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Fullam S, Costello DJ. Clinical characteristics of patients with refractory non-epileptic seizures. Epilepsy Behav 2024; 155:109783. [PMID: 38642527 DOI: 10.1016/j.yebeh.2024.109783] [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: 12/19/2023] [Revised: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES This incidence of non-epileptic seizures (NES) is estimated at 1-35 per 100,000 population. While many patients achieve remission, a significant fraction of patients have a poor prognosis despite optimal interventions. This study reports on the characteristics of patients with refractory NES diagnosed and treated at a comprehensive epilepsy centre. METHODS A retrospective review of admissions to the Epilepsy Monitoring Unit identified patients diagnosed with NES over a 6-year period. Patients with refractory NES were identified through review of medical files. A diagnosis of refractory NES was assigned when patients experienced ongoing NES at least 1 year after diagnostic video-EEG monitoring. Data pertaining to predisposing, precipitating and perpetuating factors was collected on all patients and a comparative analysis was conducted between refractory and non-refractory cases. RESULTS 66 patients with NES were identified, 35% were deemed refractory. There was no significant difference amongst predisposing factors between the groups. Psychosocial adversity and a clear precipitant proximate to the onset of NES were significantly more common in the refractory cohort. Unemployment at time of diagnosis was a significant perpetuating factor associated with poor outcome. CONCLUSION This study provides insight into the features associated with refractory NES and may serve to improve prognostication and management in this disabling condition.
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Affiliation(s)
- Sarah Fullam
- Epilepsy Service, Department of Neurology, Cork University Hospital, Cork, Ireland.
| | - Daniel J Costello
- Epilepsy Service, Department of Neurology, Cork University Hospital, Cork, Ireland; College of Medicine and Health, University College Cork, Cork, Ireland; FutureNeuro SFI Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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2
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Malda-Castillo J, Howell B, Russell L, Town J, Abbass A, Perez-Algorta G, Valavanis S. Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures. Epilepsy Behav 2023; 141:109147. [PMID: 36924611 DOI: 10.1016/j.yebeh.2023.109147] [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: 12/09/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures. This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy. The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP. The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted.
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Affiliation(s)
- Javier Malda-Castillo
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Bethany Howell
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Leo Russell
- Functional Neurological Disorder Service, Devon Partnership NHS Trust, Exeter, UK.
| | - Joel Town
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | - Allan Abbass
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | | | - Sophie Valavanis
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
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Hingray C, Ertan D, Reuber M, Lother A, Chrusciel J, Tarrada A, Michel N, Meyer M, Klemina I, Maillard L, Sanchez S, El‐Hage W. Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles. Epilepsia 2022; 63:1500-1515. [PMID: 35305025 PMCID: PMC9790427 DOI: 10.1111/epi.17230] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis. METHODS We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics), and psychopathological data (psychiatric comorbidities, dissociation, and alexithymia) through psychiatric interviews and standardized scales. Clusters were identified by the Partitioning Around Medoids method. The similarity of patients was computed using Gower distance. The clusters were compared using analysis of variance, chi-squared, or Fisher exact tests. RESULTS Three patient clusters were identified in this exploratory, hypothesis-generating study and named on the basis of their most prominent characteristics: A "No/Single Trauma" group (31.4%), with more male patients, intellectual disabilities, and nonhyperkinetic seizures, and a low level of psychopathology; A "Cumulative Lifetime Traumas" group (42.6%), with clear female predominance, hyperkinetic seizures, relatively common comorbid epilepsy, and a high level of psychopathology; and A "Childhood Traumas" group (26%), commonly with comorbid epilepsy, history of childhood sexual abuse (75%), and posttraumatic stress disorder, but also with a high level of anxiety and dissociation. SIGNIFICANCE Although our cluster analysis was undertaken without any a priori hypothesis, the nature of the trauma history emerged as the most important differentiator between three common FDS disorder subtypes. This subdifferentiation of FDS disorders may facilitate the development of more specific therapeutic programs for each patient profile.
