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Moro P, Lattanzi S, Beier CP, Di Bonaventura C, Cerulli Irelli E. Cognitive behavioral therapy in adults with functional seizures: A systematic review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 159:109981. [PMID: 39181107 DOI: 10.1016/j.yebeh.2024.109981] [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: 05/11/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Randomized controlled clinical trials (RCTs) investigating cognitive-behavioral therapy (CBT) among adults with functional seizures (FS) have become increasingly available, prompting the opportunity to critically appraise the efficacy and safety of CBT in this population. METHODS We conducted a systematic review and meta-analysis including RCTs comparing CBT in addition to standardized medical treatment (SMT) versus SMT alone for adults with FS. The primary outcome was seizure freedom at the end of treatment. Secondary outcomes included measures of quality of life, anxiety and depression assessed via standardized clinical questionnaires. RESULTS Three RCTs were included comprising 228 participants treated with CBT and 222 with SMT. The intervention was significantly associated with seizure freedom (Odds Ratio [OR] 1.98; 95 % confidence interval [CI] 1.14, 3.46; p = 0.02; I2 = 0 %), reductions in anxiety (standardized mean difference [SMD] -0.21; 95 % CI -0.41, -0.003; p = 0.047; I2 = 0 %) and improvements in quality of life (SMD 0.34; 95 % CI 0.12, 0.57; p = 0.003; I2 = 0 %) at the end of treatment. Conversely, no significant differences between groups were observed in depression symptoms (SMD -0.19; 95 % CI -0.39, 0.02; p = 0.08; I2 = 0 %). There was no statistically significant increase in the risk of suicidal ideation and self-harm with CBT (OR 2.11; 95 % CI 0.81, 5.48; p = 0.13; I2 = 0 %) nor were there differences in terms of discontinuation rates during follow-up (OR 0.92; 95 % CI 0.49, 1.72; p = 0.79; I2 = 7 %). CONCLUSIONS There is high-quality evidence supporting the efficacy and safety of CBT in treating FS. Future research should investigate whether combining CBT with other therapeutic methods could potentially enhance treatment efficacy.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Underwood R, Falshaw L, McFarlane F. Psychoeducation interventions for people with non-epileptic seizures: A scoping review. Seizure 2024; 120:15-24. [PMID: 38889520 DOI: 10.1016/j.seizure.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) and other psychological approaches have a growing evidence base for treating Non-Epileptic Seizures (NES). However, communication about the diagnosis can be difficult for clinicians and is not always well received. It is thought that Psychoeducation about NES may improve engagement with treatment such as CBT and may contribute to reductions in the frequency of seizures and improvements in health related quality of life. However, psychoeducational components of treatment are often not evaluated in isolation meaning the specific benefit to patients is not currently well understood. AIMS The researchers aimed to examine the outcomes associated with psychoeducational interventions and the content of these programmes for NES. METHOD A scoping review was undertaken across four databases with seventeen eligible studies identified which were charted to analyse the data. RESULTS Findings revealed that components and modalities of interventions varied as did methods of evaluating the interventions. A number of different outcome measures were used and not all studies reported the significance of findings. Results across studies were inconsistent; however, there was a general trend across the studies of symptom reduction and improvement in mental health. CONCLUSIONS Findings illustrate that psychoeducation has potential benefits as an intervention in its own right. However, it may be best placed as a second step in a stepped care model, between initial diagnosis and further psychological treatment. The present literature needs replication and more robust studies for more certain conclusions to be drawn.
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Affiliation(s)
- Rebecca Underwood
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Lawson Falshaw
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Fiona McFarlane
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK.
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3
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Gaskell C, Power N, Novakova B, Simmonds-Buckley M, Kerr WT, Reuber M, Kellett S, Rawlings GH. A meta-analytic evaluation of the effectiveness and durability of psychotherapy for adults presenting with functional dissociative seizures. Seizure 2024; 119:98-109. [PMID: 38824867 DOI: 10.1016/j.seizure.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes. METHODS This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes. RESULTS Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis. CONCLUSIONS The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
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Affiliation(s)
- Chris Gaskell
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Department of Neuropsychology, North Staffordshire Combined NHS Foundation Trust, Stoke-on-Trent, UK.
| | - Niall Power
- South West Yorkshire Partnership NHS Foundation Trust, UK
| | - Barbora Novakova
- Health and Wellbeing Service, NHS Sheffield Talking Therapies, Sheffield Health and Social Care NHS Foundation Trust, UK
| | - Melanie Simmonds-Buckley
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Wesley T Kerr
- Departments of Neurology & Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, S10 2JF Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Gregg H Rawlings
- Clinical and Applied Psychology Unit, University of Sheffield, UK
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4
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Stanton B, Segal T, Bradley-Westguard A, Edwards M. How to set up a functional neurological disorder education group. Pract Neurol 2023:pn-2023-003713. [PMID: 37100593 DOI: 10.1136/pn-2023-003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/28/2023]
Abstract
Functional neurological disorder (FND) can be a difficult diagnosis for patients to understand and for clinicians to explain. The postdiagnostic support that patients with other chronic neurological illnesses normally receive is often not available to patients with FND. Here, we share our experience of how to set up an FND education group, including the content, practical aspects of delivering groups and how to avoid potential pitfalls. A group education session can improve understanding of the diagnosis among patients and caregivers, reduce stigma and provide self-management advice. Such groups should be multidisciplinary and include input from service users.
