standard VEM diagnosis. RESULTS One thousand two hundred ninety-one patients were included in the retrospective study; mean age was 39.5 years (range: 18-99), 58% were female, 67% had epilepsy, and 33% had PNES. Psychometric data for 192 instrument items were reviewed, receiver operating characteristic curves were computed, and a 20-item AASQ was created. Prospective validation in 74 patients showed that a one-point increase in the AASQ score was associated with 11 times increase in the odds of having PNES compared with epilepsy. Low scores on the AASQ were associated with a low probability of PNES with a negative predictive value of 95%. SIGNIFICANCE The AASQ is quick, inexpensive, and clinically useful for workup of seizure disorders. The AASQ excludes PNES with a high degree of confidence and can predict PNES with significance when combined with basic clinicodemographic variables. Future research will investigate diagnostic performance of the AASQ in relevant clinical subgroups, such as patients with comorbid epilepsy and PNES.
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Affiliation(s)
- David Trainor
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia.
| | - Emma Foster
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Maria Rychkova
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Michelle Leong
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Albert D Wang
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia; The Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Terence J O'Brien
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia
| | - Patrick Kwan
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia
| | - Samantha M Loi
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Australia; The Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Australia
| | - Charles B Malpas
- The Epilepsy Unit, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia
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Hansen AS, Rask CU, Rodrigo-Domingo M, Pristed SG, Christensen J, Nielsen RE. Incidence rates and characteristics of pediatric onset psychogenic nonepileptic seizures. Pediatr Res 2020; 88:796-803. [PMID: 32392575 DOI: 10.1038/s41390-020-0945-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pediatric onset psychogenic nonepileptic seizures (PNES) is a highly disabling disorder and potentially misdiagnosed as epilepsy. Still, knowledge regarding PNES in children and adolescents is limited and data on both incidence and characteristics are scarce. This study investigated the incidence rate (IR) and clinical characteristics of pediatric onset PNES, including possible differences when having comorbid epilepsy. METHODS A population-based study of children and adolescents aged 5-17 years with an incident diagnosis of PNES in the Danish healthcare registries between 1996 and 2014. In total, 386 children and adolescents were included after assessment of diagnostic validity using medical record data. RESULTS The IR increased during the study period with the maximum IR observed in 2014 (7.4 per 100,000 person-years). A history of both neurologic and psychiatric problems as well as negative life events was identified. Comorbid epilepsy was confirmed for 55 cases (14.2%) and was associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. CONCLUSIONS PNES are increasingly diagnosed in children and adolescents, and the clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. These findings provide important information for future healthcare planning in this area. IMPACT This nationwide study is the first to report population-based incidence rates of pediatric onset PNES documenting markedly increasing incidence rates between 1996 and 2014. A history of both neurologic and psychiatric problems as well as negative life events was identified for pediatric onset PNES. Comorbid epileptic seizures were associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. The clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. The increasing number of children and adolescents diagnosed with PNES is important information for future healthcare planning in this area.
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Affiliation(s)
- Anne S Hansen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Rodrigo-Domingo
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Sofie G Pristed
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Psychogenic Non-Epileptic Status as Refractory, Generalized Hypertonic Posturing: Report of Two Adolescents. MEDICINA-LITHUANIA 2020; 56:medicina56100508. [PMID: 32998279 PMCID: PMC7600080 DOI: 10.3390/medicina56100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) or dissociative seizures are found under the umbrella headings of functional/dissociative neurological disorders (FND) in psychiatric classifications (DSM-5; ICD-11). PNES are not characterized by any specific ictal or postictal EEG abnormalities. Patients with PNES can present with motor or non-motor symptoms, frequently associated with a change in the level of consciousness. PNES duration is variable, often longer than that of epileptic seizures. Prolonged PNES, sometimes termed PNES status, involve continuous or repetitive events that exceed 30 min. Prolonged PNES are often misdiagnosed as an epileptic event and are often inappropriately treated with high doses of antiseizure drugs. In this report, we describe two adolescent patients who presented with prolonged PNES characterized by generalized hypertonic posturing and low levels of consciousness. Despite multiple presentation to the Emergency department, and multiple normal video-EEG, the patients were misdiagnosed with epilepsy and were inappropriately treated with antiseizure medications. Both patients presented psychiatric comorbidity, consisting of a major depressive disorder, obsessive-compulsive symptoms, social withdrawal, difficulty of social interaction, and anxious-perfectionist personality traits. The episodes of prolonged PNES gradually declined within 18 months in both patients.
