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Leroy A, Derambure P, Hingray C, El-Hage W, Warembourg I, Vaiva G, Amad A. Right temporoparietal junction transcranial direct current stimulation in the treatment of functional dissociative seizures: a case series. Eur Arch Psychiatry Clin Neurosci 2024; 274:83-86. [PMID: 36602649 DOI: 10.1007/s00406-022-01533-2] [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: 09/21/2022] [Accepted: 12/03/2022] [Indexed: 01/06/2023]
Abstract
Functional dissociative seizures (FDSs) are clinical events that resemble epileptic seizures but are not associated with abnormal brain electrical discharges or other physiological problems. In this pilot case series, ten adults with FDSs were recruited from our psychiatry department after being referred by a neurologist who made the diagnosis of FDS based on video EEG results. Each subject received ten sessions of cathodal tDCS focused on the right temporoparietal junction. A significant decrease in weekly seizure frequency was seen in all participants between baseline (30.2 ± 70.3 events) and 1 month after tDCS treatment (0.2 ± 0.3events) (p = 0.006). Main predisposing factors were unchanged after treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France.
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France.
- Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000, Lille, France.
| | - Philippe Derambure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Department of Clinical Neurophysiology, 59000, Lille, France
| | - Coraline Hingray
- Pôle Universitaire de Psychiatrie adulte du Grand Nancy, CPN, Laxou, France
- CNRS CRAN, UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU de Tours, Pôle de Psychiatrie et d'addictologie, Tours, France
| | - Isabelle Warembourg
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
| | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
- Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000, Lille, France
| | - Ali Amad
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
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Roze E, Hingray C, Degos B, Drapier S, Tyvaert L, Garcin B, Carle-Toulemonde G. [Functional neurological disorders: A clinical anthology]. L'ENCEPHALE 2023:S0013-7006(23)00084-2. [PMID: 37400338 DOI: 10.1016/j.encep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorders have a broad phenotypic spectrum and include different clinical syndromes, which are sometimes associated to each other or appear consecutively over the course of the disease. This clinical anthology provides details on the specific and sensitive positive signs that are to be sought in the context of a suspected functional neurological disorder. Beside these positive elements leading to the diagnosis of functional neurological disorder, we should keep in mind the possibility of an associated organic disorder as the combination of both organic and functional disorders is a relatively frequent situation in clinical practice. Here we describe the clinical characteristics of different functional neurological syndromes: motor deficits, abnormal hyperkinetic and hypokinetic movements, voice or speech disorders, sensory disorders, and functional dissociative seizures. The clinical examination and the identification of positive signs play a critical role in the diagnosis of functional neurological disorder. Knowledge of the specific signs associated with each phenotype render possible to make an early diagnosis. For that matter, it contributes to the improvement of patient care management. It allows to a better engagement in an appropriate care pathway, which influence their prognosis. Highlighting and discussing positive signs with patients can also be an interesting step in the process of explaining the disease and its management.
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Affiliation(s)
- Emmanuel Roze
- Hôpital Salpêtrière, DMU neurosciences, Assistance publique des Hôpitaux de Paris, Paris, France; Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France
| | | | - Bertrand Degos
- Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France; Centre de recherche interdisciplinaire en biologie (CIRB), Collège de France, CNRS UMR7241/Inserm U1050, Université PSL, Paris, France
| | - Sophie Drapier
- Département de neurologie, CHU de Rennes, CIC Inserm 1414, Rennes, France
| | - Louise Tyvaert
- Centre de psychothérapie du CHRU de Nancy, Nancy, France
| | - Béatrice Garcin
- Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France; Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, 29, rue Émile-Lecrivain, 31400 Toulouse, France.
