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Gaskell C, Power N, Novakova B, Simmonds-Buckley M, Kerr WT, Reuber M, Kellett S, Rawlings GH. A meta-analytic evaluation of the effectiveness and durability of psychotherapy for adults presenting with functional dissociative seizures. Seizure 2024; 119:98-109. [PMID: 38824867 DOI: 10.1016/j.seizure.2024.05.016] [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: 01/22/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes. METHODS This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes. RESULTS Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis. CONCLUSIONS The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
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Affiliation(s)
- Chris Gaskell
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Department of Neuropsychology, North Staffordshire Combined NHS Foundation Trust, Stoke-on-Trent, UK.
| | - Niall Power
- South West Yorkshire Partnership NHS Foundation Trust, UK
| | - Barbora Novakova
- Health and Wellbeing Service, NHS Sheffield Talking Therapies, Sheffield Health and Social Care NHS Foundation Trust, UK
| | - Melanie Simmonds-Buckley
- Clinical and Applied Psychology Unit, University of Sheffield, UK; Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Wesley T Kerr
- Departments of Neurology & Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, S10 2JF Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Gregg H Rawlings
- Clinical and Applied Psychology Unit, University of Sheffield, UK
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Van Patten R, Austin TA, Cotton E, Chan L, Bellone JA, Mordecai K, Altalib H, Correia S, Twamley EW, Jones RN, Sawyer K, LaFrance WC. Cognitive performance in functional seizures compared with epilepsy and healthy controls: a systematic review and meta analysis. Lancet Psychiatry 2024; 11:516-525. [PMID: 38879275 DOI: 10.1016/s2215-0366(24)00132-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Cognition is a core component of functional seizures, but the literature on cognition in this disorder has been heterogeneous, with no clear unifying profile emerging from individual studies. The aim of this study was to do a systematic review and meta-analysis of cognitive performance in adults with functional seizures compared with epilepsy (including left temporal lobe epilepsy) and compared with healthy non-seizure cohorts. METHODS In this systematic review and meta-analysis, starting Feb 6, 2023, replicated and updated on Oct 31, 2023, a medical librarian searched MEDLINE, Embase, PsycINFO, and Web of Science. Inclusion criteria were full reports documenting raw or standardised cognitive test data in adults with functional seizures compared with adults with epilepsy, prospectively recruited healthy comparisons, or published norms. Grey literature was retained and there were no language or date restrictions. We excluded studies only reporting on mixed functional seizures and epilepsy, or mixed functional neurological samples, with no pure functional seizures group. Risk of bias was evaluated using a modified version of the Newcastle-Ottawa Scale. People with lived experiences were not involved in the design or execution of this study. This study is registered as CRD42023392385 in PROSPERO. FINDINGS Of 3834 records initially identified, 84 articles were retained, including 8654 participants (functional seizures 4193, epilepsy 3638, and healthy comparisons 823). Mean age was 36 years (SD 12) for functional seizures, 36 years (12) for epilepsy, and 34 years (10) for healthy comparisons, and the proportion of women per group was 72% (range 18-100) for functional seizures, 59% (range 15-100) for epilepsy, and 69% (range 34-100) for healthy comparisons. Data on race or ethnicity were rarely reported in the individual studies. Risk of bias was moderate. Cognitive performance was better in people with functional seizures than those with epilepsy (Hedges' g=0·17 [95% CI 0·10-0·25)], p<0·0001), with moderate-to-high heterogeneity (Q[56]=128·91, p=0·0001, I2=57%). The functional seizures group performed better than the epilepsy group on global cognition and intelligence quotient (g=0·15 [0·02-0·28], p=0·022) and language (g=0·28 [0·14-0·43], p=0·0001), but not other cognitive domains. A larger effect was noted in language tests when comparing functional seizures with left temporal lobe epilepsy (k=5; g=0·51 [0·10 to 0·91], p=0·015). The functional seizures group underperformed relative to healthy comparisons (g=-0·61 [-0·78 to -0·44], p<0·0001), with significant differences in all cognitive domains. Meta regressions examining effects of multiple covariates on global cognition were not significant. INTERPRETATION Patients with functional seizures have widespread cognitive impairments that are likely to be clinically meaningful on the basis of moderate effect sizes in multiple domains. These deficits might be slightly less severe than those seen in many patients with epilepsy but nevertheless argue for consideration of clinical assessment and treatment. FUNDING Department of Veterans Affairs, Veterans Health Administration.
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Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Tara A Austin
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Erica Cotton
- Department of Psychiatry & Behavioral Sciences and Department of Neurology, Northwestern University, Evanston, IL, USA
| | - Lawrence Chan
- VA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - John A Bellone
- Kaiser Permanente, Department of Behavioral Health, San Bernardino, CA, USA
| | | | - Hamada Altalib
- VA Connecticut, West Haven, CT, USA; Department of Neurology and Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Stephen Correia
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Kelsey Sawyer
- Health and Biomedical Library Sciences, San Diego, CA, USA
| | - W Curt LaFrance
- VA Providence Healthcare System, Center for Neurorestoration and Neurotechnology, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA; VA Providence Healthcare System, Rhode Island Hospital, Providence, RI, USA
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Capitaine P, Thomas B, Gradel A, Ferté T, Branchard O, Frison E, Renaudeau V, Aupy J. Evaluation of quality of life's prognostic factors in people with functional seizures. Rev Neurol (Paris) 2024; 180:524-531. [PMID: 38040548 DOI: 10.1016/j.neurol.2023.09.007] [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: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/03/2023]
Abstract
AIMS Functional non-epileptic seizures significantly impact the quality of life of patients. We aimed to identify prognostic factors associated with the quality of life in individuals with functional non-epileptic seizures. SUBJECTS AND METHODS Adult patients diagnosed with definite or documented functional seizures based on LaFrance's criteria (n=72) were enrolled at the time of diagnosis. Quality of life was assessed using the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) at diagnosis and at a six-month follow-up. Demographic and medical information was collected, and psychiatric comorbidities were evaluated using validated scales. RESULTS Comparisons between diagnosis and follow-up did not reveal any factors associated with improvement in quality of life at six months after diagnosis. However, multivariable analysis, adjusted for age, sex, diagnosis delay, and frequency of functional seizures showed a significant cross-sectional relationship with a QOLIE-31 score decrease of 0.66 [95% CI -0.93;-0.39], -0.32 [-0.61; -0.03], and -0.22 [-0.42; -0.02] for an increase of 1 point of BDI-2 score, BAI score, and CTQ score respectively. CONCLUSION Psychiatric comorbidities, particularly depression and anxiety, are associated with worse quality of life in patients with functional seizures. This underscores the crucial importance of multidisciplinary care involving both neurological and psychiatric expertise when managing individuals with functional seizures.