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Affiliation(s)
- Coraline Hingray
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance,Nancy Psychotherapeutic CenterUniversity Hospital Center for Adult Psychiatry of Greater NancyLaxouFrance
| | - Deniz Ertan
- National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance,Clinical Research UnitTeppe InstituteTain‐l’HérmitageFrance
| | - Markus Reuber
- Academic Neurology UnitRoyal Hallamshire HospitalUniversity of SheffieldSheffieldUK
| | | | - Jan Chrusciel
- Public Health and Performance Territorial CenterTroyes Hospital CenterTroyesFrance
| | - Alexis Tarrada
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance
| | - Nathalie Michel
- La Conception Hospital, Marseille University HospitalsPublic Assistance–Marseille HospitalsMarseilleFrance
| | - Mylene Meyer
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance
| | - Irina Klemina
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance
| | - Louis Maillard
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance
| | - Stephane Sanchez
- Public Health and Performance Territorial CenterTroyes Hospital CenterTroyesFrance
| | - Wissam El‐Hage
- Mixed Unit of Research 1253iBrainNational Institute of Health and Medical ResearchUniversity of ToursToursFrance,Psychiatry Center, Tours Regional University Hospital CenterToursFrance
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Asadi-Pooya AA, Brigo F, Tolchin B, Valente KD. Functional seizures are not less important than epilepsy. Epilepsy Behav Rep 2021; 16:100495. [PMID: 34805820 PMCID: PMC8585631 DOI: 10.1016/j.ebr.2021.100495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
People with functional seizures often suffer from psychiatric comorbidities. People with FS report detrimental effects on social aspects of their lives. FS are associated with a considerable direct and indirect economic burden. FS have increased rates of mortality compared to healthy controls.
Functional seizures (FS) are frequently encountered in neurology clinics, often affect young adults, and have significant negative impacts on many aspects of a person’s life. In the current narrative review, we searched the literature regarding some of the consequences of FS (i.e., psychiatric comorbidities, social consequences, costs that are associated with the condition, cognitive impairment in patients with FS, the quality of life of the people with FS, and the increased risk of mortality that is associated with FS). Evidence shows that FS have significant negative consequences, comparable in their magnitude to those affecting patients with epilepsy. The clinical and scientific communities should take steps to address these consequences through clinical care and research that prioritizes, facilitates, and expedites evidence-based diagnosis and treatment for FS.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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Psychiatric co-morbidities and factors associated with psychogenic non-epileptic seizures: a case–control study. Seizure 2020; 81:325-331. [DOI: 10.1016/j.seizure.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/03/2023] Open
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Beghi M, Zhang L, Beghi E, Giussani G, Erba G, Longinetti E, D'Onofrio BM, Bianchi E, Fang F, Tomson T, Chang Z. History of violence/maltreatment and psychogenic non-epileptic seizures. Seizure 2020; 81:8-12. [PMID: 32683268 DOI: 10.1016/j.seizure.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To study the association of earlier violence/maltreatment with the occurrence of PNES in a nationwide population sample. METHODS This is a nested case-control study performed using Swedish nationwide registers. Cases were all individuals born in Sweden between 1941 and 2009 with incident PNES between 2001 and 2013 while resident in Sweden according to the Swedish Patient Register. For each case, 10 controls, alive and PNES-free at time of PNES diagnosis of the matched case, were randomly selected from the Swedish Total Population Register, matched on age and sex. To test the specificity of the association, we conducted two similar analyses for epilepsy and dissociative disorder with motor symptoms or deficit, as comparators to PNES. Registers were examined in search of all coded diagnoses of child maltreatment or violence episodes before the index date among the cases and controls. RESULTS 885 patients received a first diagnosis of PNES. 7.6 % of cases had a history of violence/maltreatment, compared to 1.1 % of controls, giving a crude OR of 7.9 (95 % CI: 3.7-11.0). The ORs decreased but remained significant after adjustment for socio-economic factors (OR = 6.3, 95 % CI: 4.4-9.0) and psychiatric comorbidities (OR = 5.2, 95 % CI: 3.5-7.9). The association was also evident for epilepsy and dissociative disorder, although of lower magnitude. CONCLUSION Patients with PNES have a history of violence/maltreatment more frequently than the rest of the population. This association can be influenced by socio-economic factors and the presence of concurrent psychiatric disturbances.