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Affiliation(s)
- Biba Stanton
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
- Neurology, King's College Hospital, London, UK
| | - Tim Segal
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
| | | | - Mark Edwards
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
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5
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Leroy A, Tarrada A, Garcin B, Hingray C. Crisi psicogene non epilettiche (funzionali/dissociative). Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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6
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Cobb SJ, Vaughn BV, Sagherian K. Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review. J Am Psychiatr Nurses Assoc 2022:10783903221107637. [PMID: 35801259 DOI: 10.1177/10783903221107637] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS An integrative review guided by the Whittemore and Knafl approach. RESULTS The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
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Affiliation(s)
- Sandra J Cobb
- Sandra J. Cobb, MSN, FNP-C, RN, REEGT, PhD in nursing candidate, University of Tennessee Knoxville, College of Nursing, Knoxville, TN, USA
| | - Bradley V Vaughn
- Bradley V. Vaughn, MD, Professor, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Knar Sagherian
- Knar Sagherian, PhD, RN, Assistant Professor, University of Tennessee Knoxville College of Nursing, Knoxville, TN, USA
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Gurcan L, McAllister E, Gilmour J, Green DJ, McFarlane FA, Hadji-Michael M, Heyman I, Stark D. Improved understanding of non-epileptic seizures and reduced emergency health care usage following a single psychoeducational group for children and their parents. Seizure 2022; 101:1-7. [PMID: 35841833 DOI: 10.1016/j.seizure.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
RATIONALE The aim of this study was to evaluate the effectiveness of a three-hour psychoeducation group in improving understanding of non-epileptic seizures (NES), health outcomes and quality of life in young people with NES. BACKGROUND Multi-session psychoeducational groups for adults with NES have reported improved psychosocial functioning and reduced NES compared to those who do not receive psychoeducational interventions. To date there have been no studies in young people examining the effects of a single session of psychoeducation. METHOD 15 young people with NES and their families attended a psychoeducation group within a specialist hospital following a multidisciplinary assessment. The group's effectiveness was evaluated in terms of perceptions of seizure controllability, seizure severity, the management of the condition and health-related quality of life measures. RESULTS A significant decrease in accident and emergency (A&E) visits and ambulance call outs was observed following the psychoeducation group. Young people additionally reported increased knowledge of NES and ability to cope with the condition which was maintained at 6-week follow-up. Significant reduction in NES occurrence or quality of life was not observed. CONCLUSION Significant reduction in A&E attendance and ambulance use was found following group psychoeducation and improvements in psychosocial functioning and knowledge about NES. Group psychoeducation has the potential to increase child and parental understanding of NES and reduce inappropriate healthcare usage.
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Affiliation(s)
- Lara Gurcan
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Eve McAllister
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Jane Gilmour
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | | | - Fiona A McFarlane
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Maria Hadji-Michael
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Isobel Heyman
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom.
| | - Daniel Stark
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
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Abstract
Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery-albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.
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Affiliation(s)
- Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Inselspital University Hospital, Bern, and Bern University, Bern, Switzerland
| | - David L Perez
- Divisions of Cognitive Behavioral Neurology and Neuropsychiatry, Functional Neurological Disorder Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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9
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Kotwas I, Arthuis M, Cermolacce M, Bartolomei F, McGonigal A. Psychogenic non-epileptic seizures: Chronology of multidisciplinary team approach to diagnosis and management. Rev Neurol (Paris) 2021; 178:692-702. [PMID: 34980511 DOI: 10.1016/j.neurol.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
While the diagnosis and management of psychogenic non-epileptic seizures (PNES) remain challenging, certain evidence-based guidelines exist, which can help to optimize patient care. A multidisciplinary team approach appears to have many benefits. Current recommendations exist for some aspects of diagnosis and management of PNES, including levels of diagnostic certainty as proposed by the International League Against Epilepsy's expert Task Force on PNES. Other aspects of clinical still care lack clear consensus, including use of suggestion techniques for recording PNES and optimal terminology, since the term "functional seizures" has recently been proposed as a possible term to replace "PNES". The present article aims to (1) review current recommendations and (2) discuss our own team's experience in managing patients with PNES. This is organized chronologically in terms of the roles of the neurologist, psychiatrist and psychologist, and discusses diagnostic issues, psychiatric assessment and treatment, and psychotherapeutic approaches.
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Affiliation(s)
- I Kotwas
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Arthuis
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Cermolacce
- University Department of Psychiatry, AP-HM, Sainte-Marguerite Hospital, Marseille, France
| | - F Bartolomei
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - A McGonigal
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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10
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Goldstein LH, Robinson EJ, Mellers JDC, Stone J, Carson A, Chalder T, Reuber M, Eastwood C, Landau S, McCrone P, Moore M, Mosweu I, Murray J, Perdue I, Pilecka I, Richardson MP, Medford N. Psychological and demographic characteristics of 368 patients with dissociative seizures: data from the CODES cohort. Psychol Med 2021; 51:2433-2445. [PMID: 32389147 PMCID: PMC8506352 DOI: 10.1017/s0033291720001051] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology. METHODS Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic). RESULTS Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men. CONCLUSIONS Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
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Affiliation(s)
- Laura H. Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Emily J. Robinson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
- King's College London, School of Population Health and Environmental Sciences, UK
| | | | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Carole Eastwood
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Sabine Landau
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Paul McCrone
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Michele Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK
| | - Iris Mosweu
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Izabela Pilecka
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Mark P. Richardson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Nick Medford
- South London and Maudsley NHS Foundation Trust, London, UK
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Agarwal R, Gathers-Hutchins L, Stephanou H. Psychogenic non-epileptic seizures in children. Curr Probl Pediatr Adolesc Health Care 2021; 51:101036. [PMID: 34373198 DOI: 10.1016/j.cppeds.2021.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychogenic Non-Epileptic Seizures (PNES) are a relatively common condition in children. While their clinical presentation resembles epileptic seizures, the underlying cause for PNES involves a multitude of bio-psychosocial factors. Patients may be misdiagnosed with epilepsy and subjected to unnecessary treatments, often delaying the diagnosis for years. A strong understanding of its symptomatology is essential for diagnosis of PNES. Successful management depends on effective teamwork that involves the neurologist as well as mental health professionals. This paper reviews the various aspects of PNES in children with emphasis on the clinical presentation, diagnosis as well as the underlying psychological basis and treatment.