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Affiliation(s)
- P Capitaine
- Department of Clinical Neurosciences, CHU de Bordeaux, 33076 Bordeaux, France
| | - B Thomas
- Department of Clinical Neurosciences, CHU de Bordeaux, 33076 Bordeaux, France
| | - A Gradel
- Department of Clinical Neurosciences, CHU de Bordeaux, 33076 Bordeaux, France
| | - T Ferté
- Service d'information médicale, CHU de Bordeaux, Bordeaux, France
| | - O Branchard
- Department of Clinical Neurosciences, CHU de Bordeaux, 33076 Bordeaux, France
| | - E Frison
- Service d'information médicale, CHU de Bordeaux, Bordeaux, France
| | - V Renaudeau
- Service d'information médicale, CHU de Bordeaux, Bordeaux, France
| | - J Aupy
- Department of Clinical Neurosciences, CHU de Bordeaux, 33076 Bordeaux, France; Université de Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France.
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Van Patten R, Mordecai K, LaFrance WC. The role of neuropsychology in the care of patients with functional neurological symptom disorder. J Int Neuropsychol Soc 2024:1-8. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. METHODS A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. RESULTS Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. CONCLUSIONS Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | | | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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Van Patten R, Chan L, Tocco K, Mordecai K, Altalib H, Cotton E, Correia S, Gaston TE, Grayson LP, Martin A, Fry S, Goodman A, Allendorfer JB, Szaflarski J, LaFrance WC. Reduced Subjective Cognitive Concerns With Neurobehavioral Therapy in Functional Seizures and Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2024; 36:197-205. [PMID: 38481168 DOI: 10.1176/appi.neuropsych.20230138] [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] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Functional seizures are common among people with traumatic brain injury (TBI). Subjective cognitive concerns refer to a person's own perception of problems with cognitive functioning in everyday life. The authors investigated the presence and correlates of subjective cognitive concerns and the response to neurobehavioral therapy among adults with TBI and functional seizures (TBI+FS group). METHODS In this observational study, participants in the TBI+FS group (N=47) completed a 12-session neurobehavioral therapy protocol for seizures, while participants in the comparison group (TBI without seizures) (N=50) received usual treatment. Subjective cognitive concerns, objective cognition, mental health, and quality of life were assessed before and after treatment. Data collection occurred from 2018 to 2022. RESULTS Baseline subjective cognitive concerns were reported for 37 (79%) participants in the TBI+FS group and 20 (40%) participants in the comparison group. In a multivariable regression model in the TBI+FS group, baseline global mental health (β=-0.97) and obsessive-compulsive symptoms (β=-1.01) were associated with subjective cognitive concerns at baseline. The TBI+FS group had fewer subjective cognitive concerns after treatment (η2=0.09), whereas the TBI comparison group showed a nonsignificant increase in subjective cognitive concerns. CONCLUSIONS Subjective cognitive concerns are common among people with TBI and functional seizures and may be related to general mental health and obsessive-compulsive symptoms. Evidence-based neurobehavioral therapy for functional seizures is a reasonable treatment option to address such concerns in this population, although additional studies in culturally diverse samples are needed. In addition, people with functional seizures would likely benefit from rehabilitation specifically targeted toward cognitive functioning.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Lawrence Chan
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Krista Tocco
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Kristen Mordecai
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Hamada Altalib
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Erica Cotton
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Stephen Correia
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Tyler E Gaston
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Leslie P Grayson
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Amber Martin
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Samantha Fry
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Adam Goodman
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jane B Allendorfer
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - Jerzy Szaflarski
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
| | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, Veterans Affairs (VA) Providence Health Care System, and Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Van Patten, Chan, Tocco, LaFrance); Rhode Island Hospital, Providence (Tocco, LaFrance); VA Maryland Health Care System, Baltimore (Mordecai); VA Connecticut Health Care System and Department of Neurology, Yale University, New Haven (Altalib); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Northwestern University Feinberg School of Medicine, Evanston, Ill. (Cotton); College of Public Health, University of Georgia, Athens (Correia); Department of Neurology, University of Alabama at Birmingham, Birmingham (Gaston, Grayson, Martin, Fry, Goodman, Allendorfer, Szaflarski)
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Fox J, Mishra M. Hypertension and other vascular risk factors in patients with functional seizures. Epilepsy Behav 2024; 152:109650. [PMID: 38277850 DOI: 10.1016/j.yebeh.2024.109650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Recent literature has suggested that functional seizures are associated with an elevated risk for vascular disease and mortality. We investigated the prevalence of risk factors for vascular disease in patients who were admitted to the epilepsy monitoring unit. METHODS Patients who were admitted to the epilepsy monitoring unit and received a definitive diagnosis of either functional seizures or epilepsy were identified. Data collected included demographic, clinical characteristics, medication list, comorbidities, and scheduled blood pressure measurements that occurred every 12 h during the admission. The mean blood pressures were calculated and if they were above the American College of Cardiology and the American Heart Association guideline cutoff of 130/80 mm Hg or the patient had a documented history of hypertension the patient was counted as having the condition. A multiple logistic regression model was developed to evaluate the independent association of the patient's diagnosis (i.e., epilepsy or functional seizures) and vascular risk factors that controlled for the number of blood pressure measurements, age, sex, and if the patient was taking antihypertensive medications. RESULTS 270 patients were included in this study of which 147 patients had epilepsy and 123 had functional seizures. Among those with functional seizures, 57.72 % had either a history of hypertension or a mean blood pressure above 130/80 compared to 38.78 % of those with epilepsy (p = 0.0022). In addition, 30.89 % of functional seizures patients had hyperlipidemia and 63.41 % were obese. The logistic regression model indicated that functional seizures were independently associated with high blood pressure (OR: 2.47, 95 % CI 1.10-5.69), hyperlipidemia (OR: 3.38, 95 % CI 1.35-8.86), and obesity (OR: 4.25, 95 % CI 2.22-8.36) compared to those with epilepsy. There was no significant difference in the prevalence of diabetes (OR: 0.81, 95 % CI 0.24-2.77) or current tobacco use (OR: 1.04, 95 % CI 0.48-2.25) between the groups. SIGNIFICANCE Patients with functional seizures had an elevated prevalence of several vascular risk factors. These findings may partially account for complications associated with functional seizures and have implications related to their pathophysiology.
