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Bahous E, Wagner R, Herskovitz M. Functional seizures: Are they consistent over time? Brain Behav 2024; 14:e3375. [PMID: 38376023 PMCID: PMC10823445 DOI: 10.1002/brb3.3375] [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: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Our previous study showed that functional seizures (FS) are consistent in the same patient during a single video EEG monitoring (VEEG). This study aimed to check whether FS remains consistent across VEEG sessions even after several years. METHODS The study evaluated the consistency of FS across different VEEG sessions using five criteria: FS type, the main anatomical region involved (specifically, the body part most affected during the seizure), other involved anatomical regions, frequency of movements, and duration of FS. Consistency levels were categorized as low (one consistent axis), moderate (two consistent axes), and high (three or more consistent axes). RESULTS Fourteen patients were included in the final analysis. The mean time between monitoring was 3.8 ± 2.5 years (0.5-8 year). In 13 of 14 patients, the first and second monitoring events were classified into the same FS category. There was consistency in the main anatomical region involved in 9 out of 12 patients with motor FS. In 9 out of 12 patients with motor FS, the other anatomical regions involved were consistent in both sessions. The mean duration of the FS between sessions was inconsistent in most of the patients. Ten patients were classified with high consistency, one patient with moderate consistency, two patients with low consistency, and in one patient, the events were classified as inconsistent. CONCLUSIONS Our results show that FS tends to remain consistent in a single patient even after several years, and there is probably no correlation between the degree of consistency and the time between VEEG sessions. These findings have implications for supporting the concept of FS as a consistent phenomenon. Additionally, they may suggest potential avenues for future research to elucidate the origins of FS. Subsequent studies are essential to validate and expand upon these preliminary observations.
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Affiliation(s)
- Elian Bahous
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Raz Wagner
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Moshe Herskovitz
- Department of NeurologyRambam Health Care CampusHaifaIsrael
- Technion Institute of TechnologyRappaport Faculty of MedicineHaifaIsrael
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Schneider G, Levin L, Herskovitz M. Psychogenic nonepileptic seizures: Are they a freeze reaction? Epilepsy Behav 2022; 129:108655. [PMID: 35299088 DOI: 10.1016/j.yebeh.2022.108655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) clinically resemble epileptic seizures (ES) but lack epileptic activity at the time of the seizure and are also not due to any other pathophysiological disorder. The integrative cognitive model (ICM) suggests that PNES is an automatic reaction generated from distorted memory and is perceived as uncontrollable and unwanted. Furthermore, the ICM model implies that a PNES event occurs due to an external or internal cue. Intrigued by this assumption, we wanted to examine why a PNES event occurs at a particular moment by investigating the pre-ictal behavior. This study is a retrospective study. We included all patients diagnosed with PNES or ES admitted to our long-term video-EEG monitoring unit (LTVEM) between 01/01/2018 and 30/08/2020. Using thorough video analysis, we checked the patient's state at the onset of the event and looked back to see what the patient was doing before the event onset. We defined 4 types of pre-ictal behavior A. Inactivity. B. Environment arrangement c. Other. D. No apparent pre-ictal behavior. Thirty patients with PNES and 30 patients with ES were included in the study. In total, 46 PNES events and 56 ES events were recorded and analyzed. In 33 /46 PNES seizures (72%), a type A, A + B or C pre-ictal behavior was observed compared to 1/56 ES (1.78%) with type A pre-ictal behavior. All other pre-ictal behavior in the ES group were of type D. Patients with PNES have a unique pre-ictal behavior before most PNES events with motor manifestations. Since the pre-ictal behavior consists mainly of inactivity, we believe it may imply that PNES represents a freeze reaction or a reconstruction of a freeze reaction.
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Affiliation(s)
- Galit Schneider
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Lera Levin
- Department of Psychology, Rambam Health Care Campus, Haifa, Israel
| | - Moshe Herskovitz
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
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Duncan AJ, Peric I, Boston R, Seneviratne U. Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit. J Neurol 2021; 269:2172-2178. [PMID: 34550469 PMCID: PMC8456070 DOI: 10.1007/s00415-021-10805-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
Introduction The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES). Methods We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES. Results A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56–102.96, P < 0.0001), head shaking (OR 2.95, 95% CI 1.26–6.79, P = 0.012), and hip thrusting (OR 4.28, 95% CI 1.21–15.18, P = 0.02) were each significantly predictive of PNES. Fluctuating course had the highest sensitivity (76.16%). Back arching (OR 1.06, 95% CI 0.35–3.20, P = 0.92) was not significantly associated with PNES. Conclusion Fluctuating course, head shaking, and hip thrusting are semiological features significantly more common in PNES than ES. Fluctuating course is the most reliable sign. Back arching does not appear to differentiate PNES from ES.
