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Vilyte G, Butler J, Ives-Deliperi V, Pretorius C. Medication use in patients with functional seizures from a public and a private hospital. Seizure 2024; 117:142-149. [PMID: 38417213 DOI: 10.1016/j.seizure.2024.02.017] [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: 12/17/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE Currently, we have limited knowledge of any potential differences among patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds. Investigating medication use among these patients may provide insight into the quality and intensity of medical care they receive. Thus, we aimed to assess and compare the frequency and quantity of antiseizure medications (ASMs), and psychiatric and other medications used among patients with FS from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. METHODS Only video-electroencephalographically (video-EEG) confirmed patients with FS with no comorbid epilepsy were eligible for the study. For this retrospective case-control study we collected data on patients' medication-taking histories using digital patient records, starting with the earliest available digital patient record for each hospital. RESULTS A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Patients with FS attending the public hospital had lower odds of taking any ASMs at presentation (aOR=0.39, 95% CI [0.20, 0.75]) and ever taking psychiatric medications (aOR=0.41, 95% CI [0.22, 0.78]) compared to FS patients from the private hospital. They did, however, have higher odds of being discharged with an ASM (aOR=6.60, 95% CI [3.27, 13.35]) and ever taking cardiovascular medication (aOR=2.69, 95% CI [1.22, 5.90]) when compared to the private hospital patients. With every additional presenting ASM (aOR=0.63, 95% CI [0.45, 0.89]) and psychiatric medication (aOR=0.58, 95% CI [0.40, 0.84]) the odds of being from the public hospital decreased. However, they increased with every additional discharge ASM (aOR=3.63, 95% CI [2.30, 5.72]) and cardiovascular medication (aOR=1.26, 95% CI [1.02, 1.55]). CONCLUSION Standard approaches to pharmacological treatment for patients with FS differed between the public and private hospitals and may indicate a gap in quality of care.
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Affiliation(s)
- Gabriele Vilyte
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - James Butler
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Victoria Ives-Deliperi
- Division of Psychiatry, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chrisma Pretorius
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
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Reilly C, Jette N, Johnson EC, Kariuki SM, Meredith F, Wirrell E, Mula M, Smith ML, Walsh S, Fong CY, Wilmshurst JM, Kerr M, Valente K, Auvin S. Scoping review and expert-based consensus recommendations for assessment and management of psychogenic non-epileptic (functional) seizures (PNES) in children: A report from the Pediatric Psychiatric Issues Task Force of the International League Against Epilepsy. Epilepsia 2023; 64:3160-3195. [PMID: 37804168 DOI: 10.1111/epi.17768] [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: 03/01/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
Limited guidance exists regarding the assessment and management of psychogenic non-epileptic seizures (PNES) in children. Our aim was to develop consensus-based recommendations to fill this gap. The members of the International League Against Epilepsy (ILAE) Task Force on Pediatric Psychiatric Issues conducted a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) standards. This was supplemented with a Delphi process sent to pediatric PNES experts. Consensus was defined as ≥80% agreement. The systematic search identified 77 studies, the majority (55%) of which were retrospective (only one randomized clinical trial). The primary means of PNES identification was video electroencephalography (vEEG) in 84% of studies. Better outcome was associated with access to counseling/psychological intervention. Children with PNES have more frequent psychiatric disorders than controls. The Delphi resulted in 22 recommendations: Assessment-There was consensus on the importance of (1) taking a comprehensive developmental history; (2) obtaining a description of the events; (3) asking about potential stressors; (4) the need to use vEEG if available parent, self, and school reports and video recordings can contribute to a "probable" diagnosis; and (5) that invasive provocation techniques or deceit should not be employed. Management-There was consensus about the (1) need for a professional with expertise in epilepsy to remain involved for a period after PNES diagnosis; (2) provision of appropriate educational materials to the child and caregivers; and (3) that the decision on treatment modality for PNES in children should consider the child's age, cognitive ability, and family factors. Comorbidities-There was consensus that all children with PNES should be screened for mental health and neurodevelopmental difficulties. Recommendations to facilitate the assessment and management of PNES in children were developed. Future directions to fill knowledge gaps were proposed.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, UK
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinia, New York City, New York, USA
| | | | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Health, Pwani University, Kilifi, Kenya
| | | | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Mula
- IMBE, St George's University and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga and Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mike Kerr
- Institute of Psychological Medicine and Clinical Neurosciences Cardiff University, Cardiff, UK
| | - Kette Valente
- Clinical Neurophysiology Sector, University of São Paulo, Clinic Hospital (HCFMUSP), São Paulo, Brazil
| | - Stephane Auvin
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Pediatric Neurology Department, APHP, Robert Debré University Hospital, CRMR epilepsies rares, EpiCare member, Paris, France
- Institut Universitaire de France (IUF), Paris, France
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Vilyte G, Butler J, Pretorius C. Prevalence and comparison of psychological trauma and stressors in functional seizure patients from a public and private hospital. Seizure 2023; 112:112-120. [PMID: 37797429 DOI: 10.1016/j.seizure.2023.10.001] [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: 08/10/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To date not much is known about the differences, if any, between patients with functional seizures (FS) from different socioeconomic backgrounds. We sought to compare the psychological stress and trauma profiles of patients with FS from a private and public hospital in Cape Town, South Africa. METHODS Only video-electroencephalography-confirmed patients with FS were eligible for the study. In this retrospective case-control study we collected data on self-reported demographic and psychological stressor/trauma variables using digital patient records starting with the earliest available digital patient record for each hospital. RESULTS A total of 321 patients from a private hospital and 68 patients from a public hospital were included in the study. Most factors showed no significant differences. However, public hospital patients had higher odds of being older (p = 0.002), almost nine times the odds of reporting physical violence by an intimate partner (aOR = 8.65, 95% CI [1.70, 44.08]), more than eight times the odds of reporting psychological stress in the form of death and/or sickness in the family (aOR = 8.56, 95% CI [1.81, 40.41]) and almost three times the odds for other general psychosocial stressors (aOR = 2.82, 95% CI [1.08, 7.42]) compared to those attending the private hospital. They also had half the odds of being female compared to the private hospital patients (aOR = 0.47, 95% CI [0.23, 0.95]) and 93% fewer odds of reporting coming from an abusive home (aOR = 0.07, 95% CI [0.01, 0.52]). CONCLUSION History and psychological trauma and stressor profiles showed many similarities between the public and private hospital groups; however, some differences were noted and could benefit further exploration and consideration in therapeutic and diagnostic contexts.
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Affiliation(s)
- Gabriele Vilyte
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa.
| | - James Butler
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chrisma Pretorius
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa
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Tayeb HO. Functional Neurological Disorder in Saudi Arabia: An Update. Cureus 2023; 15:e47607. [PMID: 38021543 PMCID: PMC10667081 DOI: 10.7759/cureus.47607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Functional neurological disorder (FND) is characterized by neurological symptoms that lack congruence with traditional neurological diagnoses. Historically viewed through a Freudian psychoanalytic lens, FND has been conceptualized as a purely psychogenic disorder. However, the contemporary biopsychosocial perspective on FND emphasizes contributions of cognitive and neural circuit dysfunction and the disabling and involuntary nature of the illness. In Saudi Arabia, evidence suggests the prevalence of FND is significant. However, clinical programs and research focused on FND have been lacking. Studies from the region indicate that practitioners may have outdated views of FND. To address this, this narrative review provides an updated perspective on FND that is relevant to Saudi Arabia and the region. It delves into the evolving perception of FND, its underlying pathophysiology, risk factors, clinical presentations, and recent diagnostic and management advances. Unique features of FND in Saudi Arabia may include a significant role for family disputes as a risk factor, prevalent supernatural perceptions of FND, high prevalence of somatization, and cognitive dysfunction, and a potential favorable prognosis. The article concludes by providing the following recommendations related to FND in Saudi Arabia and the region: i) building educational programs to update clinicians about contemporary biopsychosocial perspectives on FND; ii) emphasizing a positive diagnostic approach based on clinical findings in FND; iii) instituting multidisciplinary programs to care for FND patients; iv) supporting systematic research efforts to explore culture-specific FND risk factors, patient outcome measures, and attitudes toward the disorder; v) developing national FND clinical practice guidelines; and vi) launching awareness campaigns to reduce FND stigma.
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Affiliation(s)
- Haythum O Tayeb
- Medicine, The Mind and Brain Studies Initiative, The Neuroscience Research Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Front Psychiatry 2022; 13:897002. [PMID: 35958663 PMCID: PMC9358691 DOI: 10.3389/fpsyt.2022.897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.
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Affiliation(s)
- Mathilde Salmon
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Aurélie Harf
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Maude Ludot-Grégoire
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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Psychogenic Nonepileptic Seizures in Children and Adolescents. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Asadi-Pooya AA, Alsaadi T, Gigineishvili D, Hingray C, Hosny H, Karakis I, Mesraoua B, Ali MA, Janocko NJ, Elsheikh L, Tarrada A, Yaghmoor BE, Brigo F. Social aspects of life in patients with functional (psychogenic nonepileptic) seizures: An international study. Epilepsy Behav 2020; 113:107534. [PMID: 33254034 DOI: 10.1016/j.yebeh.2020.107534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore various social aspects of life (i.e., employment, education, and driving) in a large sample of patients with functional seizures (FS) living in seven countries from four continents. METHODS In this retrospective study, we investigated adult patients with FS, who were admitted to the epilepsy monitoring units at centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We studied the social aspects of life in the whole cohort. Then, we compared the social aspects of life between different world regions. RESULTS Four hundred and forty patients were included (241 from Iran, 56 from Qatar, 52 from France, 41 from the USA, 19 from UAE, 18 from Egypt, and 13 from Georgia). One hundred and twenty six people (30%) had college education, 142 (33%) were employed, and 101 (28%) drove a motor vehicle in their routine daily lives. People with FS and college education were more likely to report a history of sexual abuse compared with those with a lower education. Patients with no loss of responsiveness with their FS were more likely to be employed. Male patients and patients without aura were more likely to drive a motor vehicle in their routine daily lives. None of the social characteristics of the patients with FS showed significant differences among the two large culturally different groups (Muslim nations vs. Christian nations). CONCLUSION It appears that patients with FS across cultures have significant problems in their social aspects of life.
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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, Pennsylvania, PA, USA.
| | - Taoufik Alsaadi
- Department of Neurology- American Center for Psychiatry and Neurology, Dubai, United Arab Emirates.
| | - David Gigineishvili
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia.
| | - Coraline Hingray
- Service de neurologie, CHRU de NANCY et Pole universitaire adulte du grand Nancy, CPN, Laxou, France.
| | - Hassan Hosny
- Department of Neurology, Cairo University, Egypt
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, USA.
| | | | - Musab A Ali
- Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | | | - Lubna Elsheikh
- Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | - Alexis Tarrada
- Service de neurologie, CHRU de NANCY et Pole universitaire adulte du grand Nancy, CPN, Laxou, France.
| | - Bassam E Yaghmoor
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
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Asadi-Pooya AA, Brigo F, Mesraoua B, Tarrada A, Karakis I, Hosny H, Alsaadi T, Gigineishvili D, Ali MA, Janocko NJ, Elsheikh L, Hingray C. Clinical characteristics of functional (psychogenic nonepileptic) seizures: An international retrospective study. Epilepsy Behav 2020; 111:107197. [PMID: 32540770 DOI: 10.1016/j.yebeh.2020.107197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE We conducted a multicenter international cross-cultural comparative study to investigate clinical semiology and predisposing factors of functional seizures in a large cohort of patients living in different countries around the world. We hypothesized that semiology and predisposing factors of functional seizures differ between various world regions. METHODS We conducted this retrospective observational study in adults with functional seizures admitted to epilepsy centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We assessed and compared the demographic and clinical seizure characteristics of these patients, according to the patients' reports and review of the ictal recordings during video-electroencephalogram (EEG) monitoring. RESULTS Five hundred nine patients were included (270 from Iran, 74 from Qatar, 63 from France, 43 from the USA, 22 from Egypt, 20 from UAE, and 17 from Georgia). Although all major manifestations of functional seizures (e.g., aura, loss of responsiveness, generalized motor seizures, ictal injury) were seen in all world regions, seizure semiology differed significantly across countries. Auras, ictal urinary incontinence, and ictal injury were more commonly reported by the American patients than patients from other world regions, whereas loss of responsiveness and generalized motor seizures were more frequently observed in the Iranian and American patients than the European and Arab patients. CONCLUSION Semiology of functional seizures seems to vary across various regions of the world; socioeconomic, cultural, ethnic, and religious differences may play an essential role in the modulation of functional seizures semiology across different nations and cultures.