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Affiliation(s)
- Jonah Fox
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Murli Mishra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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Van Patten R, Bellone JA. The neuropsychology of functional neurological disorders. J Clin Exp Neuropsychol 2023; 45:957-969. [PMID: 38441076 DOI: 10.1080/13803395.2024.2322798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center for Neurorestoration & Neurotechnology, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - John A Bellone
- Department of Behavioral Health, Kaiser Permanente, San Bernardino, CA, USA
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Uhlmann C, Schmid P. Long-term course of psychogenic nonepileptic seizures: Who gets seizure-free, has better functional level and higher health-related quality of life? Epilepsy Behav 2023; 148:109463. [PMID: 37839244 DOI: 10.1016/j.yebeh.2023.109463] [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: 07/20/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The disease course of psychogenic nonepileptic seizures (PNES) over a prolonged period of time remains unclear. The aims of the study were: 1. to describe the course of illness with a median follow-up time of 4 years and a range of 2-15 years; and 2. to identify distinguishing features between participants regarding seizure cessation, functional level and health-related quality of life. METHODS Formerly, inpatients of an epileptic ward diagnosed with PNES between 2000 and 2013 were contacted via mail. They were asked by questionnaire about illness characteristics, i.e., age at onset, PNES status at onset and in the course, treatments, psychosocial situation, and quality of life status. RESULTS Two-thirds of the N = 63 formerly inpatients were female, their age at onset was 26.7 years. Seizure frequency decreased significantly over time, 31.7% were currently seizure-free, but still only 37% were regularly employed. Only 48% had a satisfying health-related quality of life. The remitted participants had a shorter duration of illness and higher health-related quality of life. Participants with a good level of functioning were more likely to be male, took fewer medications, and had a higher health-related quality of life. Those participants with higher quality of life were more frequently employed and had fewer seizures. CONCLUSIONS As participants continue to be severely limited in their functional level and quality of life over the period under review, enhanced treatment approaches that address experiential avoidance seem to be needed.
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Affiliation(s)
- Carmen Uhlmann
- Department of Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Petra Schmid
- Department of Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany.
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9
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Duque L, Garza I, Cascino GD, Staab JP. Functional neurological seizures and migraine: A systematic review and case series. Epilepsy Behav 2023; 147:109437. [PMID: 37717461 DOI: 10.1016/j.yebeh.2023.109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The seizure subtype of functional neurological disorder (FND-seizures) is a common neuropsychiatric condition manifesting with episodic epilepsy-like events. Despite the common belief that FND-seizures are precipitated by psychological stressors, neurological disorders may also be triggers. In 1890, Babinski described four cases of FND symptoms associated with migraine attacks. Despite the passing of more than 130 years since this first clinical observation, the relationship between FND-seizures and migraine is not fully elucidated. OBJECTIVES (1) To complete a systematic review of the literature that investigated potential associations between FND-seizures and migraine and the response of FND seizures to treatment with migraine prophylactic medications (2). To undertake a retrospective study of patients with FND-seizures and migraine, including response to migraine prophylaxis. METHODS (1) Using PRISMA methods, we completed a systematic review of EMBASE and Scopus databases from inception to March 31, 2021, for literature on FND-seizures and migraine. (2) Our multi-disciplinary team, including subspecialists in psychosomatic medicine, epilepsy, and headache disorders, reviewed consecutive patients diagnosed with FND-seizures and migraine to assess potential causal associations and responses to standard migraine prophylactic medications. RESULTS (1) The search yielded seven studies from 126 screened manuscripts (N = 1,186 patients with FND-seizures; mean age 38.7 years; 72.6% female). They varied substantially in design, population, diagnostic measures, and outcomes. Nevertheless, all studies found associations between FND-seizures and migraine, which were stronger than those between epileptic seizures and migraine in comparative investigations, but provided limited information on treatment response. (2) In our case series, investigators reached unanimous consensus that migraine attacks triggered FND-seizures in 28/43 (65.1%) patients reviewed (mean age, 38.8 years; 74% female). In 19/26 (73%) patients with adequate follow-up data, treatment with migraine prophylactic medications alone (no behavioral interventions) concomitantly reduced FND-seizure and headache frequency by >50%. CONCLUSION Our systematic review and case series indicate that migraine attacks may trigger FND-seizures, perhaps more often that currently understood, and suggest that migraine prophylaxis may reduce FND-seizure frequency in such cases. To validate these observations, fully powered prospective investigations are required.
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Affiliation(s)
- Laura Duque
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ivan Garza
- Department of Neurology (Headache Division), Mayo Clinic, Rochester, MN, USA
| | - Gregory D Cascino
- Department of Neurology (Epilepsy Division), Mayo Clinic, Rochester, MN, USA
| | - Jeffrey P Staab
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN.
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Van Patten R, Chan L, Tocco K, Mordecai K, Altalib H, Twamley EW, Gaston TE, Grayson LP, Martin A, Fry S, Goodman A, Allendorfer JB, Correia S, Szaflarski J, LaFrance WC. Improvements in Montreal Cognitive Assessment scores after neurobehavioral therapy in adults with functional (nonepileptic) seizures and traumatic brain injury. J Psychiatr Res 2023; 165:282-289. [PMID: 37549503 DOI: 10.1016/j.jpsychires.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
Cognitive functioning impacts clinical symptoms, treatment response, and quality of life in adults with functional/nonepileptic seizures (FS/NES), but no study to date examines effects of behavioral FS/NES treatment on cognition in these patients. We hypothesized that there would be a reduction in cognitive symptoms in participants with FS/NES and traumatic brain injury (TBI) following neurobehavioral therapy (NBT). We also hypothesized that select seizure-related, medication, subjective cognitive, and mental health symptoms would be negatively correlated with improvements in cognitive performance after NBT. Participants were 37 adults with TBI + FS/NES and 35 adults with TBI only, recruited from medical centers in the northeastern or southeastern U.S. TBI + FS/NES participants completed a 12 session NBT intervention, and TBI without seizures participants were not treated. All participants completed pre-post assessments of cognition (Montreal Cognitive Assessment [MoCA]) and baseline sociodemographic factors and mental health symptoms. Pre-post MoCA scores increased significantly in TBI + FS/NES participants (28/37 [75.7%] improved) but not in TBI comparisons (10/35 [28.6%] improved). Language, memory, and visuospatial/executive functions, but not attention, improved over time in the TBI + FS/NES group. Gains in cognition were concentrated in those TBI + FS/NES participants with likely baseline cognitive impairments (MoCA total score <26), and 9/17 of these participants moved from the "impaired" range at baseline (<26) to the "intact" range at endpoint (≥26). Lastly, participants taking fewer medications and reporting lower subjective cognitive difficulties at baseline showed larger pre-post MoCA total score improvements. Overall, results from this study suggest the potential for positive change in cognition in FS/NES and co-occurring TBI using evidence-based psychotherapy.