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Affiliation(s)
- Rajkumar Agarwal
- Division of Neurology, Dayton Children's Hospital, Dayton, Ohio, USA; Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA.
| | - Latisha Gathers-Hutchins
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA; Division of Psychology, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Hara Stephanou
- Department of School Psychology, Doctoral Student, St. John's University, New York City, New York, USA
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12
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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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13
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Cope SR, Smith JG, Edwards MJ, Holt K, Agrawal N. Enhancing the communication of functional neurological disorder diagnosis: a multidisciplinary education session. Eur J Neurol 2020; 28:40-47. [PMID: 32918317 DOI: 10.1111/ene.14525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Functional neurological disorder (FND) is a common diagnosis within neurology. Effective communication of the diagnosis is known to be an important part of treatment and can result in reduction or cessation of symptoms, as well as decreased healthcare utilisation. A single group education session, facilitated by professionals commonly involved in the care of patients with FND, was developed to further enhance patients' and relatives' understanding and acceptance of diagnosis. METHODS Patients and relatives attending a single education session were asked to complete self-report ratings of understanding of diagnosis, acceptance of diagnosis, belief in treatability and hopefulness regarding recovery, at the beginning and end of the session. Satisfaction data were also collected. RESULTS Data were obtained from 193 patients and 153 relatives. Patients had experienced a median duration of symptoms of 4 years, and more than 80% of patients reported more than one functional neurological symptom. There were significant increases in terms of understanding, acceptance, belief in treatability and hopefulness for patients and relatives. Effect sizes ranged from large for improved understanding of FND to small-to-medium for increased agreement with FND diagnosis. High levels of satisfaction were also reported. CONCLUSIONS A multidisciplinary, single group education session is an effective and acceptable method of increasing understanding and acceptance of an FND diagnosis, even for patients with a long duration of symptoms and high symptom burden. It could help improve readiness for further treatment.
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Affiliation(s)
- S R Cope
- Department of Neuropsychiatry, South West London and St. George's Mental Health National Health Service Trust, London, UK
| | - J G Smith
- Population Health Research Institute, St. George's, University of London, London, UK
| | - M J Edwards
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK.,Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - K Holt
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - N Agrawal
- Department of Neuropsychiatry, South West London and St. George's Mental Health National Health Service Trust, London, UK.,Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
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LaFrance WC, Ho WLN, Bhatla A, Baird GL, Altalib HH, Godleski L. Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth. Epilepsia 2020; 61:2572-2582. [PMID: 33015831 DOI: 10.1111/epi.16689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies have shown the effectiveness of manual-based treatment for psychogenic nonepileptic seizures (PNES), but access to mental health care still remains a problem, especially for patients living in areas without medical professionals who treat conversion disorder. Thus, we evaluated patients treated with cognitive behavioral therapy-informed psychotherapy for seizures with clinical video telehealth (CVT). We evaluated neuropsychiatric and seizure treatment outcomes in veterans diagnosed with PNES seen remotely via telehealth. We hypothesized that seizures and comorbidities will improve with treatment. METHODS This was a single-arm, prospective, observational, cohort, consecutive outpatient study. Patients with video-electroencephalography-confirmed PNES (n = 32) documented their seizure counts daily and comorbid symptoms prospectively over the course of treatment. Treatment was provided using a 12-session manual-based psychotherapy treatment given once per week, via CVT with a clinician at the Providence Veterans Affairs Medical Center. RESULTS The primary outcome, seizure reduction, was 46% (P = .0001) per month over the course of treatment. Patients also showed significant improvements in global functioning (Global Assessment of Functioning, P = < .0001), quality of life (Quality of Life in Epilepsy Inventory-31, P = .0088), and health status scales (Short Form 36 Health Survey, P < .05), and reductions in both depression (Beck Depression Inventory-II, P = .0028) and anxiety (Beck Anxiety Inventory, P = .0013) scores. SIGNIFICANCE Patients with PNES treated remotely with manual-based seizure therapy decreased seizure frequency and comorbid symptoms and improved functioning using telehealth. These results suggest that psychotherapy via telehealth for PNES is a viable option for patients across the nation, eliminating one of the many barriers of access to mental health care.
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Affiliation(s)
- William Curt LaFrance
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wing Lam Natalie Ho
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Alana Bhatla
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Grayson L Baird
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA.,Department of Biostatistics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hamada Hamid Altalib
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
| | - Linda Godleski
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
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15
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Sarudiansky M, Pablo Korman G, Lanzillotti AI, Areco Pico MM, Tenreyro C, Paolasini GV, Wolfzun C, Kochen S, D'Alessio L, Myers L. Report on a psychoeducational intervention for psychogenic non-epileptic seizures in Argentina. Seizure 2020; 80:270-277. [PMID: 32475751 DOI: 10.1016/j.seizure.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To examine the effects of a three-session psychoeducational intervention on patients diagnosed with psychogenic non-epileptic seizures (PNES) in an Argentinian public hospital. It was hypothesized that patients would experience improvements in their understanding of PNES, illness perception and affective scores, but might not necessarily experience a significant change in post-traumatic and dissociative symptoms and in seizure frequency. METHODS This study included 12 patients (10 women, 2 men) who were invited to participate in a psychoeducational group after receiving a V-EEG confirmed diagnosis of PNES. The group consisted of 3 sessions lasting 2 h each. Pre and post measures included Psychoeducational Intervention Questionnaire, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Brief Illness Perception Questionnaire, Posttraumatic Stress Disorder Diagnostic Scale 5, Dissociative Experiences Scale (DES-M). RESULTS This psychoeducational intervention produced results that were similar to interventions reported in US and European studies with regard to changes on psychological measures. Moreover, many patients also reported (on the final day of the intervention) a decrease in seizure frequency. All patients reported that participating in the intervention was a positive experience. Also, all but one patient referred that the participation in the group would have a positive impact on their quality of life. CONCLUSIONS Psychoeducational interventions appear to have had positive results in Argentinian patients with PNES. This is initial step in the design of empirically based psychoeducational/supportive initiatives for patients in South America.
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Affiliation(s)
- Mercedes Sarudiansky
- CAEA, CONICET, Buenos Aires, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | - Guido Pablo Korman
- CAEA, CONICET, Buenos Aires, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | | | - María Marta Areco Pico
- CAEA, CONICET, Buenos Aires, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | | | | | - Camila Wolfzun
- Facultad de Psicología, Universidad de Buenos Aires, Argentina
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16
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Libbon R, Gadbaw J, Watson M, Rothberg B, Sillau S, Heru A, Strom L. The feasibility of a multidisciplinary group therapy clinic for the treatment of nonepileptic seizures. Epilepsy Behav 2019; 98:117-123. [PMID: 31369968 DOI: 10.1016/j.yebeh.2019.06.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
A high percentage of patients presenting to epilepsy centers have a functional neurological disorder with apparent seizures, ultimately diagnosed as nonepileptic seizures (NES). Meta-analyses suggest that psychological treatment is required, but this treatment is not reliably available, resulting in reentry of these patients to neurology clinics and urgent care settings, reducing access for these services to patients with epilepsy and resulting in inadequate psychological care for patients with NES. A sustainable, group therapy-focused treatment clinic for patients with NES was developed as a combined effort between the departments of neurology and psychiatry at the University of Colorado Hospital, consisting of a full psychiatric evaluation, a five-week psychoeducational group, a 12-week psychodynamic therapy group, individual therapy, medication management, and family assessment. One hundred and six patients were treated in this clinic between July 2016 and October 2018. Patient retention after referral for treatment was 89/136 (65.4%), and group therapy adherence was 89/106 (84.0%). Healthcare utilization, used as a proxy to demonstrate worth, decreased during and after treatment. Analysis of the 106 treated patients elucidates other clinical characteristics of this population, including psychiatric comorbidities and specific medication classes at time of NES diagnosis. We conclude that this clinic model is feasible for recruiting, retaining, and engaging patients in appropriate treatment for their NES.
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Affiliation(s)
- Randi Libbon
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Jacob Gadbaw
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Meagan Watson
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Brian Rothberg
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Stefan Sillau
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Alison Heru
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Laura Strom
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, United States of America
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17
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Coping with stress: A pilot study of a self-help stress management intervention for patients with epileptic or psychogenic nonepileptic seizures. Epilepsy Behav 2019; 94:169-177. [PMID: 30959274 DOI: 10.1016/j.yebeh.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Many patients with epilepsy or psychogenic nonepileptic seizures (PNES) experience high levels of stress. Although psychological interventions have been developed for seizure disorders, few patients can currently access them. We aimed to assess the acceptability and feasibility of a self-help intervention targeting stress in patients with seizures, and to provide preliminary evidence for its effectiveness. METHOD Patients were recruited from outpatient neurology clinics and randomized to an immediate intervention group (n = 39), who received the intervention at baseline, or a delayed intervention group (n = 43), who received the intervention one-month postbaseline. Participants completed self-report questionnaires measuring stress (Smith Stress Symptom Inventory [SSSI]), anxiety (Generalized Anxiety Disorder 7-item Scale [GAD-7]), depression (Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]), quality of life (European Quality of Life - 5 Dimensions [EQ-5D]), and seizure severity and frequency (Liverpool Seizure Severity Scale [LSSS-3]) at baseline, and at one- and two-month follow-up. Participants also provided telephone feedback. The intervention consisted of a self-help stress management workbook based on an integrative stress model framework. RESULTS Although the rate of participants failing to return follow-up information at two months was approximately 50%, those who completed the trial found the intervention acceptable; with the majority rating it as helpful (63.6%) and that they would recommend it to others with seizures (88.1%). A significant reduction in self-reported stress (P = .01) with a medium effect size (dz = 0.51) was observed one-month postintervention. There were no significant changes in any other measures. CONCLUSION The intervention was perceived to be acceptable, safe, and helpful by participants. It could be a useful complementary treatment option for reducing stress experienced by patients living with seizure disorders. Further evaluation in a larger trial is warranted.
