Psychogenic nonepileptic seizures in Latin America: A survey describing current practices

Stigma in functional neurological disorder (FND) - A systematic review

OBJECTIVE

The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions.

METHODS

We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by "aggregation and configuration" to synthesise and analyse the data into emergent themes.

RESULTS

We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions.

CONCLUSION

Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.

Quality of life for patients with psychogenic nonepilepsy seizures in comparison with age- and gender-matched patients with epilepsy - Cross-sectional study

AIMS

Patients with psychogenic nonepileptic seizures (PNES), and age- and gender-matched patients with epilepsy (PWE) who utilized an out-patient service were compared regarding quality of life (QoL) and self-reported symptoms of depression. Additionally, the impact of miscellaneous clinical variables including symptoms of depression on QoL in patients with PNES and PWE in real-world settings was assessed.

SUBJECTS AND METHODS

Adult patients who had a diagnosis of definite or documented PNES based on LaFrance's criteria (PNES group, n = 62), or of epilepsy based on results of clinical and EEG procedures (Epilepsy group, n = 61) were enrolled. To assess QoL and evaluate depression, the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), respectively, were administered.

RESULTS

Comparisons between the groups revealed a shorter duration of illness and fewer number of attacks in patients with PNES as compared to the Epilepsy group (p < 0.0001; p = 0.0003, respectively). There was no significant difference between the groups revealed by the QOLIE-10 (p = 0.141), while the patients with PNES tended to have higher NDDI-E scores (p = 0.068). Multiple regression analysis of QOLIE-10 results in the PNES group revealed that NDDI-E score was the sole significant contributor (β = -0.425 p = 0.001). In contrast, NDDI-E score as well as attack frequency had a significant impact on QOLIE-10 results in the Epilepsy group (β = -0.283 p = 0.026; β = -0.272 p = 0.031, respectively).

CONCLUSION

In PWE and patients with PNES who utilized an out-patient service, QoL did not differ significantly between those groups. For treating PNES, psychosocial factors may be a more appropriate indicator of therapeutic goal than attack frequency.

Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation

INTRODUCTION

Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains.

OBJECTIVE

To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors.

MATERIALS AND METHODOLOGY

One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE).

RESULTS

Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471).

DISCUSSION

Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation.