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Xing Y, Wang J, Yin X, Fan Z, Luan S, Sun F. Optimizing electroencephalogram duration for efficient detection of epileptiform abnormalities in diverse patient groups: a retrospective study. BMC Neurol 2024; 24:285. [PMID: 39143558 PMCID: PMC11323660 DOI: 10.1186/s12883-024-03796-9] [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: 12/19/2023] [Accepted: 08/09/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND There is no standardized EEG duration guideline for detecting epileptiform abnormalities in patients, and research on this topic is scarce. This study aims to determine an optimal EEG duration for efficient detection of epileptiform abnormalities across different patient groups. METHODS Retrospective analysis was performed on EEG recordings and clinical data of patients with the first seizure and epilepsy. Patients were categorized based on various factors, including the interval time since the last seizure, use of anti-seizure medication (ASM), and seizure frequency. The detection ratio (DR) of epileptiform abnormalities and latency time for their discovery were calculated. Statistical analyses, including chi-square tests, logistic regression, and survival analysis were utilized to illustrate DR and latency times. RESULTS In whole-night EEG recordings, the DR was 37.6% for the first seizure group and 57.4% for the epilepsy group. Although the maximum latency times were 720 min in both two groups, DR in the first seizure group was distinctly decreased beyond 300 min. Significant factors influencing the DR included the use of ASM in the first seizure group (P < 0.05) and seizure frequency in the epilepsy group (P < 0.001). For epilepsy patients who experience a seizure at least once a month or undergo timely EEG recordings (within 24 h after a seizure), the DR significantly increases, and the maximum latency time is reduced to 600 min (P < 0.001). Additionally, the DR was significantly reduced after 240 min in epilepsy patients who had been seizure-free for more than one year. CONCLUSIONS In this retrospective study, we observed a maximum latency of 720 min for detecting epileptiform abnormalities in whole-night EEG recordings. Notably, epilepsy patients with a higher seizure frequency or timely EEG recordings demonstrated both a higher detection ratio and a shorter maximum latency time. For patients exhibiting a low detection ratio, such as those experiencing their first seizure or those with epilepsy who have been seizure-free for more than a year, a shorter EEG duration is recommended. These findings underscore the importance of implementing customized EEG strategies to meet the specific needs of different patient groups.
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Affiliation(s)
- Yinxue Xing
- Neurology Department, Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China.
| | - Jing Wang
- Neurology Department, Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China
| | - Xiaoqian Yin
- Imaging Department, Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China
| | - Zhiliang Fan
- Neurology Department, Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China
| | - Shaoqun Luan
- Neurology Department, Affiliated Xing Tai People Hospital of Hebei Medical University, Xingtai, China
| | - Fan Sun
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, China
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Walsh G, Wilson CE, Hevey D, Moore S, Flynn C, Breheny E, O'Keeffe F. "This is real", "this is hard" and "I'm not making it up": Experience of diagnosis and living with non-epileptic attack disorder. Epilepsy Behav 2024; 154:109753. [PMID: 38636109 DOI: 10.1016/j.yebeh.2024.109753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To use a qualitative research approach to explore adults' experience of living with non-epileptic attack disorder. OBJECTIVE The objective was to explore the experience of adults (18 years+) with a confirmed diagnosis of non-epileptic attack disorder (NEAD) across the trajectory of the disorder. The topics investigated included the onset of symptoms, the experience of non-epileptic attacks, the diagnostic process and living with NEAD. METHOD Twelve people diagnosed with NEAD who attended a tertiary hospital neurology department took part in semi-structured interviews. The data generated were analysed using reflexive thematic analysis. RESULTS Eleven women and one man with median age of 25 years took part. Three themes were developed: mind-body (dis)connect, a stigmatised diagnosis and a role for containment. Adults spoke about their experience of nonepileptic attacks, the diagnostic and management process and the impact of both nonepileptic attacks and the NEAD diagnosis on their lives. CONCLUSIONS Adults' experience's within the healthcare system across the trajectory of NEAD influenced their own understanding and trust in their NEAD experience, how they shared this with others in their social and work lives and how they managed their NEAD symptoms on a daily basis. The research suggests the need for a consistent, timely implementation of a rule-in diagnostic approach and multi-disciplinary management of NEAD. It is recommended that lessons be taken from theoretical models including the common-sense model and a modified version of the reattribution model to support the de-stigmatisation of this diagnosis to inform psychoeducation and professionally facilitated peer-support groups.
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Affiliation(s)
- Geralynn Walsh
- The School of Psychology, Trinity College Dublin, Ireland.
| | | | - David Hevey
- The School of Psychology, Trinity College Dublin, Ireland
| | - Susan Moore
- St Vincent's University Hospital, Dublin, Ireland
| | - Cora Flynn
- St Vincent's University Hospital, Dublin, Ireland
| | - Erin Breheny
- St Vincent's University Hospital, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- The School of Psychology, Trinity College Dublin, Ireland; St Vincent's University Hospital, Dublin, Ireland; School of Applied Psychology, University College Cork
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3
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María Marta AP, Mercedes S, Alejandra Inés L, Cristina T, Camila W, Luciana DA, Guido Pablo K. Cultural issues: Perspectives and experiences of patients with dissociative seizures in Argentina. Seizure 2023; 106:101-109. [PMID: 36812680 DOI: 10.1016/j.seizure.2023.02.009] [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: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE To explore patients' subjective experience when receiving a diagnosis of Dissociative Seizures (DS) in Buenos Aires, Argentina, and their explanatory models about DS. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 19 patients with DS. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Four main themes emerged: 1) Reactions to the Diagnosis; 2) Ways of Naming the Disease; 3) Own Explanatory Models; 4) External Explanatory Models. CONCLUSIONS This information might help achieve an adequate knowledge of the local characteristics of patients with DS. Most patients could not express any emotions or considerations about being diagnosed with DS, and they related their seizures to a personal or social-emotional conflict and environmental stress; however, family members related patients' seizures to a biological cause. It is important to analyze cultural differences in patients with DS in order to develop appropriate interventions for this specific population.
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Affiliation(s)
- Areco Pico María Marta
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina.
| | - Sarudiansky Mercedes
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Lanzillotti Alejandra Inés
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Tenreyro Cristina
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Wolfzun Camila
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - D' Alessio Luciana
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina; Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Gral. Urquiza 609, C1221ADC, Buenos Aires, Argentina; Buenos Aires University, Medicine School, Cell Biology and Neuroscience Institute (IBCN)- National Council for Scientific and Technical Research (CONICET), Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Korman Guido Pablo
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
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4
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Russell L, Abbass A, Allder S. A review of the treatment of functional neurological disorder with intensive short-term dynamic psychotherapy. Epilepsy Behav 2022; 130:108657. [PMID: 35390566 DOI: 10.1016/j.yebeh.2022.108657] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this article was to raise awareness of an under-recognized but well-supported treatment for Functional Neurological Disorders (FND) termed Intensive Short-term Dynamic Psychotherapy (ISTDP). There has been significant interest in the role of psychological mechanisms in FND onset and maintenance with specific evidence for maladaptive emotional processing. We outline how this supports the theoretical basis for ISTDP as an option in FND treatment and undertake a literature review of the current evidence base. We describe the application of ISTDP to FND illustrated through direct therapy transcripts. We conclude with reflections on the strengths and limitations of ISTDP as well as recommendations regarding future research.
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Affiliation(s)
- Leo Russell
- Clinical Health and Neuropsychology Department, Devon Partnership NHS Trust, Exeter, United Kingdom.
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Steven Allder
- Neurological Services, Re:Cognition Health, London, United Kingdom
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5
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Yeom JS, Bernard H, Koh S. Myths and truths about pediatric psychogenic nonepileptic seizures. Clin Exp Pediatr 2021; 64:251-259. [PMID: 33091974 PMCID: PMC8181023 DOI: 10.3345/cep.2020.00892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mindbody dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.,Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Heather Bernard
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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6
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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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7
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Ganslev CA, Storebø OJ, Callesen HE, Ruddy R, Søgaard U. Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database Syst Rev 2020; 7:CD005331. [PMID: 32681745 PMCID: PMC7388313 DOI: 10.1002/14651858.cd005331.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them. OBJECTIVES To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults. SEARCH METHODS We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial). DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias. MAIN RESULTS We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence). Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence). Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence). Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment. Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence). CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence). Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence). Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17 studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect. AUTHORS' CONCLUSIONS The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
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Affiliation(s)
- Christina A Ganslev
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Ulf Søgaard
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
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Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol 2020; 11:461. [PMID: 32582005 PMCID: PMC7280483 DOI: 10.3389/fneur.2020.00461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4-4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to "dual diagnosis," is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.