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18
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Tolchin B, Baslet G, Suzuki J, Martino S, Blumenfeld H, Hirsch LJ, Altalib H, Dworetzky BA. Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures. Epilepsia 2019; 60:986-995. [DOI: 10.1111/epi.14728] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin Tolchin
- Department of NeurologyComprehensive Epilepsy CenterYale University School of Medicine New Haven Connecticut
- Epilepsy Center of Excellence, Neurology ServiceVeterans Administration Connecticut Healthcare System West Haven Connecticut
- Department of NeurologyBrigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Gaston Baslet
- Department of PsychiatryBrigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Joji Suzuki
- Department of PsychiatryBrigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Steve Martino
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
- Psychology ServiceVeterans Administration Connecticut Healthcare System West Haven Connecticut
| | - Hal Blumenfeld
- Department of NeurologyComprehensive Epilepsy CenterYale University School of Medicine New Haven Connecticut
| | - Lawrence J. Hirsch
- Department of NeurologyComprehensive Epilepsy CenterYale University School of Medicine New Haven Connecticut
| | - Hamada Altalib
- Department of NeurologyComprehensive Epilepsy CenterYale University School of Medicine New Haven Connecticut
- Epilepsy Center of Excellence, Neurology ServiceVeterans Administration Connecticut Healthcare System West Haven Connecticut
- Department of PsychiatryYale University School of Medicine New Haven Connecticut
| | - Barbara A. Dworetzky
- Department of NeurologyBrigham and Women's HospitalHarvard Medical School Boston Massachusetts
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19
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Reuber M. Dissociative (non-epileptic) seizures: tackling common challenges after the diagnosis. Pract Neurol 2019; 19:332-341. [DOI: 10.1136/practneurol-2018-002177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/17/2019] [Accepted: 01/28/2019] [Indexed: 11/03/2022]
Abstract
Dissociative (non-epileptic) seizures are one of the three major causes of transient loss of consciousness. As such, their treatment cannot be left to superspecialised experts. In this article I draw on personal experience to suggest ways to tackle some challenges that commonly arise after diagnosing dissociative seizures, focusing on three issues: “I want to know what is wrong with me,” “I hear what you are saying but it doesn’t apply to me” and “What if I have a seizure?” The suggestions detail both actions and words that may help at a crucial point in the patient’s journey. If handled well, the process can leave the patient better equipped to understand their seizures and to engage in further treatment; if handled badly, patients may be left more traumatised, angry and with additional disability.
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20
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Rawlings GH, Brown I, Stone B, Reuber M. Written accounts of living with psychogenic nonepileptic seizures: A thematic analysis. Seizure 2017. [PMID: 28633044 DOI: 10.1016/j.seizure.2017.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Qualitative studies examining lived experiences of psychogenic nonepileptic seizures (PNES) have predominantly relied on datasets collected using clinical or research interviews. This study pursued a different approach by investigating individuals' written accounts of their condition. METHODS Participants (n=19) were recruited from membership-led organisations for individuals living with seizures and from a United Kingdom hospital. Participants were instructed to produce four pieces of writing: 1) about their thoughts and feelings about their condition; 2) a letter to their condition; 3) a letter to their younger self; and 4) about a personal value. All writings were analysed using thematic analysis. RESULTS Six main-themes emerged from the data. Theme 1: 'living with PNES' demonstrated that all participants presented the condition as having a debilitating effect. Theme 2: 'Emotions' revealed that individuals were struggling with anxiety, low mood and self-worth. Theme 3: 'Seizure symptoms' showed variability was a prominent feature in the description of ictal events. Theme 4: 'Treatment and outcomes' demonstrated that individual's perception of diagnosis and therapy differed greatly. Theme 5: 'Causation and development' revealed that the majority of participants spontaneously reported experiencing a traumatic event in the past. Theme 6: 'Lack of understanding' by themselves, the public and healthcare professionals appeared to pose considerable challenges to participants. CONCLUSIONS Qualitative research has an important role to play for improving our understanding of PNES. The findings contribute to the literature by highlighting the nature of stigma that people with PNES experience, and also their proneness to demonstrate problems with self-worth.
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Affiliation(s)
| | - Ian Brown
- Department of Psychology, University of Sheffield, UK.
| | | | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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21
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Cope SR, Smith JG, King T, Agrawal N. Evaluation of a pilot innovative cognitive-behavioral therapy-based psychoeducation group treatment for functional non-epileptic attacks. Epilepsy Behav 2017; 70:238-244. [PMID: 28454061 DOI: 10.1016/j.yebeh.2017.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/26/2022]
Abstract
A high proportion of patients presenting at epilepsy clinics experience functional non-epileptic attacks (FNEA), and while psychological treatment is generally thought to be the required intervention, evidence regarding psychological treatment of FNEA is limited. A small number of psychoeducation treatments have been evaluated, with promising results. As part of routine care within a neuropsychiatry service, a 3-session cognitive-behavior therapy- (CBT-) informed psychoeducation group was developed. Patients with comorbid epilepsy were included. The group's effectiveness was evaluated in terms of attack frequency, mood, illness perception, dissociative experiences, and patient feedback. Pre- and post-treatment data were obtained for 19 patients. The proportion of patients experiencing attacks significantly decreased, with almost 40% of treatment completers reporting being attack-free at the end of treatment. Significant improvements were also found on level of psychological distress, illness beliefs, and understanding of the condition. No significant changes in mood or general functioning were observed. High satisfaction was reported by almost all patients. Treatment outcome was not significantly affected by the level of dissociative experiences. The results suggest that CBT-based psychoeducation group treatment can be a beneficial part of treatment for those with FNEA, even for those experiencing high levels of dissociation. Further controlled studies with larger sample sizes are required.