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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, Franz Tappeiner Hospital, Merano, Italy
| | | | - Alexis Tarrada
- Service de Neurologie, CHRU de NANCY et Pole Universitaire Adulte Du Grand Nancy, CPN, Laxou, France
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, USA.
| | - Hassan Hosny
- Department of Neurology, Cairo University, Egypt
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, United Arab Emirates.
| | - David Gigineishvili
- Department of Neurology & Neurosurgery, Tbilisi State University, Tbilisi, Georgia.
| | - Musab A Ali
- Hamad Medical Corporation, Neurosciences Institute, Doha, Qatar.
| | | | - Lubna Elsheikh
- Hamad Medical Corporation, Neurosciences Institute, Doha, Qatar.
| | - Coraline Hingray
- Service de Neurologie, CHRU de NANCY et Pole Universitaire Adulte Du Grand Nancy, CPN, Laxou, France.
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Asadi-Pooya AA, Homayoun M. Psychogenic nonepileptic (functional) seizures: Significance of family history and model learning. Psychiatry Res 2020; 290:113166. [PMID: 32512356 DOI: 10.1016/j.psychres.2020.113166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE If a positive family history of seizures plays a significant role that contributes to the risk for developing psychogenic nonepileptic seizures (PNES) by means of model learning, one would expect that patients with PNES with a family history of seizures show a different semiology than those without such a history. We investigated whether the above hypothesis is valid. METHODS In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, Iran, from 2008 until 2019, were investigated. Demographic and clinical characteristics were compared between patients with a positive family history of seizures and those without such a history RESULTS: During the study period, 274 patients with PNES-only had the inclusion criteria. Seventy-seven (28%) patients had a positive family history of seizures and 197 (72%) patients did not have such a history. There were no significant demographic or clinical differences between the two groups. CONCLUSION It seems that a positive family history of seizures and model learning does not play a significant role in the development of PNES. Investigators should explore other potentially significant contributors and risk factors for developing PNES in future studies.
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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, Pennsylvania, PA, USA.
| | - Maryam Homayoun
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Asadi-Pooya AA. International multicenter studies on psychogenic nonepileptic seizures: A systematic review. Psychiatry Res 2020; 285:112812. [PMID: 32014624 DOI: 10.1016/j.psychres.2020.112812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
The aim of the current paper is to systematically review the literature on the existing international multicenter studies on various aspects of PNES and to highlight their findings and significance. I searched the electronic database PubMed for articles that included any of these search terms: Non-epileptic seizures, Nonepileptic seizures, Pseudoseizures, Non-epileptic events, Nonepileptic events, Dissociative seizures, Psychogenic, PNES, AND "international" or "multicenter" or "cross cultural", in their abstracts and titles and published before August 6, 2019. I searched PsycINFO database (keywords in the abstracts) and also included some of the references of the selected articles if they were relevant. I could identify 12 related manuscripts through the search strategy. These included seven studies on patients with PNES, two surveys, and three consensus group reports. This systematic review showed that international and cross-cultural studies on PNES to date are very limited in number and quality. However, these limited studies have resulted in intriguing observations and conclusions. International and cross-cultural studies may make important contributions to our understanding of different aspects of PNES across borders.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA.