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Affiliation(s)
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Camilla Ferrante
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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9
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Psychogenic nonepileptic seizures: Comparing what South African healthcare providers communicate to patients at the point of diagnosis against international guidelines. Epilepsy Behav 2019; 101:106399. [PMID: 31698264 DOI: 10.1016/j.yebeh.2019.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022]
Abstract
The process of communicating a diagnosis of psychogenic nonepileptic seizures (PNES) has been widely studied internationally and found to be an important factor in the reduction of symptoms as well as promoting the uptake of treatment. To date, no research has focused on diagnosis communication in the South African context. This study used applied thematic analysis to explore the content addressed by a sample of 11 South African healthcare providers (HCPs) when presenting a diagnosis of PNES to a patient. The purpose was to investigate the areas of alignment between the international guidelines and what is done in practice and to identify other elements communicated by South African HCPs that were not addressed in the guidelines. The key communication elements described in five international guidelines were grouped into nine main themes, and coding frequencies were used to identify areas of alignment. In general, the practices of the participants aligned closely to the international guidelines. There was close alignment between the guidelines and the practices of HCPs in respect of six themes, namely: that the diagnosis was not epilepsy; how the diagnosis was made; that PNES was a real, debilitating condition; an explanation of possible causes and maintaining factors; that antiepileptic drugs are not effective in treating PNES; and a description of appropriate treatment. Participants suggested four additional subthemes that may be included when presenting a diagnosis: what to do in the event of future seizures; that further investigations are not helpful; enquiry into the link between stressors and seizures; and a discussion about comorbid conditions. Participants noted the value of utilizing a guideline as a means to ensure that all HCPs involved with a patient communicate a consistent message. They emphasized that diagnosis presentation must be relevant to the South African population and discussed the need to tailor explanations for the patient's home language and level of education. Cross-cultural barriers and different cultural health beliefs may require a specially tailored communication approach grounded in a clear cultural understanding.
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10
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Early communication is key - Designing a new communication tool to immediately empower people with psychogenic nonepileptic seizures. Epilepsy Behav 2019; 100:106518. [PMID: 31665693 DOI: 10.1016/j.yebeh.2019.106518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient empowerment and shared decision-making has been increasingly recognized as key factors for a favorable prognosis. This is particularly true in complex brain disorders such as psychogenic nonepileptic seizures (PNES) which go along with several challenges. People with PNES (PW-PNES) often feel lost in the healthcare system. Early clear communication is one of the few favorable prognostic variables. Our goal was to design a new ultrashort user-friendly communication tool allowing immediate patient empowerment. METHODS We conceptualized a design thinking process with patient engagement of PW-PNES. Together with a larger group of PW-PNES, we developed a comprehensive user-friendly 1-page document summarizing the key features of PNES. We applied document engineering (DE) as a cognitive science-based new methodology. Document engineering is well established in the aviation, oil, and mining industries and measurably reduces comprehension and performance errors. RESULTS The design thinking process encompassed 5 phases (empathize, ideate, define, prototype, and test). A prototype of a 1-page document, the 1-Pager-PNES, was created which contained the essential 7 domains organized in a simple structure such as a promise-question-answer (PQA) format. Information was kept poignant, complete, easy-to-read integrating cognitive principles to optimize navigation. The prototype "1-Pager-PNES" was subsequently tested in a 7-member focus group. All patients expressed significant improvement in understanding their disease and felt immediately empowered. Implementing their specific feedbacks, reiterative testing, and involving PNES experts resulted in the final version of the "1-Pager-PNES". CONCLUSION A promising new communication tool reduced to 1-page only is introduced which improves patient guidance and enables better coping mechanisms with this complex disease. The patient/user is empowered quickly through finding answers to pressing questions. Our study is unique for three reasons: 1) it engaged patients in the developing process, 2) it produced a tool for immediate communication for PW-PNES, which follows principles of human behavior and cognitive science, and 3) it used cross-industry thinking. Despite all limitations, we consider our small pilot study an inspiration for future studies with focus on patient empowerment through user-friendly documents.