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Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Lawrence Chan
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Krista Tocco
- VA Providence Healthcare System, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | | | | | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System and UC San Diego, San Diego, CA, USA
| | - Tyler E Gaston
- University of Alabama Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Amber Martin
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Samantha Fry
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Adam Goodman
- University of Alabama Birmingham, Birmingham, AL, USA
| | | | | | | | - W Curt LaFrance
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
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11
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Woodward J, Asadi-Pooya AA, Mildon B, Tolchin B. Work difficulties, work restrictions, and disability benefits in people with functional seizures: A survey study. Epilepsy Behav Rep 2023; 23:100610. [PMID: 37645697 PMCID: PMC10460675 DOI: 10.1016/j.ebr.2023.100610] [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: 03/14/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose Functional seizures (FS) cause significant long-term disability and clinicians offer differing views on proper work restrictions and qualifications for disability benefits in this population. We assess the views and perspectives of experienced disability and work limitations in people living with functional seizures. Methods Between (4/29/2020-1/13/2021) an open-access 21-item internet survey was conducted via FNDHope.org; allowing for people living with self-reported functional seizures to remark on topics of work difficulties, work restrictions, qualifications for disability benefits, and driving. Demographic information was collected, and univariate and multivariate logistic regressions were used to evaluate potential predictors of current employment status. Results One hundred eighteen (118) responses were received, of which 92 (84.4%) completed > 50% of the survey; they were predominantly (92%) female. Most respondents (88%) reported some personal difficulty at work and nearly all (99%) believed that others with FS would experience difficulties in the workplace. A majority (71%) felt that work restrictions should apply to people living with active FS, at least in certain lines of work. Most (64%) felt people with FS should qualify for disability benefits; however, 35% stated work accommodations or a new job compatible with FS was more appropriate. Of those who felt people with FS should qualify for disability, 60% thought recipients should remain eligible for disability while symptomatic and 38% felt benefits should be lifelong. In univariate and multivariate logistic regressions, older age was predictive of unemployment (univariate OR 0.95 ± 0.02, 95% CI 0.92-0.98, p-value 0.002). Conclusion Our results suggest that work difficulties are common in people with FS, with older age being a predictor of unemployment. A majority of people with FS support work restrictions for those with their disorder, at least in some lines of work. In comparison to a prior study of clinicians, a higher percentage of people with FS supported work restrictions. These results may help facilitate productive discussions between people with FS, providers, and policymakers regarding appropriate work and disability limitations.
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Affiliation(s)
- Jared Woodward
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA
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Malda-Castillo J, Howell B, Russell L, Town J, Abbass A, Perez-Algorta G, Valavanis S. Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures. Epilepsy Behav 2023; 141:109147. [PMID: 36924611 DOI: 10.1016/j.yebeh.2023.109147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures. This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy. The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP. The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted.
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Affiliation(s)
- Javier Malda-Castillo
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Bethany Howell
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Leo Russell
- Functional Neurological Disorder Service, Devon Partnership NHS Trust, Exeter, UK.
| | - Joel Town
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | - Allan Abbass
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | | | - Sophie Valavanis
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
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Kanemoto K, Tadokoro Y, Motooka H, Kawasaki J, Horinouchi T, Tsuji T, Fukuchi T, Tomohiro O. Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases-Results at 1-year follow-up examinations. Epilepsia Open 2023; 8:134-145. [PMID: 36509699 PMCID: PMC9978061 DOI: 10.1002/epi4.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The primary purpose of this prospective multicenter study was to examine clinical and demographic feature differences according to the diagnostic level of psychogenic nonepileptic seizures (PNES) and then clarify whether prognosis may also differ accordingly. METHODS Two hundred forty-two consecutive patients strongly suspected of having PNES attacks were invited to participate, of whom 52 did not consent or contact was lost. At the 1-year follow-up examination, PNES diagnosis was reconsidered in nine patients. In 96 patients, the diagnostic level remained the same (P-group), with that in 43 considered to be clinically established (CE-group) and in 42 documented (D-group). The Qolie-10 and NDDI-E questionnaires were examined at both the study entry and the follow-up examination. RESULTS Multiple regression analysis of quality of life (QoL) score (n = 173; R2 = 0.374; F = 7.349; P < 0.001) revealed NDDI-E score (t = -6.402; P < 0.001), age of PNES onset (t = -3.026; P = 0.003), and ethnic minority status (t = 3.068; P = 0.003) as significant contributors. At entry, the P-group showed the lowest PNES attack frequency (P < 0.000), the lowest rate of antiseizure, antidepressant, and antipsychotic medication (P < 0.000; P = 0.031; P = 0.013, respectively), and the lowest proportion of psychosis (P = 0.046). At follow-up, PNES attack frequency (P < 0.000), number of admittances to emergency room (P < 0.000), and scores for QoL (P < 0.000) as well as depression (P = 0.004) were found to be significantly improved together with other collateral indicators, such as rate of antiseizure medication prescription (P = 0.001) and psychiatric symptoms (P = 0.03). Multiple regression analysis of a sample limited to patients with intellectual disability (ID) (n = 44; R2 = 0.366; F = 4.493; P = 0.002) revealed continued psychotherapy at follow-up (t = 2.610, P = 0.013) and successful reduction in antiseizure medication (t = 2.868; P = 0.007) as positively related with improved QoL. SIGNIFICANCE Clinical and the socio-psychological constellation of possible, clinically established, and documented PNES were found to differ greatly. Unexpectedly, significant effects of the continuous psychotherapeutic intervention were confirmed in PNES patients with ID.
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Affiliation(s)
| | | | | | | | - Toru Horinouchi
- Department of Psychiatry & Neurology, Hokkaido University, Sapporo, Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama University, Wakayama, Japan
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Kastell SU, Hohmann L, Holtkamp M, Berger J. Psycho-socio-clinical profiles and quality of life in seizure disorders: A cross-sectional registry study. Epilepsy Behav 2022; 136:108916. [PMID: 36179607 DOI: 10.1016/j.yebeh.2022.108916] [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: 04/07/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This prospective study aimed at comparing quality of life (QoL) and psycho-socio-clinical profiles between patients with epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. We also intended to identify predictors of QoL in these three seizure disorders. METHODS A total of 245 inpatients (epilepsy n = 182, PNES n = 50, syncope n = 13) from a tertiary epilepsy clinic were included. Information on QoL as well as on psychological, sociodemographic, and clinical profiles was retrieved using questionnaires and medical records. Group comparisons on QoL and psycho-socio-clinical profiles were performed via analyses of variance, chi-square tests, and related post hoc tests. Predictors of QoL in epilepsy and PNES were determined using general linear modeling, which was not possible for syncope due to a small sample size. RESULTS Patients with epilepsy, PNES, and syncope reported levels of QoL impairment that did not differ significantly between groups (p = 0.266). However, there were significant group differences regarding sex distribution (p < 0.001), seizure disorder duration (p = 0.004), seizure frequency (p = 0.019), current treatment with antiseizure medications (ASM) (p < 0.001), number of current ASM (p < 0.001), and adverse ASM events (p = 0.019). More depressive symptoms (p = 0.001), more adverse ASM events (p = 0.036), and unemployment (p = 0.046) (in this order) independently predicted a diminished QoL in epilepsy. For PNES, more depressive symptoms were the only independent predictor of lower QoL (p = 0.029). CONCLUSIONS Patients with epilepsy, PNES, and syncope experience similarly diminished QoL and show a general psycho-socio-clinical burden with a specific pattern for each seizure disorder diagnosis. Although clinical aspects play an undisputed role for QoL in epilepsy, the psychosocial aspects and consequences are equally, or for PNES probably even more, meaningful. A comprehensive approach to research and treatment of seizure disorders seems mandatory to increase QoL for these patients. More research on QoL in syncope is needed.