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Semiological classification of psychogenic nonepileptic seizures: A systematic review and a new proposal. Epilepsy Behav 2019; 100:106412. [PMID: 31645005 DOI: 10.1016/j.yebeh.2019.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE A semiological classification of psychogenic nonepileptic seizures (PNES) may help address proper diagnosis and management and also provide standardization for future studies. The aim of the current paper was to systematically review the literature on the proposed classification systems for the semiology of PNES and to provide a new proposal based on the best available evidence. METHODS I searched the electronic database PubMed on May 16, 2019 for articles that included the following search terms: "psychogenic" AND "semiology" or "classification" and also "nonepileptic" AND "semiology" or "classification" and also "pseudoseizure" AND "semiology" or "classification" since 1940. I applied the same methodology using the electronic database Scopus, though I limited the search to the title, abstract, and keywords. RESULTS I could identify 15 classification systems through this search strategy using the electronic database PubMed. Searching the Scopus did not yield any additional relevant papers. CONCLUSION I proposed a new semiological classification system for PNES based on this systematic review. This includes three major classes of motor seizures, nonmotor seizures, and mixed semiology. A universally accepted and appropriate semiological classification system for PNES may lead to better standardization of future studies and may also help in better understanding of the pathophysiological basis of this condition.
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Asadi-Pooya AA, Myers L, Valente K, Sawchuk T, Restrepo AD, Homayoun M, Buchhalter J, Bahrami Z, Taha F, Lazar LM, Paytan AA, D' Alessio L, Kochen S, Alessi R, Pick S, Nicholson TR. Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study. Seizure 2019; 71:56-59. [DOI: 10.1016/j.seizure.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
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Asadi-Pooya AA, Valente K, Restrepo AD, D' Alessio L, Homayoun M, Bahrami Z, Alessi R, Paytan AA, Kochen S, Myers L, Sawchuk T, Buchhalter J, Taha F, Lazar LM, Pick S, Nicholson T. Adult-onset psychogenic nonepileptic seizures: A multicenter international study. Epilepsy Behav 2019; 98:36-39. [PMID: 31299530 DOI: 10.1016/j.yebeh.2019.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this multicenter international cross-cultural study was to compare clinical variables in a large sample of people with adult-onset psychogenic nonepileptic seizures (PNES). METHODS In this retrospective study, we evaluated persons with documented PNES, who were older than 16 years of age at the onset, from four countries (i.e., Iran, Brazil, Venezuela, and Argentina) regarding their age, gender, PNES semiology, and possible predisposing factors. RESULTS We included 389 patients (244 from Iran, 66 from Brazil, 51 from Venezuela, and 28 from Argentina). Age at diagnosis was 32 ± 9 years (range: 17-64 years), and age at the onset of seizures was 27 ± 8 years (range: 17-49 years). There was a female predominance in all countries. The demographic characteristics and factors associated with PNES were similar among the countries. However, there were significant semiological differences among the countries. CONCLUSION This study corroborates the notion that PNES share more similarities than differences cross-culturally and across international borders. However, the background determined by cultural, ethnic, and religious differences may influence the semiology of PNES. Further cross-cultural studies involving more than two continents may advance our understanding of PNES.
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Affiliation(s)
- Ali A Asadi-Pooya
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Kette Valente
- Institute of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Luciana D' Alessio
- Buenos Aires University, Epilepsy Center, Ramos Mejía and EL Cruce Hospitals, ENyS-IBCN-CONICET, Buenos Aires, Argentina
| | - Maryam Homayoun
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bahrami
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rudá Alessi
- Institute of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Silvia Kochen
- Buenos Aires University, Epilepsy Center, Ramos Mejía and EL Cruce Hospitals, ENyS-IBCN-CONICET, Buenos Aires, Argentina
| | - Lorna Myers
- Northeast Regional Epilepsy Group, New York, USA.
| | - Tyson Sawchuk
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus.
| | - Jeffrey Buchhalter
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Calgary, Cumming School of Medicine, Departments of Pediatrics, Canada
| | - Firas Taha
- Northeast Regional Epilepsy Group, New York, USA.