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Huang LL, Wang YY, Liu LY, Tang HP, Zhang MN, Ma SF, Zou LP. Home Videos as a Cost-Effective Tool for the Diagnosis of Paroxysmal Events in Infants: Prospective Study. JMIR Mhealth Uhealth 2019; 7:e11229. [PMID: 31516128 PMCID: PMC6746063 DOI: 10.2196/11229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/01/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023] Open
Abstract
Background The diagnosis of paroxysmal events in infants is often challenging. Reasons include the child’s inability to express discomfort and the inability to record video electroencephalography at home. The prevalence of mobile phones, which can record videos, may be beneficial to these patients. In China, this advantage may be even more significant given the vast population and the uneven distribution of medical resources. Objective The aim of this study is to investigate the value of mobile phone videos in increasing the diagnostic accuracy and cost savings of paroxysmal events in infants. Methods Clinical data, including descriptions and home videos of episodes, from 12 patients with paroxysmal events were collected. The investigation was conducted in six centers during pediatric academic conferences. All 452 practitioners present were asked to make their diagnoses by just the descriptions of the events, and then remake their diagnoses after watching the corresponding home videos of the episodes. The doctor’s information, including educational background, profession, working years, and working hospital level, was also recorded. The cost savings from accurate diagnoses were measured on the basis of using online consultation, which can also be done easily by mobile phone. All data were recorded in the form of questionnaires designed for this study. Results We collected 452 questionnaires, 301 of which met the criteria (66.6%) and were analyzed. The mean correct diagnoses with and without videos was 8.4 (SD 1.7) of 12 and 7.5 (SD 1.7) of 12, respectively. For epileptic seizures, mobile phone videos increased the mean accurate diagnoses by 3.9%; for nonepileptic events, it was 11.5% and both were statistically different (P=.006 for epileptic events; P<.001 for nonepileptic events). Pediatric neurologists with longer working years had higher diagnostic accuracy; whereas, their working hospital level and educational background made no difference. For patients with paroxysmal events, at least US $673.90 per capita and US $128 million nationwide could be saved annually, which is 12.02% of the total cost for correct diagnosis. Conclusions Home videos made on mobile phones are a cost-effective tool for the diagnosis of paroxysmal events in infants. They can facilitate the diagnosis of paroxysmal events in infants and thereby save costs. The best choice for infants with paroxysmal events on their initial visit is to record their events first and then show the video to a neurologist with longer working years through online consultation.
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Affiliation(s)
- Lu-Lu Huang
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang-Yang Wang
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li-Ying Liu
- Chinese People's Liberation Army General Hospital, Beijing, China
| | | | - Meng-Na Zhang
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shu-Fang Ma
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li-Ping Zou
- Chinese People's Liberation Army General Hospital, Beijing, China
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Deleuran M, Nørgaard K, Andersen NB, Sabers A. Psychogenic nonepileptic seizures treated with psychotherapy: Long-term outcome on seizures and healthcare utilization. Epilepsy Behav 2019; 98:195-200. [PMID: 31377661 DOI: 10.1016/j.yebeh.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
UNLABELLED Psychogenic nonepileptic seizures (PNES) are known to be associated with significant costs of healthcare services. Here, we report the impact of psychotherapy on behavior surrounding healthcare utilization and the potential economic benefits associated with long-term seizure control. METHODS This retrospective study describes patients seen between 2010 and 2016 at the epilepsy clinic at Glostrup University Hospital in Denmark and offered a psychotherapeutic treatment program for PNES. Forty-two patients were interviewed about seizure outcome 12-24 months after psychotherapy, and the annual changes in healthcare utilization and associated costs of services provided in a period of 24 months before and up to 24 months after treatment were compared. RESULTS At 12-month follow-up, 83% of the patients had achieved above 50% reduction in seizures. The 24-month pretreatment costs compared with the 24-month posttreatment costs directly associated with seizures dropped by 95.8%, and total healthcare costs were reduced by 63%. Estimation of annual savings from the program comes to 1060 € per patient. An association was found between seizure rate and number of healthcare contacts. CONCLUSION This study adds to the evidence that psychotherapy is a cost-effective way of treating PNES. The economic benefits from this form of intervention appear not only to diminish costs directly associated with PNES, but also healthcare utilization in general.
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Affiliation(s)
- Mads Deleuran
- The Epilepsy Clinic, Rigshospitalet-Glostrup, Denmark
| | | | | | - Anne Sabers
- The Epilepsy Clinic, Rigshospitalet-Glostrup, Denmark.