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8
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Leu C, Bautista JF, Sudarsanam M, Niestroj LM, Stefanski A, Ferguson L, Daly MJ, Jehi L, Najm IM, Busch RM, Lal D. Neurological disorder-associated genetic variants in individuals with psychogenic nonepileptic seizures. Sci Rep 2020; 10:15205. [PMID: 32938993 PMCID: PMC7495430 DOI: 10.1038/s41598-020-72101-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are diagnosed in approximately 30% of patients referred to tertiary care epilepsy centers. Little is known about the molecular pathology of PNES, much less about possible underlying genetic factors. We generated whole-exome sequencing and whole-genome genotyping data to identify rare, pathogenic (P) or likely pathogenic (LP) variants in 102 individuals with PNES and 448 individuals with focal (FE) or generalized (GE) epilepsy. Variants were classified for all individuals based on the ACMG-AMP 2015 guidelines. For research purposes only, we considered genes associated with neurological or psychiatric disorders as candidate genes for PNES. We observe in this first genetic investigation of PNES that six (5.88%) individuals with PNES without coexistent epilepsy carry P/LP variants (deletions at 10q11.22-q11.23, 10q23.1-q23.2, distal 16p11.2, and 17p13.3, and nonsynonymous variants in NSD1 and GABRA5). Notably, the burden of P/LP variants among the individuals with PNES was similar and not significantly different to the burden observed in the individuals with FE (3.05%) or GE (1.82%) (PNES vs. FE vs. GE (3 × 2 χ2), P = 0.30; PNES vs. epilepsy (2 × 2 χ2), P = 0.14). The presence of variants in genes associated with monogenic forms of neurological and psychiatric disorders in individuals with PNES shows that genetic factors are likely to play a role in PNES or its comorbidities in a subset of individuals. Future large-scale genetic research studies are needed to further corroborate these interesting findings in PNES.
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Affiliation(s)
- Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA.
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
| | - Jocelyn F Bautista
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Monica Sudarsanam
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lisa-Marie Niestroj
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, DE, 50931, USA
| | - Arthur Stefanski
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Mark J Daly
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Institute of Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, DE, 50931, USA.
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9
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School bullying: an increasingly recognized etiology for psychogenic non-epileptic seizures: report of two cases. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2020; 6:155-157. [PMID: 31890842 PMCID: PMC6926182 DOI: 10.1016/j.ijpam.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/04/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) are seizure-like episodes that are not associated with changes on electroencephalogram. They are the result of a wide range of possible psychological stressors including being a victim of bullying. Currently, reports regarding PNES in bullied patients are lacking. In this case report, we describe two cases; the first is a 10-year-old boy who presented to the emergency room once for visual loss and another for inability to walk. The other is a 12-year-old boy who has experienced recurrent episodes of loss of consciousness. Based on the negative investigations for any other possible diagnosis, and upon the nature of the episodes, a diagnosis of PNES was made after a history of bullying victimization was revealed. This suggests that PNES can result from psychological distress caused by school bullying victimization in children and highlights the importance of screening for bullying in patients with PNES.
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Sawchuk T, Asadi-Pooya AA, Myers L, Valente KD, Restrepo AD, D' Alessio L, Homayoun M, Bahrami Z, Alessi R, Paytan AA, Kochen S, Taha F, Lazar LM, Pick S, Nicholson TR, Buchhalter J. Clinical characteristics of psychogenic nonepileptic seizures across the lifespan: An international retrospective study. Epilepsy Behav 2020; 102:106705. [PMID: 31785480 DOI: 10.1016/j.yebeh.2019.106705] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/12/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. METHODS In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). RESULTS A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). CONCLUSION While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.
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Affiliation(s)
- Tyson Sawchuk
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus.
| | - Ali A Asadi-Pooya
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lorna Myers
- Northeast Regional Epilepsy Group, New York, USA.