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Affiliation(s)
- Andrew J Duncan
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
| | - Ivana Peric
- Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia
| | - Ray Boston
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA
| | - Udaya Seneviratne
- Department of Clinical Neurosciences, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia
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Garg D, Agarwal A, Malhotra V, Thacker AK, Singh AK, Singh MB, Srivastava AK. Classification and comparative analysis of psychogenic nonepileptic seizures (PNES) semiology based on video-electroencephalography (VEEG). Epilepsy Behav 2021; 115:107697. [PMID: 33383482 DOI: 10.1016/j.yebeh.2020.107697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple classification systems for psychogenic nonepileptic seizures (PNES) based on semiological features have been described. We sought to compare the efficiency of four PNES classification systems. METHODS We retrospectively analyzed medical and video-electroencephalography (VEEG) records of patients with PNES with at least one typical event recorded on VEEG. Semiology of PNES events was stringently classified using Hubsch, Dhiman, Wadwekar, and Asadi-Pooya's classification systems. RESULTS We studied 248 patients with PNES (78% females, mean age 23.1 ± 10.3 years) and reviewed 498 PNES events. Using Hubsch's scheme, we classified events into: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.7%), pseudosyncope (59.8%), hyperkinetic prolonged attacks (16.2%) and axial dystonic prolonged attacks (1.6%), and unclassified (7.5%). Using Dhiman's classification, events were: abnormal motor (hypermotor [10.4%]/ partial motor [12.7%]), dialeptic type (58.6%), mixed patterns (17.3%), and unclassified (1%). Using Wadwekar's classification: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.6%), pseudosyncope with/without hyperventilation (65.1%), hyperkinetic prolonged attacks involving limbs ± trunk (18.5%), and axial dystonic prolonged attacks (1.6%). Using Asadi-Pooya's classification, events were: hypermotor (30.1%), non-motor (62.9%), and mixed (7.0%). All events could be classified via Wadwekar and Asadi-Pooya systems. CONCLUSION In our study, pseudosyncope/dialeptic/non-motor semiology emerged as most frequent. Most of our patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al. Dhiman et al. scheme could classify 99% and 7.5% remained unclassified using Hubsch et al. scheme.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Varun Malhotra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Kumar Thacker
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ajai Kumar Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Lombardi N, Scévola L, Sarudiansky M, Giagante B, Gargiulo A, Alonso N, Stivala EG, Oddo S, Fernandez-Lima M, Kochen S, Guido Korman, D'Alessio L. Differential Semiology Based on Video Electroencephalography Monitoring Between Psychogenic Nonepileptic Seizures and Temporal Lobe Epileptic Seizures. J Acad Consult Liaison Psychiatry 2020; 62:22-28. [PMID: 32950266 DOI: 10.1016/j.psym.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNESs) are disruptive changes in behavior without ictal correlate of epileptic activity and high prevalence of psychiatric morbidity. Differential diagnosis is difficult particularly with temporal lobe epilepsy (TLE), which is also associated with high prevalence of psychiatric comorbidity. Although video electroencephalography is the gold standard for differential diagnosis, clinical semiology analysis may help the clinician in general medical practice. OBJECTIVE In this study, the differential semiology, based on video electroencephalography, between PNESs and TLE seizures was analyzed. METHODS The video electroencephalography of patients with diagnosis of PNES and TLE were reviewed and compared between groups. Clinical semiology of all episodes recorded by video electroencephalography in each patient was analyzed and classified in accordance with the presence of behavioral arrest, motor hyperkinetic activity, impaired awareness, aura, and automatisms. Chi square test and binary logistic regression were determined. RESULTS Thirty-two patients with PNES (32 ± 11 y) and 34 with TLE (32 ± 12 y) were included. Female patients were predominant in the PNES group (P < 0.05). Mean time duration of episodes was 6.8 ± 10 minutes in PNES and 1.6 ± 0.8 minutes in TLE (P < 0.05). Impaired awareness (odds ratio = 24.4; 95% confidence interval = 3.79 -157.3, P < 0.01), automatisms (odds ratio = 13.9; 95% confidence interval = 2.1- 90.5, P < 0.01), and shorter duration of the events (odds ratio = 2.261, 95% confidence interval = 1.149 - 4.449, P = 0.018) were found as independent factors for detecting TLE seizures comparing PNESs. CONCLUSION Clinical semiology analysis may orientate the differential diagnosis in general medical practice, between PNESs and TLE seizures. Further studies comparing PNES semiology with other subtypes of epilepsies may complete these preliminary findings.
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Affiliation(s)
- Nicolás Lombardi
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina
| | - Laura Scévola
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Universidad de Buenos Aires, CAEA-CONICET, Buenos Aires, Argentina
| | - Brenda Giagante
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Hospital El Cruce, Centro de Epilepsia, ENyS-CONICET, Buenos Aires, Argentina
| | - Angel Gargiulo
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina
| | - Nicolás Alonso
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina
| | - Ernesto Gonzalez Stivala
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Universidad de Buenos Aires, IBCN-CONICET, Buenos Aires, Argentina
| | - Silvia Oddo
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Hospital El Cruce, Centro de Epilepsia, ENyS-CONICET, Buenos Aires, Argentina
| | - Mónica Fernandez-Lima
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Hospital El Cruce, Centro de Epilepsia, ENyS-CONICET, Buenos Aires, Argentina
| | - Silvia Kochen
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Hospital El Cruce, Centro de Epilepsia, ENyS-CONICET, Buenos Aires, Argentina
| | - Guido Korman
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Universidad de Buenos Aires, CAEA-CONICET, Buenos Aires, Argentina
| | - Luciana D'Alessio
- Universidad de Buenos Aires, Hospital Ramos Mejía, Centro de Epilepsia, Buenos Aires, Argentina; Universidad de Buenos Aires, IBCN-CONICET, Buenos Aires, Argentina.
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Kerr WT, Chau AM, Janio EA, Braesch CT, Le JM, Hori JM, Patel AB, Gallardo NL, Bauirjan J, Allas CH, Karimi AH, Hwang ES, Davis EC, Buchard A, Torres-Barba D, D'Ambrosio S, Al Banna M, Cho AY, Engel J, Cohen MS, Stern JM. Reliability of reported peri-ictal behavior to identify psychogenic nonepileptic seizures. Seizure 2019; 67:45-51. [PMID: 30884437 DOI: 10.1016/j.seizure.2019.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/24/2019] [Accepted: 02/27/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Differentiating psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES) can be difficult, even when expert clinicians have video recordings of seizures. Moreover, witnesses who are not trained observers may provide descriptions that differ from the expert clinicians', which often raises concern about whether the patient has both ES and PNES. As such, quantitative, evidence-based tools to help differentiate ES from PNES based on patients' and witnesses' descriptions of seizures may assist in the early, accurate diagnosis of patients. METHODS Based on patient- and observer-reported data from 1372 patients with diagnoses documented by video-elect roencephalography (vEEG), we used logistic regression (LR) to compare specific peri-ictal behaviors and seizure triggers in five mutually exclusive groups: ES, PNES, physiologic non-epileptic seizure-like events, mixed PNES plus ES, and inconclusive monitoring. To differentiate PNES-only from ES-only, we retrospectively trained multivariate LR and a forest of decision trees (DF) to predict the documented diagnoses of 246 prospective patients. RESULTS The areas under the receiver operating characteristic curve (AUCs) of the DF and LR were 75% and 74%, respectively (empiric 95% CI of chance 37-62%). The overall accuracy was not significantly higher than the naïve assumption that all patients have ES (accuracy DF 71%, LR 70%, naïve 68%, p > 0.05). CONCLUSIONS Quantitative analysis of patient- and observer-reported peri-ictal behaviors objectively changed the likelihood that a patient's seizures were psychogenic, but these reports were not reliable enough to be diagnostic in isolation. Instead, our scores may identify patients with "probable" PNES that, in the right clinical context, may warrant further diagnostic assessment.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Justine M Le
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Janar Bauirjan
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Corinne H Allas
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Albert Buchard
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - David Torres-Barba
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Shannon D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Mona Al Banna
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Brain Research Institute, UCLA, Los Angeles, CA, USA
| | - Mark S Cohen
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Departments of Radiology, Psychology,Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, USA; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Vogrig A, Hsiang JC, Ng J, Rolnick J, Cheng J, Parvizi J. A systematic study of stereotypy in epileptic seizures versus psychogenic seizure-like events. Epilepsy Behav 2019; 90:172-177. [PMID: 30580068 DOI: 10.1016/j.yebeh.2018.11.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to quantify the features of stereotypy in epileptic seizures and compare it with that of stereotypy in psychogenic nonepileptic seizure-like events (PNES) confirmed by video-electroencephalography (VEEG) monitoring. METHODS Video-electroencephalography monitoring records of 20 patients with temporal lobe seizures (TLS) and 20 with PNES were retrospectively reviewed (n = 138 seizures, 48 TLS and 90 PNES). We analyzed the semiology of 59 behaviors of interest for their presence, duration, sequence, and continuity using quantified measures that were entered into statistical analysis. RESULTS We identified discontinuity as the parameter that was clearly distinct between PNES and epileptic TLS events: there were significantly more frequent pauses of behavior (i.e., "on-off" pattern) in PNES compared with TLS (P = 0.012). The frequency of pauses during an event was diagnostic of PNES events. For instance, the presence of 2 "pauses" during an episode determines a 69% probability of the seizure being nonepileptic. Moreover, PNES events had significantly greater duration (143 s) than TLS events (68 s) (excluding outliers, P = 0.002) and greater duration variability from one event to another in the same subject (P = 0.005). SIGNIFICANCE Our work provides the first quantified measure of behavioral semiology during epileptic and nonepileptic seizures and offers novel behavioral measures to differentiate them from each other.
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Affiliation(s)
- Alberto Vogrig
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jen Chun Hsiang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jacqueline Ng
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Joshua Rolnick
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Cheng
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Josef Parvizi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
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Semiological characteristics of patients with psychogenic nonepileptic seizures: Gender-related differences. Epilepsy Behav 2018; 89:130-134. [PMID: 30415134 DOI: 10.1016/j.yebeh.2018.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are more prevalent among women, and diagnosis may sometimes be delayed by as much as seven years. Understanding the effect of gender on the presentation of a PNES may assist with diagnosis based on semiological details in the clinical setting. Although video-EEG monitoring (VEM) is the gold standard for diagnosing PNES, determining gender-related seizure semiology through careful history may prevent diagnostic delay while waiting for VEM. The aim of this study was to investigate gender-related differences in the semiology of PNES. Patients, all aged at least 16 years, diagnosed with PNES following VEM between December 2005 and November 2016 were included in this study. All patients' medical records and video-EEG-documented PNES were reviewed, and the presence or absence of semiological signs was recorded for each documented attack. Demographic features and semiological signs of PNES were compared between female and male patients. Forty-one patients (31 females, 10 males) aged 27.2 ± 12.2 years (range: 16-65) were included in the study. Mean age at onset of PNES was higher for female patients than males, at 24.3 ± 11.5 versus 17.5 ± 3.2 years (p = 0.005). The median duration of PNES was longer for female patients than males, at 10 min (range: 5 s-120 min) versus 2 min (range: 10 s-60 min) (p = 0.016). The most common symptom was forced eye closure in both genders. No significant gender-specific differences were observed in terms of the type or semiology of PNES. Although there are no major gender-related differences in PNES semiology, our findings highlight the importance of greater caution, especially in male patients, when diagnosing PNES, remembering that onset may also occur at young ages and that a short seizure duration does not exclude PNES.
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Pestana Knight EM, Grinenko O, Bulacio J, Bingaman W, Gupta A, Chauvel P. Arc de cercle as a manifestation of focal epileptic seizures. Neurol Clin Pract 2018; 8:354-356. [PMID: 30140590 DOI: 10.1212/cpj.0000000000000485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/11/2018] [Indexed: 12/31/2022]
Affiliation(s)
| | - Olesya Grinenko
- Epilepsy Center, Cleveland Clinic Neurological Institute, OH
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Neurological Institute, OH
| | | | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic Neurological Institute, OH
| | - Patrick Chauvel
- Epilepsy Center, Cleveland Clinic Neurological Institute, OH
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