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Affiliation(s)
- Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany.
| | - Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365 Berlin, Germany.
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15
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Cobb SJ, Beebe LH. Quality of Life in Psychogenic Nonepileptic Seizures: An Evolutionary Concept Analysis. Issues Ment Health Nurs 2022; 43:730-736. [PMID: 35148236 DOI: 10.1080/01612840.2022.2035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) pose a serious threat to quality of life (QOL) in patients who battle the disorder. As psychological treatment options have progressed, improvement in QOL has become a more common desired outcome. Despite its relevance in PNES research and treatment, QOL has not been defined in the PNES population. Rodgers' Evolutionary Method of concept analysis was used to analyze 47 articles and clarify the concept of QOL in PNES. QOL in PNES is subjective, multidimensional, associated with symptoms, and dynamic in nature. This conceptualization of QOL in PNES may be useful in future PNES research and treatment.
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Affiliation(s)
- Sandra J Cobb
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Lora Humphrey Beebe
- College of Nursing, University of Tennessee Knoxville, Knoxville, Tennessee, USA
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16
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Cobb SJ, Vaughn BV, Sagherian K. Nonpharmacologic Interventions and Seizure Frequency in Patients With Psychogenic Nonepileptic Seizures: An Integrative Review. J Am Psychiatr Nurses Assoc 2022:10783903221107637. [PMID: 35801259 DOI: 10.1177/10783903221107637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices. AIM To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES. METHODS An integrative review guided by the Whittemore and Knafl approach. RESULTS The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies). CONCLUSIONS Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
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Affiliation(s)
- Sandra J Cobb
- Sandra J. Cobb, MSN, FNP-C, RN, REEGT, PhD in nursing candidate, University of Tennessee Knoxville, College of Nursing, Knoxville, TN, USA
| | - Bradley V Vaughn
- Bradley V. Vaughn, MD, Professor, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Knar Sagherian
- Knar Sagherian, PhD, RN, Assistant Professor, University of Tennessee Knoxville College of Nursing, Knoxville, TN, USA
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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18
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Stigma in Functional Seizures: A Scoping Review. Seizure 2022; 99:131-152. [DOI: 10.1016/j.seizure.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
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Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol 2022; 21:537-550. [PMID: 35430029 PMCID: PMC9107510 DOI: 10.1016/s1474-4422(21)00422-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/12/2023]
Abstract
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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Psychogenic Nonepileptic Seizures in Children and Adolescents. Semin Pediatr Neurol 2022; 41:100949. [PMID: 35450667 DOI: 10.1016/j.spen.2021.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are a common condition seen in children and adolescents. The diagnosis is clinical, based on a description of events, and can be supported using video electroencephalography recording. Children and adolescents with PNES often have comorbid psychiatric conditions and psychosocial stressors, although this is not a requisite for diagnosis. The pathophysiology is not fully understood but may be related to emotional processing and underlying aberrant functional connectivity. Communication of the diagnosis to patients and families in a compassionate way that leads to understanding is of paramount importance and the key first step to treatment. Psychotherapy that utilizes principles of cognitive behavioral therapy is the current standard for therapy. Symptoms can improve and many with PNES do experience remission of events with treatment, although not all. There is still much to be elucidated regarding underlying mechanisms and best treatments to help patients with this condition. In this article I review current knowledge about PNES in children and adolescents as well as share practical advice gleaned from clinical experience at Nationwide Children's Hospital's PNES Clinic.
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Sakurai H, Kanemoto K. Quality of life for patients with psychogenic nonepilepsy seizures in comparison with age- and gender-matched patients with epilepsy - Cross-sectional study. Epilepsy Behav 2022; 128:108539. [PMID: 35124523 DOI: 10.1016/j.yebeh.2021.108539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
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.
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Abstract
Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery-albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.
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Affiliation(s)
- Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Inselspital University Hospital, Bern, and Bern University, Bern, Switzerland
| | - David L Perez
- Divisions of Cognitive Behavioral Neurology and Neuropsychiatry, Functional Neurological Disorder Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Tolchin B, Baslet G, Carson A, Dworetzky BA, Goldstein LH, LaFrance WC, Martino S, Perez DL, Reuber M, Stone J, Szaflarski JP. The role of evidence-based guidelines in the diagnosis and treatment of functional neurological disorder. Epilepsy Behav Rep 2021; 16:100494. [PMID: 34877515 PMCID: PMC8627961 DOI: 10.1016/j.ebr.2021.100494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
Evidence-based guidelines use systematic reviews to support clinical recommendations. Adherence to evidence-based guidelines improves healthcare costs and patient outcomes. Recent randomized trials make guidelines for functional neurological disorders possible.
Evidence-based clinical practice guidelines, based on systematic reviews of existing evidence, play an important role in improving and standardizing the quality of patient care in many medical and psychiatric disorders, and could play an important role in the diagnosis and treatment of functional seizures and other functional neurological disorder (FND) subtypes. There are several reasons to think that evidence-based guidelines might be especially beneficial for the management of FND. In particular, the interdisciplinary and multidisciplinary teamwork necessary for the care of people with FND, the current lack of formal clinical training in FND, and the rapidly expanding body of evidence relating to FND all make guidelines based on systematic literature reviews especially valuable. In this perspective piece, we review clinical practice guidelines, their advantages and limitations, the reasons why evidence-based guidelines might be especially beneficial in the diagnosis and treatment of FND, and the steps that must be taken to create such guidelines for FND. We propose that professional organizations such as the American Academy of Neurology and the American Psychiatric Association undertake guideline development, ideally to create a co-authored or jointly endorsed set of guidelines that can set standards for interdisciplinary care for neurologists and mental health clinicians alike.
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Affiliation(s)
- Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Yale New Haven Health System Center for Clinical Ethics, New Haven, CT, USA
- Corresponding author at: Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, 15 York Street, New Haven, CT 06510, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Barbara A. Dworetzky
- Department of Neurology, The Edward B. Bromfield Epilepsy Center, Brigham and Women’s Hospital, Harvard Medical School., Boston, MA, USA
| | - Laura H. Goldstein
- King’s College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - W. Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, VA Connecticut Health Care System, West Haven, CT, USA
| | - David L. Perez
- Functional Neurological Disorder Unit, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jerzy P. Szaflarski
- UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Asadi-Pooya AA, Brigo F, Tolchin B, Valente KD. Functional seizures are not less important than epilepsy. Epilepsy Behav Rep 2021; 16:100495. [PMID: 34805820 PMCID: PMC8585631 DOI: 10.1016/j.ebr.2021.100495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
People with functional seizures often suffer from psychiatric comorbidities. People with FS report detrimental effects on social aspects of their lives. FS are associated with a considerable direct and indirect economic burden. FS have increased rates of mortality compared to healthy controls.
Functional seizures (FS) are frequently encountered in neurology clinics, often affect young adults, and have significant negative impacts on many aspects of a person’s life. In the current narrative review, we searched the literature regarding some of the consequences of FS (i.e., psychiatric comorbidities, social consequences, costs that are associated with the condition, cognitive impairment in patients with FS, the quality of life of the people with FS, and the increased risk of mortality that is associated with FS). Evidence shows that FS have significant negative consequences, comparable in their magnitude to those affecting patients with epilepsy. The clinical and scientific communities should take steps to address these consequences through clinical care and research that prioritizes, facilitates, and expedites evidence-based diagnosis and treatment for FS.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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Wang L, Zhang Y, Zhang X, Fan X, Qiong L, Hu C. The Potential Impact of Childhood Traumatic Experiences on Coping Styles and Emotion Regulation of Nurse Practitioners During the COVID-19 Outbreak. Front Psychol 2021; 12:718780. [PMID: 34764907 PMCID: PMC8576184 DOI: 10.3389/fpsyg.2021.718780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During an epidemic of a novel infectious disease, frontline medical staff suffer from high psychological stress. Previous studies have found that traumatic childhood experiences are associated with mental and physical health in adulthood. Anxiety and depression were measured and analyzed in relation to childhood trauma and coping styles. This study aims to explore the correlational study between traumatic childhood experiences and coping styles among nurse practitioners. Method: This study sampled 278 nurse practitioners from hospitals designated for the treatment of the novel coronavirus in Sichuan Province. The study measures included the Simplified Coping Style Questionnaire and the Childhood Trauma Questionnaire-Short Form. This research intends to use correlational study methods to explore the relationship between the two factors. Results: Statistical analysis showed that there was no statistically significant difference in the general demographic data between the two groups. Conclusion: Childhood traumatic experiences have a significant impact on the active coping of nurse practitioners, and active coping may be emotionally protective for nurse practitioners.
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Affiliation(s)
- Liyuanke Wang
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Yan Zhang
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Xiaoli Zhang
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Xiwang Fan
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Luo Qiong
- Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, China
| | - Chengping Hu
- Department of Psychiatry, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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Salinsky M, Evrard C, Joos S, Boudreau E. Utility of mental health and sleep screening questionnaires for patients admitted to a seizure monitoring unit. Epilepsy Behav 2021; 123:108237. [PMID: 34375800 DOI: 10.1016/j.yebeh.2021.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Patients with seizure disorders have relatively high rates of comorbid psychological and sleep disorders. Because these can profoundly affect quality of life, early recognition and treatment are of potential benefit. As a quality improvement project, we evaluated the performance and utility of a set of mental health and sleep quality screening questionnaires in patients admitted to a VA seizure monitoring unit (SMU). METHODS Questionnaires, including the Beck Depression Inventory-II (BDI-II), the post-traumatic stress disorder (PTSD) checklist (PCL), the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and the Pittsburgh Sleep Quality Index (PSQI), were administered to 100 patients admitted to the Portland VAMC SMU. Scored results were entered into the electronic medical record (EMR) within 72 h of hospital admission. We assessed how many patients exceeded questionnaire cutoff scores, and whether these patients had prior mental health or sleep diagnoses or evaluations within the six months preceding admission. Following hospital discharge, providers completed a survey regarding the utility of the questionnaire results. We also reviewed EMR documented mental health and sleep visits during the six months following the SMU admission. RESULTS Forty-seven patients (47.5%) exceeded the cutoff score for the BDI-II, including 15 without an admission diagnosis of depression, and 14 who had not seen a mental health provider in the previous six months. Similarly, 33 patients (33.3%) exceeded the cutoff score for the PCL, including nine without a diagnosis of PTSD. Scores on the BDI-II and PCL were highly correlated with the QOLIE-31 total score (r = 0.7). Seventy patients (70.7%) exceeded the cutoff score for poor sleep quality, and 37 did not have a sleep disorder diagnosis. Providers indicated that the questionnaire results were moderately or very helpful in most cases and influenced discharge recommendations to patients and referring providers in more than 50% of cases. Discharge recommendations for mental health or sleep follow-up were associated with EMR documented consultations within the six months following SMU admission. CONCLUSIONS The results suggest that a standard set of screening questionnaires can identify SMU patients at risk for mental health and sleep disorders, including patients not currently diagnosed or recently evaluated. Questionnaire results were perceived as helpful by providers and influenced discharge recommendations. Given that these disorders are treatable and have a major influence on health-related quality of life, the effort to collect and document this information is well justified.
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Affiliation(s)
- Martin Salinsky
- VA Portland Health Care System, Portland, OR, United States; Oregon Health & Science University, Portland, OR, United States.
| | | | - Sandra Joos
- VA Portland Health Care System, Portland, OR, United States
| | - Eilis Boudreau
- VA Portland Health Care System, Portland, OR, United States; Oregon Health & Science University, Portland, OR, United States
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27
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Scévola L, Wolfzun C, Sarudiansky M, Pico MMA, Ponieman M, Stivala EG, Korman G, Kochen S, D'Alessio L. Psychiatric disorders, depression and quality of life in patients with psychogenic non-epileptic seizures and drug resistant epilepsy living in Argentina. Seizure 2021; 92:174-181. [PMID: 34536854 DOI: 10.1016/j.seizure.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Psychiatric disorders are frequently found in both patients with PNES and DRE, making the differential diagnosis even more complex. The aim of this study was to analyze and compare psychiatric aspects and the quality of life in patients with psychogenic non-epileptic seizures (PNES) and drug resistant epilepsy (DRE). METHODS Patients admitted to video-electroencephalograpy (VEEG) unit with confirmed PNES and DRE were included. Demographical characteristics, psychiatric diagnosis according to SCID I and II of DSM IV, pharmacological treatment, general functioning measured with GAF (Global assessment of functionality), quality of life (QoL) using QlesQSF (Quality of Life Enjoyment and Satisfaction Questionnaire Short Form) and depression severity using BDI II (Beck depression inventory), were compared between the groups. Non-parametric tests, chi square test, and logistic regression were used for statistical analysis. RESULTS 148 patients consecutively admitted to VEEG were included (DRE n = 97; PNES n = 51). Somatization disorder (RR: 13.02, 95% CI: 1.23-137.39, p = 0.03) and a history of trauma (RR: 8.66, 95% CI: 3.21-23.31, p = 0.001) were associated with PNES. The QlesQ score and the GAF score were lower with a higher prevalence of suicide attempts in the PNES group (p < 0.01). A negative correlation was observed between the severity of depression and the quality of life (DRE r = - 0.28, p = 0.013; PNES r = - 0.59, p = 0.001). CONCLUSIONS Higher psychiatric comorbidity with poorer QoL were found in PNES patients compared to DRE. However, depression comorbidity negatively affected the QoL in both groups. Future studies based on illness perception will be orientated to complete this analysis.