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil.
| | - Anilu Daza Restrepo
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - Maryam Homayoun
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bahrami
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rudá Alessi
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - Silvia Kochen
- Buenos Aires University, Epilepsy Center, Ramos Mejía and el Cruce Hospitals, ENyS-IBCN-CONICET, Buenos Aires, Argentina
| | - Firas Taha
- Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA.
| | - Lorraine M Lazar
- Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA.
| | - Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
| | - Jeffrey Buchhalter
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus; University of Calgary, Cumming School of Medicine, Departments of Pediatrics, Canada
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11
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Asadi-Pooya AA, Myers L, Valente K, Sawchuk T, Restrepo AD, Homayoun M, Buchhalter J, Bahrami Z, Taha F, Lazar LM, Paytan AA, D' Alessio L, Kochen S, Alessi R, Pick S, Nicholson TR. Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study. Seizure 2019; 71:56-59. [DOI: 10.1016/j.seizure.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
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12
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Asadi-Pooya AA, AlBaradie R, Sawchuk T, Bahrami Z, Al Amer A, Buchhalter J. Psychogenic nonepileptic seizures in children and adolescents: An international cross-cultural study. Epilepsy Behav 2019; 90:90-92. [PMID: 30517909 DOI: 10.1016/j.yebeh.2018.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared various clinical characteristics of psychogenic nonepileptic seizures (PNES) between young patients from Iran, Saudi Arabia, and Canada, three nations with significantly different socioeconomic and demographic characteristics. This international cross-cultural comparative study may advance our knowledge and understanding of PNES in children and adolescents across the cultures and borders. METHODS In this retrospective study, we investigated all patients 16 years of age or younger, with PNES admitted to the epilepsy monitoring units at one center in Iran, one center in Saudi Arabia, and one center in Canada. Age, gender, age at seizure onset, seizure semiology, seizure frequency, factors potentially predisposing to PNES, and video-electroencephalography (EEG) recording of all patients were registered routinely and compared between the nations. RESULTS Fifty-one patients were studied (22 from Iran, 14 from Saudi Arabia, and 15 from Canada). Age at the diagnosis was 13.4 ± 2.2 years (range: 8-16 years), and age at the onset of seizures was 12.3 ± 2.7 years (range: 5-16 years). Demographic and clinical characteristics of and associated factors in the patients among the three nations were not significantly different. Twenty-six (51%) patients were taking antiepileptic drugs at the time of diagnosis; the difference was not statistically significant between the nations (13 patients in Iran, 6 in Saudi Arabia, and 7 patients in Canada; P = 0.5). CONCLUSION Young patients with PNES across borders and between cultures share more similarities than differences with regard to their demographic and clinical characteristics.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Tyson Sawchuk
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada.
| | - Zahra Bahrami
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abeer Al Amer
- King Fahd Specialist Hospital, Dammam, Saudi Arabia.
| | - Jeffrey Buchhalter
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada; Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Luthy SK, Moss AF, Torok MR, McLeod L, Wilson KM. Characteristics of Children Hospitalized for Psychogenic Nonepileptic Seizures Due to Conversion Disorder Versus Epilepsy. Hosp Pediatr 2018; 8:321-329. [PMID: 29739840 DOI: 10.1542/hpeds.2017-0103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Psychogenic nonepileptic seizures (PNES) are a manifestation of conversion disorder among children but can be difficult to distinguish from epilepsy. We sought to identify characteristics that differentiate children with PNES from those with epilepsy. METHODS We conducted a retrospective cohort study of children admitted with epilepsy or PNES to 45 children's hospitals from 2004 to 2014. Children with PNES (n = 399) versus those with epilepsy (n = 13 241) were compared on demographic and clinical characteristics, testing, treatment, and health care use. Hierarchical multivariable logistic regression was used to identify characteristics associated with PNES diagnosis. RESULTS Children with PNES were more likely to be female (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.8-3.0), older (aOR 3.8; 95% CI 2.7-5.3 for 14-16 years old), African American (aOR 2.0; 95% CI 1.5-2.7), and have diagnosis codes for psychiatric disorders (aOR 7.1; 95% CI 5.6-9.1) and pain (aOR 2.6; 95% CI 1.9-3.4). They were also more likely to be admitted in the fall (aOR 2.0; 95% CI 1.4-2.8) or spring (aOR 1.9; 95% CI 1.4-2.6) versus summer. Total adjusted hospitalization costs were greater for children with epilepsy ($4724, 95% CI $4413-$5057 vs $5326, 95% CI $5259-$5393; P = .001); length of stay was similar. CONCLUSIONS Demographic and clinical characteristics differed among children with PNES versus those with epilepsy, including significantly increased odds of psychiatric and pain diagnoses among children with PNES. To better inform treatment and prognostication for children with PNES, research is needed to understand reasons for these differences, seasonal admission patterns, and the relationship between PNES and other psychiatric disorders.