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Affiliation(s)
- Sarah R Cope
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Tara King
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Niruj Agrawal
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK; Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
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22
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Rawlings GH, Brown I, Reuber M. Predictors of health-related quality of life in patients with epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 2017; 68:153-158. [PMID: 28189920 DOI: 10.1016/j.yebeh.2016.10.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Epilepsy and psychogenic nonepileptic seizures (PNES) are associated with reduced health-related quality of life (HRQoL). The present study investigated the profile, relationship, and predictive power of illness perceptions, psychological distress (depression and anxiety), seizure activity, and demographic factors on HRQoL in these patient groups. Patients with epilepsy (n=62) and PNES (n=45) were recruited from a United Kingdom hospital and from membership-led organizations for individuals living with seizures. Patients completed a series of self-report questionnaires assessing: anxiety (GAD-7), depression (NDDI-E), illness perceptions (B-IPQ), HRQoL (NEWQOL-6D), and seizure frequency and severity (LSSS-3). Correlational and hierarchical multiple regression analyses were conducted. Patients with epilepsy reported higher HRQoL and scored lower on measures of depression and anxiety. Patients with PNES perceived their condition as more threatening overall. In both conditions, HRQoL was negatively correlated with more severe illness perceptions and psychological distress. In epilepsy and PNES, psychological distress (epilepsy: 27%; PNES: 24.8%) and illness perceptions (epilepsy: 23.1%; PNES: 23.3%) accounted for the largest amount of variance in HRQoL. Clinical factors were found not to be significant predictors, while demographic factors predicted HRQoL in epilepsy (12.6%), but not in PNES. Our findings support the notion that psychological factors are a stronger predictor of HRQoL in epilepsy and PNES than condition-related and demographic variables. Prior research suggests that anxiety and depression are key predictors of HRQoL; this study demonstrates that the relationship between illness perceptions and HRQoL is similarly close. These findings highlight the importance of addressing patients' beliefs about their condition.
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Affiliation(s)
| | - Ian Brown
- Department of Psychology, University of Sheffield, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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23
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Carlson P, Nicholson Perry K. Psychological interventions for psychogenic non-epileptic seizures: A meta-analysis. Seizure 2017; 45:142-150. [DOI: 10.1016/j.seizure.2016.12.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 01/25/2023] Open
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Saal DP, Overdijk MJ, Thijs RD, van Vliet IM, van Dijk JG. Long-term follow-up of psychogenic pseudosyncope. Neurology 2016; 87:2214-2219. [PMID: 27784771 DOI: 10.1212/wnl.0000000000003361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis. METHODS This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis. RESULTS Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated. Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p = 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions decreased from 19 of 35 to 0 of 35 (p = 0.002). The use of somatic and mental health care shifted toward the latter (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36) showed lower scores for 7 of 8 domains compared to matched Dutch control values; quality of life was not influenced by attack freedom. CONCLUSIONS After communication of the diagnosis in PPS, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines that PPS is a serious condition.
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Affiliation(s)
- Dirk P Saal
- From the Departments of Neurology and Clinical Neurophysiology (D.P.S., J.G.v.D.) and Psychiatry (I.M.v.V.), Leiden University Medical Center; Department of Neurology (M.J.O.), Medical Center Haaglanden, The Hague; and Stichting Epilepsie Instellingen Nederland (R.D.T.), Heemstede, the Netherlands
| | - M Jolein Overdijk
- From the Departments of Neurology and Clinical Neurophysiology (D.P.S., J.G.v.D.) and Psychiatry (I.M.v.V.), Leiden University Medical Center; Department of Neurology (M.J.O.), Medical Center Haaglanden, The Hague; and Stichting Epilepsie Instellingen Nederland (R.D.T.), Heemstede, the Netherlands
| | - Roland D Thijs
- From the Departments of Neurology and Clinical Neurophysiology (D.P.S., J.G.v.D.) and Psychiatry (I.M.v.V.), Leiden University Medical Center; Department of Neurology (M.J.O.), Medical Center Haaglanden, The Hague; and Stichting Epilepsie Instellingen Nederland (R.D.T.), Heemstede, the Netherlands
| | - Irene M van Vliet
- From the Departments of Neurology and Clinical Neurophysiology (D.P.S., J.G.v.D.) and Psychiatry (I.M.v.V.), Leiden University Medical Center; Department of Neurology (M.J.O.), Medical Center Haaglanden, The Hague; and Stichting Epilepsie Instellingen Nederland (R.D.T.), Heemstede, the Netherlands
| | - J Gert van Dijk
- From the Departments of Neurology and Clinical Neurophysiology (D.P.S., J.G.v.D.) and Psychiatry (I.M.v.V.), Leiden University Medical Center; Department of Neurology (M.J.O.), Medical Center Haaglanden, The Hague; and Stichting Epilepsie Instellingen Nederland (R.D.T.), Heemstede, the Netherlands.