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Affiliation(s)
- Laura Scévola
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Camila Wolfzun
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - María Marta Areco Pico
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Micaela Ponieman
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Ernesto Gonzalez Stivala
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Guido Korman
- Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Silvia Kochen
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Luciana D'Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina.
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28
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Husain AM, Towne AR, Chen DK, Whitmire LE, Voyles SR, Cardenas DP. Differentiation of Epileptic and Psychogenic Nonepileptic Seizures Using Single-Channel Surface Electromyography. J Clin Neurophysiol 2021; 38:432-438. [PMID: 32501944 DOI: 10.1097/wnp.0000000000000703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) are difficult to differentiate when based on a patient's self-reported symptoms. This study proposes review of objective data captured by a surface electromyography (sEMG) wearable device for classification of events as ES or PNES. This may help clinicians accurately identify ES and PNES. METHODS Seventy-one subjects were prospectively enrolled across epilepsy monitoring units at VA Epilepsy Centers of Excellence. Subjects were concomitantly monitored using video EEG and a wearable sEMG epilepsy monitor, the Sensing Portable sEmg Analysis Characterization (SPEAC) System. Three epileptologists independently classified ES and PNES that contained upper extremity motor activity based on video EEG. The sEMG data from those events were automatically processed to provide a seizure score for event classification. After brief training (60 minutes), the sEMG data were reviewed by a separate group of four epileptologists to independently classify events as ES or PNES. RESULTS According to video EEG review, 17 subjects experienced 34 events (15 ES and 19 PNES with upper extremity motor activity). The automated process correctly classified 87% of ES (positive predictive value = 88%, negative predictive value = 76%) and 79% of PNES, and the expert reviewers correctly classified 77% of ES (positive predictive value = 94%, negative predictive value = 84%) and 96% of PNES. The automated process and the expert reviewers correctly classified 100% of tonic-clonic seizures as ES, and 71 and 50%, respectively, of non-tonic-clonic ES. CONCLUSIONS Automated and expert review, particularly in combination, of sEMG captured by a wearable seizure monitor (SPEAC System) may be able to differentiate ES (especially tonic-clonic) and PNES with upper extremity motor activity.
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Affiliation(s)
- Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, U.S.A
- Neurosciences Medicine, Duke Clinical Research Institute, Durham, North Carolina, U.S.A
- Neurodiagnostic Center, Veterans Affairs Medical Center Neuroscience Medicine, Durham, North Carolina, U.S.A
| | - Alan R Towne
- Virginia Commonwealth University, Richmond, Virginia, U.S.A
- Department of Veterans Affairs, Northeast Epilepsy Center of Excellence, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, U.S.A
| | - David K Chen
- Department of Neurology, Baylor College of Medicine, Southwest Epilepsy Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, U.S.A.; and
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Butler M, Shipston-Sharman O, Seynaeve M, Bao J, Pick S, Bradley-Westguard A, Ilola E, Mildon B, Golder D, Rucker J, Stone J, Nicholson T. International online survey of 1048 individuals with functional neurological disorder. Eur J Neurol 2021; 28:3591-3602. [PMID: 34245646 DOI: 10.1111/ene.15018] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Functional neurological disorder (FND) is common, and symptoms can be severe. There have been no international large-scale studies of patient experiences of FND. METHODS A patient questionnaire was created to assess FND patient characteristics, symptom comorbidities and illness perceptions. Respondents were recruited internationally through an open access questionnaire via social media and patient groups over a month-long period. RESULTS In total, 1048 respondents from 16 countries participated. Mean age was 42 years (86% female). Median FND symptom duration was 5 years, and median time from first symptom to diagnosis was 2 years. Mean number of current symptoms (core FND and associated) was 9.9. Many respondents had associated symptoms, for example fatigue (93%), memory difficulties (80%) and headache (70%). Self-reported psychiatric comorbidities were relatively common (depression, 43%; anxiety, 51%; panic, 20%; and post-traumatic stress disorder, 22%). Most respondents reported that FND had multiple causes, including physical and psychological. CONCLUSIONS This large survey adds further evidence that people with FND typically have high levels of multiple symptom comorbidity with resultant distress. It also supports the notion that associated physical symptoms are of particular clinical significance in FND patients. Dualistic ideas of FND were not supported by respondents, who generally preferred to conceptualize the disorder as one at the interface of mind and brain. The need for a broad approach to this poorly served patient group is highlighted. Potential selection and response biases due to distribution of the survey online, mostly via FND patient groups, are a key limitation.
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Affiliation(s)
- Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Mathieu Seynaeve
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jianan Bao
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eveliina Ilola
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - James Rucker
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Timothy Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Baldellou Lopez M, Goldstein LH, Robinson EJ, Vitoratou S, Chalder T, Carson A, Stone J, Reuber M. Validation of the PHQ-9 in adults with dissociative seizures. J Psychosom Res 2021; 146:110487. [PMID: 33932719 DOI: 10.1016/j.jpsychores.2021.110487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The PHQ-9 is a self-administered depression screening instrument. Little is known about its utility and accuracy in detecting depression in adults with dissociative seizures (DS). OBJECTIVES Using the Mini - International Neuropsychiatric Interview as a reference, we evaluated the diagnostic accuracy of the PHQ-9 in adults with DS, and examined its convergent and discriminant validity and uniformity. METHODS Our sample comprised 368 people with DS who completed the pre-randomisation assessment of the CODES trial. The uniformity of the PHQ-9 was determined using factor analysis for categorical data. Optimal cut-offs were determined using the area under the curve (AUC), Youden Index, and diagnostic odds ratio (DOR). Convergent and discriminant validity were assessed against pre-randomisation measures. RESULTS Internal consistency of the PHQ-9 was high (α = 0.87). While the diagnostic odds ratio suggested that a cut-off of ≥10 had the best predictive performance (DOR = 14.7), specificity at this cut off was only 0.49. AUC (0.74) and Youden Index (0.48) suggested a ≥ 13 cut-off would yield an optimal sensitivity (0.81) and specificity (0.67) balance. However, a cut-off score of ≥20 would be required to match specificity resulting from a cut-off of ≥13 in other medical conditions. We found good convergent and discriminant validity and one main factor for the PHQ-9. CONCLUSIONS In terms of internal consistency and structure, our findings were consistent with previous validation studies but indicated that a higher cut-off would be required to identify DS patients with depression with similar specificity achieved with PHQ-9 screening in different clinical and non-clinical populations.