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Dagar A, Falcone T. Pins and PNES: Systematic content analysis of Pinterest for information on psychogenic nonepileptic seizures (PNES). Epilepsy Behav 2019; 93:129-132. [PMID: 30765306 DOI: 10.1016/j.yebeh.2019.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/27/2022]
Abstract
Pinterest is a visual search based, the fourth largest social networking site in the U.S. with 81% of its users being women. Because of Pinterest's popularity and the high incidence of psychogenic nonepileptic seizures (PNES) among women, the aim of our current study was to perform a thorough content analysis of information available about PNES on Pinterest. The systematic search of Pinterest using various PNES related keywords revealed 57 unique pins. This was followed by content analysis by two independent reviewers. Most (87.7%) pins included in the final analysis reported at least one factor indicative of PNES. Most common were the consistent association of PNES with emotional triggers (61.4%), history of current or remote abuse (57.9%), and seizure's unresponsiveness to antiepileptic drugs (38.6%). Semiology of PNES was reported in 77.2% pins and two-thirds (66.6%) mentioned diagnostic procedures. Psychogenic nonepileptic seizure treatment and prognosis were reported in 68.4% and 56.1% pins, respectively. Around one-third of pins were from academic resources. More than 80% of pins targeted lay people with the primary aim of education and awareness and used a neutral or positive tone. To our knowledge, even though most pins have scientifically sound information, this widely popular web-based resource seems to be underutilized by academia, healthcare workers, and stakeholders for the dissemination of awareness about PNES.
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Affiliation(s)
- Anjali Dagar
- Department of Psychiatry, Cleveland Clinic, United States of America.
| | - Tatiana Falcone
- Department of Psychiatry, Cleveland Clinic, United States of America
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Walther K, Volbers B, Erdmann L, Dogan Onugoren M, Gollwitzer S, Kasper BS, Kurzbuch K, Lang J, Schwab S, Schwarz M, Hamer HM. Psychological long‐term outcome in patients with psychogenic nonepileptic seizures. Epilepsia 2019; 60:669-678. [DOI: 10.1111/epi.14682] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Katrin Walther
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Bastian Volbers
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
- Department of NeurologyInselspitalUniversity Hospital Bern Bern Switzerland
| | - Laura Erdmann
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | | | - Stephanie Gollwitzer
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Burkhard S. Kasper
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Katrin Kurzbuch
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Johannes Lang
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Stefan Schwab
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Michael Schwarz
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
| | - Hajo M. Hamer
- Department of NeurologyEpilepsy CenterUniversity Hospital Erlangen Erlangen Germany
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Williams IA, Levita L, Reuber M. Emotion dysregulation in patients with psychogenic nonepileptic seizures: A systematic review based on the extended process model. Epilepsy Behav 2018; 86:37-48. [PMID: 30075361 DOI: 10.1016/j.yebeh.2018.06.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Psychogenic nonepileptic seizures (PNES) are characterized by paroxysmal alterations in motor and sensory functions resembling epileptic seizures, but are not caused by epileptiform activity. In recent years, there has been increasing scientific interest in emotion dysregulation in patients with PNES (pwPNES), but the literature has not yet been interpreted within a broader model of emotion dysregulation. The aim of this review was therefore to synthesize the existing literature on emotion dysregulation in pwPNES within the extended process model (EPM) of emotion regulation. METHODS PubMed and Web of Science were searched for studies relevant to emotion dysregulation as defined by the EPM. These studies were subjected to a bespoke quality appraisal tool. Studies of acceptable quality were categorized to the different stages of the EPM and critically appraised. RESULTS Studies of emotion regulation in pwPNES were generally of low quality - a finding largely driven by small sample sizes. However, there was evidence of emotion dysregulation characterized by deficits in the identification of patients' own emotional states, as well as the selection and implementation of maladaptive regulatory strategies, and altered exteroceptive emotional processing. However, heterogeneity in findings suggests that emotion dysregulation is likely linked to other psychological factors and not common to all pwPNES. SIGNIFICANCE This review suggests that while pwPNES are likely to experience emotion dysregulation as defined by the EPM, there is variability in the distribution of regulatory deficits in this patient population, and a person-centered approach should be taken when working with these patients. There is a need for more high quality and better-powered studies in this area.