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Affiliation(s)
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ettore Beghi
- Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - Giorgia Giussani
- Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giuseppe Erba
- Department of Neurology, SEC, University of Rochester, Rochester, NY, United States
| | - Elisa Longinetti
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, United States
| | - Elisa Bianchi
- Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Torbjorn Tomson
- Department of Clinical Neuroscience Karolinska Institutet, and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Nemade D, Shivkumar V, Ferguson P, Singh J, Shah S. Psychosocial and Physiologic Characteristics of Patients with Non-epileptic Events: A Retrospective Study. Cureus 2020; 12:e6767. [PMID: 32140334 PMCID: PMC7039355 DOI: 10.7759/cureus.6767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The main focus of this study is to aid early identification of psychogenic non-epileptic seizure (PNES) patients by identifying physical and psychosocial characteristics to reduce the health care burden, to reduce the unnecessary use of anti-epileptic medications and their side effects, and maximizing cost-effective use of video electroencephalography (VEEG). Methods We analyzed PNES subject data from VEEG monitoring performed at the Epilepsy Center at the Marshall University School of Medicine. We reviewed more than 360 episodes in 54 subjects older than 18 years (mean age ± standard deviation (SD): 48 ± 12.97 years; 83% female). Results We found that most of our PNES patients were older than 45 years of age (66.7%), females (83.3%); obese (66.6%) or overweight (18.5%); either single (33.3%), separated (7.4%), divorced (22.2%), or widowed (14.8%); of low education, unemployed (either received government assistance (83.3%) or disability benefits (57.4%)) with associated physical illness (85.2%) and psychiatric illness (96.3%). Conclusion Our study adds to the current knowledge of the sociodemographic and sociocultural variability of PNES. It might enable early diagnosis and management of patients with PNES.
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Affiliation(s)
- Dipali Nemade
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Vikram Shivkumar
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Paul Ferguson
- Neurology, Marshall University School of Medicine, Huntington, USA
| | | | - Sona Shah
- Neurology, Marshall University School of Medicine, Huntington, USA
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Barron E, Rotge JY. Talking about “psychogenic nonepileptic seizure” is wrong and stigmatizing. Seizure 2019; 71:6-7. [DOI: 10.1016/j.seizure.2019.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
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Türe HS, Tatlidil I, Kiliçarslan E, Akhan G. Gender-Related Differences in Semiology of Psychogenic Non-Epileptic Seizures. ACTA ACUST UNITED AC 2019; 56:178-181. [PMID: 31523142 DOI: 10.29399/npa.23420] [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: 10/08/2018] [Accepted: 03/20/2019] [Indexed: 11/07/2022]
Abstract
Introduction The aim of the study is to detect possible gender-related differences in the semiology of psychogenic non-epileptic seizures (PNES). Methods One hundred fifty-five patients (male: female=63:92) aged 13 to 67 years, who were diagnosed with PNES by video-monitoring electroencephalogram (EEG) between 2010 and 2017, were included in this retrospective study. Patients were grouped according to their gender. The primary semiological characteristics of PNES for each case were defined, standardized, and categorized by an epileptologist during video-monitoring EEG. The chi-square test and the Fisher exact test were used statistically. Results An age histogram showed peaks at ages 20 to 23 and at ages 40 to 43, which were more prominent in the female gender. Whereas major motor activity (p=0.032), lateralizing motor activity (p=0.017), and opisthotonic posture and pelvic thrust motion (p=0.017) were significantly related to the male gender, weeping (p<0.001) was significantly related to the female gender. Conclusion Our study showed that there are some semiological differences between the genders in PNES. In male patients, lateralized motor findings are more prominent and not accompanied by ictal crying in seizures, which may lead to further confusion with epileptic seizures. It is important to know the semiological characteristics for early and accurate diagnosis.
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Affiliation(s)
- H Sabiha Türe
- Neurology Department, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
| | - Işıl Tatlidil
- Neurology Department, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
| | - Esin Kiliçarslan
- Psychiatry Department, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
| | - Galip Akhan
- Neurology Department, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir, Turkey
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