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Affiliation(s)
- Sarah K Luthy
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela F Moss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado
| | - Michelle R Torok
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado
| | - Lisa McLeod
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado; and
| | - Karen M Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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Tajmir-Riahi A, Mahler V. Psychogenic nonepileptic seizure (PNES) mimicking acute anaphylactic reaction. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Berg AT, Altalib HH, Devinsky O. Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal. Epilepsia 2017; 58:1123-1130. [PMID: 28464309 PMCID: PMC5498258 DOI: 10.1111/epi.13766] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Abstract
Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. The literature upon which most of the field relies contains some biases that must be carefully examined and resolved in future studies. First, in the pediatric epilepsy literature, many reports find that children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. Most of these studies rely on parent-proxy completed instruments to assess these behavioral endpoints. Parents' reports are not objective but reflect parents' reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. Second, periictal phenomena may be mischaracterized as underlying mood disorders. Third, many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy, suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and psychogenic nonepileptic seizures need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to ensure appropriate therapy and to avoid unnecessary and potentially harmful treatments and common misconceptions.
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Affiliation(s)
- Anne T. Berg
- Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern-Feinberg School of Medicine, Chicago, IL
| | - Hamada H. Altalib
- Hamada H. Altalib, DO, MPH, Yale University School of Medicine, New Haven, CT
| | - Orrin Devinsky
- Orrin Devinsky, MD, New York University School of Medicine, New York, NY
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16
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Psychogenic nonepileptic seizures: a concise review. Neurol Sci 2017; 38:935-940. [PMID: 28275874 DOI: 10.1007/s10072-017-2887-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are commonly diagnosed and treated at epilepsy centers; however, their neurobiology is still poorly understood. Diagnosis relies on a multidisciplinary evaluation and is usually based on different combinations of data. They are diagnosed most reliably by recording a seizure while under video-EEG monitoring. Treatment includes multiple phases. Fewer than 40% of adults with PNES are expected to become seizure-free within 5 years after diagnosis. This article presents a concise review of the current literature about the definition, diagnosis, epidemiology, clinical characteristics, treatment, and prognosis of PNES.
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De Toffol B, Biberon J, Hingray C, El-Hage W. Crisi non epilettiche psicogene (CNEP). Neurologia 2016. [DOI: 10.1016/s1634-7072(16)77533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Hingray C, Biberon J, El-Hage W, de Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris) 2016; 172:263-9. [DOI: 10.1016/j.neurol.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 10/21/2022]
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Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 2015; 46:60-5. [PMID: 25882323 DOI: 10.1016/j.yebeh.2015.03.015] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
We critically review the existing literature about the epidemiology (i.e., diagnosis, occurrence, age, gender, comorbidity with epilepsy, associated factors, prognosis, mortality, and cost) of psychogenic nonepileptic seizures (PNES) and provide suggestions for future research. Psychogenic nonepileptic seizures are commonly diagnosed at epilepsy centers. The diagnosis of PNES relies on a multidisciplinary evaluation and is usually based on different combinations of data. Recording a seizure, while under video-EEG monitoring, is the most reliable diagnostic test. However, not all patients present with seizures while under video-EEG monitoring. Furthermore, not all epileptic seizures produce visible changes in the scalp EEG. The incidence of PNES was estimated to be 1.4-4.9/100,000/year in three previous studies, and the prevalence was calculated to be between 2 to 33 per 100,000 in one study, making it a significant neuropsychiatric condition. However, there remains a scarcity of data about the epidemiology of PNES, and extant studies that assessed the epidemiological characteristics of PNES have significant limitations. For example, inconsistencies with regard to the age of patients studied and lack of standardization of the diagnostic criteria are some of the significant limitations among studies. In conclusion, PNES merit further epidemiological and pathophysiological investigation. A more precise definition and clear guidance on standards for the diagnosis might influence the direction of future research. Well-designed prospective population-based studies to clarify the epidemiology of PNES in various parts of the world, including an evaluation of the predisposing, precipitating, and perpetuating factors in cross-cultural comparisons is required.
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Affiliation(s)
- Ali A Asadi-Pooya
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA; Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA
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Abstract
There are a wide variety of paroxysmal nonepileptic events (PNEEs) in children that can mimic seizures. The type of PNEEs that need to be considered in the differential diagnosis depends on the age of symptom onset and the clinical features. In infants and toddlers, conditions that are relatively common in clinical practice such as apnea, jitteriness, shuddering attacks, and breath-holding spells may not present much of a diagnostic conundrum, whereas unusual conditions such as hyperekplexia may cause concern. Similarly, although most types of migraine are easily distinguished from seizures in school-aged children, certain variants such as the "Alice in Wonderland" syndrome or basilar migraine can create diagnostic confusion. Most types of PNEE are exclusive to childhood; therefore, the pediatrician must be familiar with a variety of physiological processes and pathological entities that can raise concern in parents. The pediatrician is in the unique position of being able to reassure families and/or guide further work-up. Many of the PNEEs in young children require no treatment and resolve spontaneously. It is important to distinguish these episodes from true seizures as to avoid unnecessary testing and pharmacological treatment. This review highlights common PNEEs in children, beginning with the neonatal age group and moving upward to adolescence.
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Asadi-Pooya AA, Emami M, Emami Y. Ictal injury in psychogenic non-epileptic seizures. Seizure 2014; 23:363-6. [DOI: 10.1016/j.seizure.2014.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022] Open
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23
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Psychogenic non-epileptic seizures - the age matters. Clin Neurol Neurosurg 2014; 120:142. [PMID: 24661717 DOI: 10.1016/j.clineuro.2013.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
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Asadi-Pooya AA, Emami Y, Emami M. Psychogenic non-epileptic seizures in Iran. Seizure 2014; 23:175-7. [DOI: 10.1016/j.seizure.2013.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/23/2013] [Accepted: 11/08/2013] [Indexed: 11/16/2022] Open
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Prolonged psychogenic nonepileptic seizures or pseudostatus. Epilepsy Behav 2014; 31:304-6. [PMID: 24262782 DOI: 10.1016/j.yebeh.2013.10.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine if patients with episodes of prolonged psychogenic nonepileptic seizures or pseudostatus are different from those with psychogenic nonepileptic seizures (PNESs) without prolonged attacks regarding their demographic and clinical characteristics and factors potentially predisposing to PNESs. METHODS In this prospective study, all patients with a clinical diagnosis of PNESs (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2013. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics of patients with PNES-status with those with PNES-only. RESULTS Two hundred and eleven patients were studied. Forty-nine patients (23.2%) reported episodes of PNES-status, and 162 patients (76.8%) did not report PNES-status. There were no significant differences between these two groups of patients regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs. CONCLUSION Psychogenic nonepileptic seizure status (PNES-status) is relatively common among patients with PNESs. It seems that patients with PNES-status are not different from those with PNES-only, at least regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs.
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Asadi-Pooya AA, Emami M, Emami Y. Gender differences in manifestations of psychogenic non-epileptic seizures in Iran. J Neurol Sci 2013; 332:66-8. [PMID: 23820124 DOI: 10.1016/j.jns.2013.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Psychogenic non-epileptic seizures (PNES) are more prevalent among women. We investigated the potential differences in demographic and clinical characteristics of PNES between women and men. METHODS In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2012. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics and seizure semiology of PNES between women and men. RESULTS Two hundred and twenty-two patients were diagnosed as having PNES. One hundred and eighty-eight patients had video-EEG recordings available and included in the study. One hundred and twenty-nine (69%) were female and 59 (31%) were male. There were no significant differences between women and men with PNES with regard to demographic, clinical and semiological characteristics. CONCLUSION We did not observe any significant demographic differences between women and men with PNES. Likewise, seizure characteristics and semiology were very similar in both genders. It appears that an Islamic lifestyle (in Iran) has little influence on the sex ratio and clinical manifestations of PNES compared with the Western studies.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
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