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
| | - Timothy Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
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Sharifian Dorche M, Sharifian Dorche AH, Asadi-Pooya AA. Psychogenic nonepileptic seizures publications in PubMed: Geographical distribution of the publications. Seizure 2019; 71:240-244. [PMID: 31425871 DOI: 10.1016/j.seizure.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/04/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of the current study was to depict a comprehensive geographical picture of the existing literature on psychogenic nonepileptic seizures (PNES) and to highlight the needs for future works. METHODS We searched the electronic database PubMed on June 8, 2019 for articles that included any of the related key words to analyze all the relevant literature. We applied the advance search; field was adjusted to the title and dates were adjusted to 01/01/2000 until 06/08/2019. We selected the relevant articles. Location of the study was determined according to the affiliation(s) of the authors. RESULTS 1017 papers were included. Interest in research and publication on PNES has risen over the past two decades. Six hundred and nine full length research original papers and 199 review articles were published on PubMed from 2000 until 2019. Continent-wise, most articles were from North America and Europe (41.1% of the whole publications from Europe and 40.8% from North America; 833 papers totally), followed by Asia (92 papers), Oceania (36 papers) and South America (31 publications), while only 0.9% of the papers (9 papers) were from Africa. CONCLUSION A global campaign is necessary to inform and educate the world on the issue of PNES and its significance. While PNES merit further epidemiological investigations, there is a significant disparity with regard to the location of the studies. There is a huge need to invest more on studies on various aspects of PNES in many places in the world, including African nations, India, and China.
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Affiliation(s)
- Maryam Sharifian Dorche
- Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Ali A Asadi-Pooya
- Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA.
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Myers L, Trobliger R, Bortnik K, Zeng R, Segal E, Lancman M. Dissociation and other clinical phenomena in youth with psychogenic non-epileptic seizures (PNES) compared to youth with epilepsy. Seizure 2019; 70:49-55. [DOI: 10.1016/j.seizure.2019.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022] Open
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Ho R, Ocol J, Lu C, Dolim S, Yang M, Carrazana E, Liow KK. Presentation of psychogenic nonepileptic seizures in Hawaii's ethnoracially diverse population. Epilepsy Behav 2019; 96:150-154. [PMID: 31146179 DOI: 10.1016/j.yebeh.2019.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This exploratory study compared the semiology of psychogenic nonepileptic seizures (PNES) between a diverse group of patients in the state of Hawaii. This study may expand understanding of PNES across different ethnocultural and gender groups. METHODS A retrospective chart review of patients admitted to our Epilepsy Monitoring Unit (EMU) over a 4-year period was performed to compare semiology in different ethnic groups and gender. RESULTS A total of 139 patients were included in this study, 37% (n = 51) with PNES, 34% (n = 47) with epilepsy only, and 29% (n = 41) with other non-PNES, nonepilepsy diagnosis. The number of Asians with PNES were found to differ when compared with the patients with epilepsy and the patients with non-PNES, nonepilepsy diagnosis. A positive trend was found in the number of Native Hawaiians and Caucasians with PNES in comparison with patients with non-PNES, nonepilepsy diagnosis. In addition, three semiology of PNES in Native Hawaiians were found to differ in comparison with other ethnic groups with PNES: rhythmic motor, mixed semiology, and nonepileptic aura. There is a significant difference in all motor manifestation between males and females in Native Hawaiians. Between patients with PNES, patients with epilepsy, and patients with non-PNES, nonepilepsy diagnosis, significant correlation was found in psychiatric disorders including posttraumatic stress disorder (PTSD), anxiety, and any psychiatric disorder. CONCLUSION This cross-cultural study found significant differences in the expression of PNES across key ethnoracial groups for the Islands of Hawaii. These findings have implications to the diagnosis and treatment of PNES for Native Hawaiians and other Pacific Islanders in the United States.
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Affiliation(s)
- Richard Ho
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Jasen Ocol
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Carol Lu
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Shelby Dolim
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Michael Yang
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Enrique Carrazana
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Kore Kai Liow
- Epilepsy Research Unit, Hawaii Pacific Neuroscience, Honolulu, HI, USA; Comprehensive Epilepsy Center and Epilepsy Monitoring Unit (EMU), Hawaii Pacific Neuroscience, Honolulu, HI, USA; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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