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Affiliation(s)
- Isobel Anne Williams
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Liat Levita
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
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Kemp S, Graham CD, Chan R, Kitchingman H, Vickerman K, Reuber M. The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy. Epilepsia 2018; 59:844-853. [DOI: 10.1111/epi.14040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Steven Kemp
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Christopher D. Graham
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
- Leeds Institute of Health Sciences; University of Leeds; Leeds UK
| | - Rebecca Chan
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Hayley Kitchingman
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Kirsty Vickerman
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
| | - Markus Reuber
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
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Rao SR, Slater JD, Kalamangalam GP. A simple clinical score for prediction of nonepileptic seizures. Epilepsy Behav 2017; 77:50-52. [PMID: 29111502 DOI: 10.1016/j.yebeh.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/21/2017] [Accepted: 09/10/2017] [Indexed: 11/26/2022]
Abstract
Psychogenic nonepileptic seizures (PNES), often mistaken for epilepsy in community practice, require inpatient video-EEG (VEEG) monitoring for diagnostic confirmation. We developed a simple score designed for use in an outpatient setting to predict the subsequent VEEG diagnosis of PNES. We retrospectively compared fifty-five consecutive patients with VEEG-proven PNES (N1=55) with a group of randomly selected patients with VEEG-proven epilepsy (N2=55). Patients were divided into two groups: I) a 'truly retrospective' group of 27 patients with PNES and 27 patients with epilepsy whose data served to develop the score, and II) a 'pseudoprospective' group of 28 patients each with PNES and epilepsy to whom the score was applied. Six features in the history of the Group I cohort appeared more prominent in patients with PNES than patients with epilepsy and were assigned escalating numerical values as follows: number of declared drug allergies (0, 0.5, 1), number of declared comorbidities (0, 0.5, 1), number of previous invasive medical interventions of any type (0, 0.5, 1), and a history of significant psychological or physical trauma (0 or 1). In addition, a score was assigned to verbal description of the seizures themselves as being consistent (=0), atypical (=1), or indeterminate (=0.5) for epilepsy. The values were added to yield an omnibus score ranging from 0 to 6. Scoring of Group II subjects in a blinded fashion revealed that in general patients with PNES had higher scores, and the majority obtained a score >2; most patients with epilepsy scored <1.5. Group difference in the mean between the PNES and epilepsy cohort was highly significant (p<0.0001, Wilcoxon rank-sum test). Our score is a simple clinical instrument based on the patient history that may find use in the triage of patients awaiting hospitalization for VEEG and in pre-VEEG counseling.
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Affiliation(s)
- Sindhu R Rao
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA
| | - Jeremy D Slater
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA
| | - Giridhar P Kalamangalam
- Department of Neurology, University of Texas Health Science Center, 6431 Fannin, Houston, TX, USA.
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Vivas AC, Reitano CJ, Waseem H, Benbadis SR, Vale FL. An analysis of quality of life (QOL) in patients with epilepsy and comorbid psychogenic nonepileptic seizures (PNES) after vagus nerve stimulation (VNS). Epilepsy Behav 2017. [PMID: 28651170 DOI: 10.1016/j.yebeh.2017.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with epilepsy (PWE) may suffer from comorbid psychogenic nonepileptic seizures (PNES). The efficacy of vagus nerve stimulation (VNS) in the treatment of epilepsy and depression is established, however the impact on PNES is unknown. Since many patients with PNES have comorbid depression, we explored the impact on quality of life (QOL) that VNS has on PWE and PNES. METHODS The video electroencephalogram (vEEG) of all patients who underwent VNS at our institution was reviewed. Patients diagnosed with both psychogenic seizures and epileptic seizures on their vEEG were included in this study. These patients were contacted, and given a QOLIE-31 survey to assess their quality of life after VNS. Patients also completed a separate survey created by our group to categorize the quartile of their improvement. Pre-operative psychiatric disease was retrospectively reviewed. RESULTS From a period of 2001 to 2016, 518 patients underwent placement of VNS for drug resistant epilepsy (DRE) at our institution. In total, 16 patients were diagnosed with both epilepsy and PNES. 11/16 patients responded to our questionnaire and survey. 9 out of 11 patients felt that their epileptic seizures had improved after VNS, while 7 of the 11 patients felt that their psychogenic episodes had improved. 2(28.6%), 1 (14.3%), and 4 (57.1%) of participants said their PNES improved by 25-50%, 50-75%, and 75-100%, respectively. 3(27.3%), 3 (27.3%), 1 (9.1%), and 4 (36.4%) of the participants said their epileptic seizures improved by 0-25%, 25-50%, 50-75%, and 75-100%, respectively. The average overall score for quality of life for the study participants was found to be 51 (±8) out of 100. CONCLUSION Patients with epilepsy and comorbid PNES may benefit from VNS. It is unclear whether the benefit is conferred strictly from decreased epileptic seizure burden. The possible effect on PNES may be related to the known effect of VNS on depression. Further studies are necessary to elucidate the role of VNS in the treatment of PNES and possibly other psychiatric disease.
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Affiliation(s)
- Andrew C Vivas
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States
| | - Christian J Reitano
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States
| | - Hena Waseem
- Department of Neurology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Selim R Benbadis
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States; Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Fernando L Vale
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States; Department of Neurology, University of South Florida, Tampa, FL, United States.