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25
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Russell LA, Abbass AA, Allder SJ, Kisely S, Pohlmann-Eden B, Town JM. A pilot study of reduction in healthcare costs following the application of intensive short-term dynamic psychotherapy for psychogenic nonepileptic seizures. Epilepsy Behav 2016; 63:17-19. [PMID: 27541836 DOI: 10.1016/j.yebeh.2016.07.017] [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: 06/16/2016] [Revised: 07/10/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to examine preliminary evidence of intensive short-term dynamic psychotherapy (ISTDP) as a treatment option for psychogenic nonepileptic seizures (PNES) in terms of impact on healthcare costs, emotional wellbeing, and somatic symptoms. METHOD Drawn from a sample of patients treated in a tertiary psychiatric service over a nine-year period, this naturalistic pilot study compared within-group changes from pretreatment with each year up to three years posttreatment, in physician visits, physician costs, hospital admissions, and overall hospital costs. RESULTS Twenty-eight patients with PNES received ISTDP with average treatment duration of 3.6 sessions. Healthcare costs significantly reduced in follow-up compared with those in baseline, with patient costs falling below the healthy population means, and reductions in healthcare costs compared with those in baseline by 88% in year one, 90% in year two, and 81% in year three. This was accompanied by significant reductions in symptoms and interpersonal problems. CONCLUSION These preliminary findings indicate the potential for short-term and long-term healthcare savings and improvements in emotional wellbeing, for patients with PNES from the application of ISTDP. Further research evaluating the impact of ISTDP on seizure reduction and comparing this approach with control conditions is warranted.
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Affiliation(s)
- Leo A Russell
- Clinical and Community Psychology Services, Devon Partnership NHS Trust, Exeter, UK.
| | - Allan A Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Steve Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Bernd Pohlmann-Eden
- Epilepsy Program, Division of Neurology, Dalhousie University, Halifax, Canada
| | - Joel M Town
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, England
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26
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A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment. Epilepsy Behav 2016; 63:50-56. [PMID: 27565438 DOI: 10.1016/j.yebeh.2016.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/19/2016] [Accepted: 07/24/2016] [Indexed: 11/20/2022]
Abstract
RATIONALE The aim of this study was to add to our understanding of the impact of psychoeducation on patients' acceptance of the diagnosis of psychogenic nonepileptic seizures (PNESs), the frequency of their seizures, and their quality of life. The study also aimed to evaluate the effectiveness of brief manualized psychoeducation interventions for PNESs, delivered by a more diverse range of clinicians and in a wider range of treatment settings. METHOD The final sample consisted of 25 patients diagnosed with PNESs by a neurologist specializing in the treatment of seizure disorder and referred to the psychotherapy service. The study included patients from four centers, using a manualized psychoeducation intervention delivered over 4 sessions by specialist epilepsy nurses and assistant psychologists. All patients completed self-measure questionnaires for Seizure Frequency, Impaired Functioning (WSAS), Psychological Distress (CORE-OM), Illness Perception (BIPQ), Health-Related Quality of Life: general (ED-QOL) and epilepsy-specific (NewQOL-6D), Symptom Attribution, and patient's perception of usefulness and relevance of the intervention. All measures were collected at baseline and after the completion of the fourth session. RESULTS All measures improved from baseline to postintervention, but this improvement was only significant for CORE-OM (p<.05) and BIPQ (p<.01). Out of the 25 patients who completed the intervention information, 6 out of 25 (24%) had been seizure-free for the past month, and an additional 6 out of 25 (24%) had achieved seizure frequency reduction. Consequently, upon completion of the intervention, 12 out of 25 patients (48%) were either seizure-free or experienced fewer seizures compared with the start of the intervention. CONCLUSION The evidence suggests that brief manualized psychoeducation intervention can reduce PNES frequency, improve the psychological distress, and have an effect on patients' illness perceptions that should help them engage with a more extended psychotherapy program if that was necessary. The intervention was carried out successfully by staff with relatively little training in delivering psychological interventions. Further controlled studies are required to provide proof of efficacy.
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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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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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Sarma AK, Khandker N, Kurczewski L, Brophy GM. Medical management of epileptic seizures: challenges and solutions. Neuropsychiatr Dis Treat 2016; 12:467-85. [PMID: 26966367 PMCID: PMC4771397 DOI: 10.2147/ndt.s80586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical-psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and "pseudoseizure" patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.
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Affiliation(s)
- Anand K Sarma
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nabil Khandker
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lisa Kurczewski
- Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen M Brophy
- Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
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Psychogenic Non-epileptic Seizures: An Updated Primer. PSYCHOSOMATICS 2016; 57:1-17. [DOI: 10.1016/j.psym.2015.10.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/10/2015] [Accepted: 10/12/2015] [Indexed: 11/18/2022]
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Goldstein LH, Mellers JDC. Psychologic treatment of functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:571-583. [PMID: 27719872 DOI: 10.1016/b978-0-12-801772-2.00046-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The management of patients with functional neurologic disorders poses many challenges. Psychologic treatments may well start at the point of delivery of the diagnosis, when careful explanations about the nature of the disorder have to be given to the patient and possibly also relatives/carers. Different conceptual models may assist in explaining the factors underlying the presentation, two of which (functional and dissociative) are briefly outlined here. The challenges for neurologists and psychiatrists of delivering a psychologic formulation as part of the diagnosis delivery are considered, along with the importance of clear communication between professionals involved in the patient's care. Existing literature on treatments incorporating psychologic components suggests that, despite limitations in the study designs and the potential bias in some outcome evaluations, there is evidence to support the use of psychologic interventions for at least some functional neurologic disorders, although larger and better-designed studies are required in this area.
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Affiliation(s)
- L H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - J D C Mellers
- Department of Neuropsychiatry, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
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Hubschmid M, Aybek S, Maccaferri GE, Chocron O, Gholamrezaee MM, Rossetti AO, Vingerhoets F, Berney A. Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks. Gen Hosp Psychiatry 2015; 37:448-55. [PMID: 26099544 DOI: 10.1016/j.genhosppsych.2015.05.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.
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Affiliation(s)
- M Hubschmid
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - S Aybek
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - G E Maccaferri
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - O Chocron
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - M M Gholamrezaee
- Department of Psychiatry, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - A O Rossetti
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - F Vingerhoets
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
| | - A Berney
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Rue du Bugnon 44, 1011 Lausanne, Switzerland.
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Wiseman H, Reuber M. New insights into psychogenic nonepileptic seizures 2011-2014. Seizure 2015; 29:69-80. [PMID: 26076846 DOI: 10.1016/j.seizure.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/24/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE There has been a rapid increase in the rate of publications about psychogenic nonepileptic seizures (PNES). This review summarises insights from the 50 most important original articles about PNES published since 2011 and describes the advances made in the understanding of PNES over the last 3 years. METHOD We carried out a systematic literature search of all English language publications about PNES published between October 2011 and October 2014 on Scopus, Ovid Medline and Web of Knowledge, and inspected all abstracts. Having excluded all review articles, case reports, conference abstracts, articles exploring PNES in children, and articles not actually focussing on PNES, we considered 150 papers for inclusion in this review. We assessed the quality of the identified studies and used expert judgement to identify the 50 most important publications from the review period and composed a narrative review based on these original papers. RESULTS Almost one half of the studies initially identified only provided Class 4 evidence. Recent work has provided more support for a biopsychosocial account of PNES. It has illustrated the heterogeneity of PNES, identifying varying and distinct psychological profiles of individuals with this disorder. These findings suggest that intervention needs to be flexible or adaptive if it is appropriately to target the different mechanisms which may give rise to PNES. Several educational and psychotherapeutic interventions for PNES have been described, but sufficiently powered randomised controlled trials are yet to be undertaken. Recent research using social, economic and quality of life indicators has provided further evidence of the societal and individual burden of PNES. CONCLUSION The research into PNES published over the last 3 years has deepened our understanding of the condition as a biopsychosocial disorder which is neither a "physical" nor a "psychological" condition. A number of small studies have demonstrated the potential of educational and psychotherapeutic treatments, but rigorous and sufficiently large trials still need to be conducted to determine the effectiveness of these interventions.
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Affiliation(s)
- Hannah Wiseman
- Academic Neurology Unit, University of Sheffield, United Kingdom.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, United Kingdom
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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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Baslet G, Dworetzky B, Perez DL, Oser M. Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clin EEG Neurosci 2015; 46:54-64. [PMID: 25465435 PMCID: PMC4552047 DOI: 10.1177/1550059414557025] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) were first described in the medical literature in the 19th century, as seizure-like attacks not related to an identified central nervous system lesion, and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment, and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less well-studied using controlled and uncontrolled trials. Within the discussion of acute interventions, we present a preliminary evaluation for feasibility of a mindfulness-based psychotherapy protocol in a very small sample of PNES patients. We demonstrated in 6 subjects that this intervention is feasible in real-life clinical scenarios and warrants further investigation in larger scale studies. The final treatment phase is long-term follow-up. Long-term outcome studies in PNES show that a significant proportion of patients remains symptomatic and experiences continued impairments in quality of life and functionality. We believe that PNES should be understood as a disease that requires different types of intervention during the various phases of treatment.
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Affiliation(s)
- Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Barbara Dworetzky
- Harvard Medical School, Boston, MA, USA Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - David L Perez
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Neurology, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Abstract
Psychogenic nonepileptic seizures (PNES) are events commonly encountered by primary care physicians, neurologists, pediatricians, and emergency medicine physicians in their practices, yet there continues to be significant variability in the way they are evaluated, diagnosed, and treated. Lack of understanding this condition and limited data on long-term outcome from current treatment paradigms have resulted in an environment with iatrogenic injury, morbidity, and significant costs to the patient and healthcare system. This article will review the current state of research addressing PNES treatment both in the adult and pediatric populations.
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Sadjadi R, Quigg M. Simultaneous nonepileptic spells and nonorganic hearing loss: A case of comorbid psychogenic symptoms. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:46-8. [PMID: 25667868 PMCID: PMC4307956 DOI: 10.1016/j.ebcr.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
A twenty-eight-year-old woman with an eight-year history of partial hearing loss presented with a two-year history of worsening deafness and new-onset seizures. Evaluations of tympanic membranes, cochlea, and auditory brain stem reflexes demonstrated no physiologic basis for deafness. Video-EEG monitoring demonstrated that the patient responded normally to spontaneous auditory stimuli and that typical spells were nonepileptic in origin. Although pseudohypacusis is reported in audiology literature, and psychogenic nonepileptic spells are well-studied phenomena in neurology literature, the present case is an unusual case of dual psychogenic symptoms, a relationship that indicates poorer prognosis.
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Affiliation(s)
| | - Mark Quigg
- Corresponding author at: Box 800394, Dept. of Neurology, University of Virginia, Charlottesville, VA 22902, USA. Fax: + 1 434 982 1726.
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