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Leroy A, Tarrada A, Garcin B, Hingray C. Crisi psicogene non epilettiche (funzionali/dissociative). Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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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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Micoulaud-Franchi JA, Kotwas I, Arthuis M, Soncin L, Rontani P, Daquin G, Cermolacce M, Bartolomei F, McGonigal A. Screening for epilepsy-specific anxiety symptoms: French validation of the EASI. Epilepsy Behav 2022; 128:108585. [PMID: 35180578 DOI: 10.1016/j.yebeh.2022.108585] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES (1) To translate and validate the Epilepsy Anxiety Survey Instrument (EASI) in French people with epilepsy (PWE); (2) to further investigate the screening properties of each dimension of the EASI in terms of Diagnostic and Statistical Manual of Mental Disorders (DSM) anxiety disorders and of epilepsy-specific anxiety disorders, namely, anticipatory anxiety of seizures (AAS) and epileptic social phobia. METHODS Following back-translation, the French EASI was tested in PWE > 18 years using the Mini-International Neuropsychiatric Interview (MINI) as gold standard for DSM anxiety disorders. We added 3 original questions to explore epilepsy-specific anxiety symptoms. The Generalized Anxiety Disorders-7 (GAD-7), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Adverse Events Profile were performed for external validity. Receiver operator characteristics (ROC) were analyzed. RESULTS One hundred and forty nine native French speakers with epilepsy were included. Concerning DSM disorders, around 25% had GAD, 18% Agoraphobia, and <10% Social Phobia or Panic Disorder. Concerning possible epilepsy-specific anxiety disorder, 35% had AAS and 38% had epileptic social phobia. Bi-dimensional structure of the EASI was confirmed. Internal and external validity was satisfactory. ROC analysis showed AUC of 0.83 for detection of GAD and AUC 0.79 for other DSM anxiety disorders. ROC analysis of the 8-item French brEASI showed good performance for detection of GAD (AUC 0.83) and other DSM anxiety disorders (AUC 0.76) but not for epilepsy-specific anxiety symptoms (AUC 0.63). Conversely, dimension 2 of the French EASI (=10 items) allowed good detection of epilepsy-specific anxiety symptoms (AUC 0.78); cutoff > 4, sensitivity 82.4, specificity 66.7. CONCLUSION Epilepsy-specific anxiety symptoms were prevalent, in around 60%. The French version of the EASI showed robust performance. The French 8-item brEASI allows screening for all DSM anxiety disorders with superior performance than the GAD-7, but is less suited to screening for epilepsy-specific anxiety. We propose the "Epilepsy-Specific Anxiety" (ESA) 10-item screening instrument, based on dimension 2 of the EASI, as a complementary clinical and research tool.
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Affiliation(s)
- Jean-Arthur Micoulaud-Franchi
- Sleep Medicine Unit, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33 076 Bordeaux, France; USR CNRS 3413 SANPSY, University Hospital of Bordeaux, 33 076 Bordeaux, France
| | - Iliana Kotwas
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Marie Arthuis
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Lisa Soncin
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Pauline Rontani
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Geraldine Daquin
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - Michel Cermolacce
- University Department of Psychiatry, APHM, Sainte Marguerite Hospital, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Aileen McGonigal
- APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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Tarrada A, Hingray C, Aron O, Dupont S, Maillard L, de Toffol B. Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients. Epilepsy Behav 2022; 127:108553. [PMID: 35074723 DOI: 10.1016/j.yebeh.2022.108553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Postictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP. METHODS We performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features. RESULTS We found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes). CONCLUSION Considering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.
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Affiliation(s)
- Alexis Tarrada
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université Paris Descartes, Faculté de Médecine, 75006 Paris, France.
| | - Coraline Hingray
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France.
| | - Olivier Aron
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - Sophie Dupont
- Unité d'Epileptologieet Unité de réadaptation, Hôpital de la Pitié-Salpêtrière, AP-HP, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France; Université Paris Sorbonne, Paris, France; CRHU de Nancy, Département de Neurologie, Nancy, France.
| | - Louis Maillard
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Service de Neurologie & Neurophysiologie Clinique, CHU Bretonneau, Tours, France; Service de Neurologie, Centre Hospitalier de Cayenne, France; CIC INSERM, 1424 CH Cayenne, France.
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Kotwas I, Arthuis M, Cermolacce M, Bartolomei F, McGonigal A. Psychogenic non-epileptic seizures: Chronology of multidisciplinary team approach to diagnosis and management. Rev Neurol (Paris) 2021; 178:692-702. [PMID: 34980511 DOI: 10.1016/j.neurol.2021.11.008] [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: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
While the diagnosis and management of psychogenic non-epileptic seizures (PNES) remain challenging, certain evidence-based guidelines exist, which can help to optimize patient care. A multidisciplinary team approach appears to have many benefits. Current recommendations exist for some aspects of diagnosis and management of PNES, including levels of diagnostic certainty as proposed by the International League Against Epilepsy's expert Task Force on PNES. Other aspects of clinical still care lack clear consensus, including use of suggestion techniques for recording PNES and optimal terminology, since the term "functional seizures" has recently been proposed as a possible term to replace "PNES". The present article aims to (1) review current recommendations and (2) discuss our own team's experience in managing patients with PNES. This is organized chronologically in terms of the roles of the neurologist, psychiatrist and psychologist, and discusses diagnostic issues, psychiatric assessment and treatment, and psychotherapeutic approaches.
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Affiliation(s)
- I Kotwas
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Arthuis
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Cermolacce
- University Department of Psychiatry, AP-HM, Sainte-Marguerite Hospital, Marseille, France
| | - F Bartolomei
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - A McGonigal
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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