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Neuroimaging studies in patients with psychogenic non-epileptic seizures: A systematic meta-review. NEUROIMAGE-CLINICAL 2017; 16:210-221. [PMID: 28808618 PMCID: PMC5544493 DOI: 10.1016/j.nicl.2017.07.025] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Psychogenic Non-epileptic Seizures (PNES) are ‘medically unexplained’ seizure-like episodes which superficially resemble epileptic seizures but which are not caused by epileptiform discharges in the brain. While many experts see PNES disorder as a multifactorial biopsychosocial condition, little is known about the neurobiological processes which may predispose, precipitate and/or perpetuate PNES symptomology. This systematic meta-review advances our knowledge and understanding of the neurobiological correlates of PNES by providing an up-to-date assessment of neuroimaging studies performed on individuals with PNES. Although the results presented appear inconclusive, they are consistent with an association between structural and functional brain abnormalities and PNES. These findings have implications for the way in which we think about this “medically unexplained” disorder and how we communicate the diagnosis to patients. However, it is also evident that neuroimaging studies in this area suffer from a number of significant limitations and future larger studies will need to better address these if we are to improve our understanding of the neurobiological correlates of predisposition to and/or manifestation of PNES. Neuroimaging results point to neurobiological correlates of PNES. Lack of convergent findings point to heterogeneous condition. Lack of high quality neuroimaging studies represents weak evidence base. Larger serial neuroimaging studies to assess state/trait characteristics required Future neuroimaging studies should use additional objective physiological measures.
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Treatment Challenges in Nonepileptic Psychogenic Seizures: Finding the Perfect Fit for the No-One-Size-Fits-All Group. Epilepsy Curr 2017; 17:147-149. [PMID: 28684944 DOI: 10.5698/1535-7511.17.3.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kanemoto K, LaFrance WC, Duncan R, Gigineishvili D, Park S, Tadokoro Y, Ikeda H, Paul R, Zhou D, Taniguchi G, Kerr M, Oshima T, Jin K, Reuber M. PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report. Epilepsia Open 2017; 2:307-316. [PMID: 29588959 PMCID: PMC5862115 DOI: 10.1002/epi4.12060] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/05/2023] Open
Abstract
An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.
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Affiliation(s)
- Kousuke Kanemoto
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - W. Curt LaFrance
- Rhode Island HospitalBrown UniversityProvidenceRhode IslandU.S.A.
| | | | - David Gigineishvili
- Department of Neurology & NeurosurgerySarajishvili Institute of NeurologyTbilisi State UniversityTbilisiGeorgia
| | - Sung‐Pa Park
- Department of NeurologyKyungpook National University School of MedicineDaeguKorea
| | - Yukari Tadokoro
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Hiroko Ikeda
- Department of PediatricsEpilepsy CenterNHO Shizuoka Institute of Epilepsy and Neurological DisordersShizuokaJapan
| | - Ravi Paul
- Department of PsychiatrySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Dong Zhou
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Go Taniguchi
- Department of Neuropsychiatrythe University of TokyoTokyoJapan
| | - Mike Kerr
- Learning Disability PsychiatryCardiff UniversityCardiffUnited Kingdom
| | - Tomohiro Oshima
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Kazutaka Jin
- Tohoku Daigaku Daigakuin Igakukei Kenkyuka IgakubuSendaiMiyagiJapan
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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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Kozlowska K, Chudleigh C, Elliott B, Landini A. The body comes to family therapy: Treatment of a school-aged boy with hyperventilation-induced non-epileptic seizures. Clin Child Psychol Psychiatry 2016; 21:669-685. [PMID: 26733398 DOI: 10.1177/1359104515621960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the case of a 10-year-old boy, Evan, where a knock to the head activated memories of past bullying, causing intense distress, activation of the body's stress-regulation systems and recurrent hospital presentations with hyperventilation-induced non-epileptic seizures. We describe the initial assessment session that enabled Evan and his family to understand the context for Evan's non-epileptic seizures, to engage with the therapeutic team and to collaborate in the implementation of a mind-body multimodal family-based intervention. Once the physical symptoms had been addressed therapeutically, we explored possible dangers within the family and school systems and we worked with Evan and his family to increase his ability to access comfort and protection from his parents. Our short hospital intervention highlighted the importance of ongoing therapeutic work with Evan and the family and laid the foundation stones for the next part of the family's therapeutic journey.
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Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia .,Discipline of Paediatrics and Child Health and Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.,Brain Dynamics Centre, Westmead Millennium Institute for Medical Research, NSW, Australia
| | - Catherine Chudleigh
- Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Andrea Landini
- Scuola Bolognese di Psicoterapia Cognitiva, Italy.,Family Relations Institute, USA/Italy
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What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies. Seizure 2016; 41:100-11. [DOI: 10.1016/j.seizure.2016.07.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022] Open
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León Ruiz M, García-Soldevilla MÁ, Benito-León J, Vidal Díaz MB, Tejeiro-Martínez J, García-Albea Ristol E. Babinski's Lost Legacy: A Remarkable Case of a Not-So-New Clinical Construct. J Clin Neurol 2016; 12:368-70. [PMID: 26869372 PMCID: PMC4960223 DOI: 10.3988/jcn.2016.12.3.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- Moisés León Ruiz
- Department of Neurology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Julián Benito-León
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Belén Vidal Díaz
- Department of Neurology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - José Tejeiro-Martínez
- Department of Neurology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Miyawaki D, Iwakura Y, Seto T, Kusaka H, Goto A, Okada Y, Asada N, Yanagihara E, Inoue K. Psychogenic nonepileptic seizures as a manifestation of psychological distress associated with undiagnosed autism spectrum disorder. Neuropsychiatr Dis Treat 2016; 12:185-9. [PMID: 26848267 PMCID: PMC4723019 DOI: 10.2147/ndt.s98698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are observable changes in behavior or consciousness that are similar to epileptic seizures but are not associated with electrophysiologic changes. PNES occur in children with underlying psychological distress and are especially frequent in those with epilepsy. Because PNES are heterogeneous, comprehensive treatment tailored to each patient is required to reduce psychosocial stress. Currently, reports regarding children with PNES concomitant with autism spectrum disorder (ASD) do not exist, and effective treatment strategies for these children are lacking. In this case report, we describe a 10-year-old Japanese girl with undiagnosed ASD who developed PNES while undergoing treatment for benign childhood epilepsy with centrotemporal spikes. She exhibited hypersensitivity to sound and interpersonal conflicts caused by social communication deficits. The PNES symptoms improved shortly after our intervention, which was designed to reduce her distress caused by auditory hypersensitivity and impaired social communication, both characteristics of ASD. To the best of our knowledge, this is the first report describing PNES in a child with ASD. Our findings suggest that PNES can result from psychological distress in children with undiagnosed ASD and highlight the importance of examining ASD traits in patients with PNES.
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Affiliation(s)
- Dai Miyawaki
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yoshihiro Iwakura
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Toshiyuki Seto
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Hiroto Kusaka
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Ayako Goto
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Yu Okada
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Nobuyoshi Asada
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Erika Yanagihara
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
| | - Koki Inoue
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Asahi-machi, Abeno-ku, Osaka, Japan
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Say GN, Taşdemir HA, İnce H. Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences. Seizure 2015; 31:144-8. [PMID: 26362392 DOI: 10.1016/j.seizure.2015.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare semiological characteristics, precipitating stress factors and psychiatric diagnoses of girls and boys with psychogenic nonepileptic seizures (PNESs). METHODS We retrospectively reviewed medical records of children diagnosed with PNES and who also underwent psychiatric evaluation. Sixty-two children (44 girls, 18 boys), aged 11-18 years (mean age 14.19 ± 1.96 years) were included. Diagnosis of PNES was established by any of the following: (1) observation of the seizure by a neurologist and routine EEG, (2) evaluation of amateur video records of the typical seizure and routine EEG, or (3) video-EEG monitoring. Psychiatric examinations of patients were performed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (KSADS-PL). RESULTS Tremor was the most prevalent ictal motor sign in both girls and boys. Atonic falls and longer episodes were significantly more frequent in girls than boys. Tonic-clonic-like movements of the extremities were significantly more prevalent in boys than girls. No gender-specific differences were observed in the rates of semiological types. Academic underachievement was the most prevalent precipitating stressor for boys, and was significantly more prevalent in boys than girls. The rate of major depression was significantly higher in girls than boys. The most prominent diagnosis in boys was attention deficit/hyperactivity disorder, and this was significantly more prevalent than in girls. CONCLUSION PNES in males of juvenile age may be a distinct entity from that in girls with different semiological and psychogenic correlates. Consideration of these gender-related differences may be beneficial for the early recognition and treatment of PNES.
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Affiliation(s)
- Gökçe Nur Say
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Haydar Ali Taşdemir
- Department of Child Neurology, Faculty of Medicine, OndokuzMayıs University, Samsun, Turkey
| | - Hülya İnce
- Department of Child Neurology, Medical Park Hospital, Samsun, Turkey
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