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Affiliation(s)
- Maria Baldellou Lopez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Emily J Robinson
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alan Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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Goldstein LH, Robinson EJ, Pilecka I, Perdue I, Mosweu I, Read J, Jordan H, Wilkinson M, Rawlings G, Feehan SJ, Callaghan H, Day E, Purnell J, Baldellou Lopez M, Brockington A, Burness C, Poole NA, Eastwood C, Moore M, Mellers JD, Stone J, Carson A, Medford N, Reuber M, McCrone P, Murray J, Richardson MP, Landau S, Chalder T. Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT. Health Technol Assess 2021; 25:1-144. [PMID: 34196269 DOI: 10.3310/hta25430] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive-behavioural therapy for adults with dissociative seizures. DESIGN This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. SETTING This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive-behavioural therapy services. PARTICIPANTS Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. INTERVENTIONS Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive-behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. MAIN OUTCOME MEASURES The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. RESULTS In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive-behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1-35 dissociative seizures); cognitive-behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0-20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive-behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7-12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect -0.39, 95% confidence interval -0.61 to -0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive-behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval -0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive-behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. LIMITATIONS Unlike outcome assessors, participants and clinicians were not blinded to the interventions. CONCLUSIONS There was no significant additional benefit of dissociative seizure-specific cognitive-behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive-behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive-behavioural therapy. FUTURE WORK Examination of moderators and mediators of outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Izabela Pilecka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain Perdue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Julie Read
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Harriet Jordan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Wilkinson
- Canterbury Christ Church University, Salamons Institute for Applied Psychology, Tunbridge Wells, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregg Rawlings
- School of Clinical Psychology, University of Sheffield, Sheffield, UK
| | - Sarah J Feehan
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Callaghan
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Elana Day
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Purnell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Baldellou Lopez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Brockington
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Norman A Poole
- Department of Neuropsychiatry, St George's Hospital, South West London and St George's NHS Mental Health NHS Trust, London, UK
| | - Carole Eastwood
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michele Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK
| | | | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nick Medford
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- Department of Health Services & Population Research, Institute of Psychiatry,Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Asadi-Pooya AA, Brigo F, Kozlowska K, Perez DL, Pretorius C, Sawchuk T, Saxena A, Tolchin B, Valente KD. Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation. Epilepsy Behav 2021; 117:107903. [PMID: 33740497 DOI: 10.1016/j.yebeh.2021.107903] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/20/2023]
Abstract
The human, as a biological system, is an open system embedded within larger systems -including the family, culture, and socio-political environment. In this context, a patient with functional seizures (FS) is embedded in relationships, educational/professional institutions, culture, and society. Both connection to these broader systems and the quality of these connections, as well as the soundness of each system in and of itself, influence the health and well-being of patients in positive or negative ways. The social aspects of life are important determinants of health and quality of life across the lifespan. The current narrative review brings out several overarching themes in patients with FS. Sections on attachment, marriage, social networking, and stigma highlight the central roles of supportive and affirmative relationships across the lifespan. The section on education underscores the importance of keeping children and youth with FS connected within their school environments, as well as managing any barriers - learning difficulties, school response to FS events, stigma, etc.-that can diminish this connection. Finally, the sections on employment and driving highlight the value of being an active participant in one's society. In summary, FS impacts patients across most social aspects of life domains regardless of age - factors that are important when developing biopsychosocial formulations. This review concludes that the multidisciplinary management of FS requires careful assessment of social aspects of life in patients which can then be targeted for treatment, to improve their quality of life, facilitating recovery, and reducing the risk of relapse.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia.
| | - David L Perez
- Functional Neurological Disorder Clinical and Research Programs, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Tyson Sawchuk
- Department of Pediatrics, Cumming School of Medicine, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.
| | - Aneeta Saxena
- Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Functional Neurological Disorder Clinical and Research Program, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.
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Liang F, Xu Q, Jiang M, Feng R, Jiang S, Yuan B, Xu S, Wu T, Wang F, Huang JH. Emotion Induced Monoamine Neuromodulator Release Affects Functional Neurological Disorders. Front Cell Dev Biol 2021; 9:633048. [PMID: 33659255 PMCID: PMC7917220 DOI: 10.3389/fcell.2021.633048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 01/11/2023] Open
Abstract
Functional neurologic disorders (FNDs), also called conversion disorder (previously called hysteria), can show almost all the symptoms of other neurological diseases, including both physical (for example, seizure, weakness, fatigue) and psychological (for instance, depression, anxiety) symptoms. In spite of our general knowledge about emotional processes and developmental defects in the formation of these somatic symptoms, there is still no systemic and comprehensive research on the effects of emotional developmental variables in FND. Recently, both experimental and theoretical emotion studies have been greatly increased, such as prediction error, conceptual act model, basic emotional theory, and monoamine neuromodulator based three primary emotions. In addition, a large amount of evidence has confirmed the role of psychosocial adversity (such as stressful life events, interpersonal difficulties) as an important risk factor for FND. Here, we review recent advances about emotional stress on FND, and pay special attention to the effects of monoamine neuromodulators, such as how norepinephrine and serotonin affect behaviors. Then, we discuss the significance of these changes for FND, which may contribute to clarifying the pathogenesis of FND, and thus provide potential therapeutic drug targets or psychological intervention methods in the future.
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Affiliation(s)
- Fei Liang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Qiuyue Xu
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingchen Jiang
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Key Laboratory of Pediatric Respiratory Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Rou Feng
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Shan Jiang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Bin Yuan
- Jiangsu Key Laboratory of Pediatric Respiratory Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shijun Xu
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ting Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, United States.,Department of Surgery, College of Medicine, Texas A&M University, Temple, TX, United States
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Bompaire F, Barthelemy S, Monin J, Quirins M, Marion L, Smith C, Boulogne S, Auxemery Y. PNES Epidemiology: What is known, what is new? EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2019.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Ladino LD, Benjumea-Cuartas V, Calle-López Y, Orozco-Hernández JP, Castrillón-Velilla DM, López-González R, Daza-Restrepo A, Genel Castillo MA, Reuber M, Denton A, Tellez-Zenteno JF. Psychogenic nonepileptic seizures in Latin America: A survey describing current practices. Epilepsy Behav 2021; 114:107150. [PMID: 32507294 DOI: 10.1016/j.yebeh.2020.107150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. This study provides an overview of diagnostic and treatment services for patients with PNES across Latin America. METHODS In 2017-2018, clinicians practicing in Latin America with responsibilities for patients with PNES were contacted to respond to a survey regarding the management of this disorder developed by the International League Against Epilepsy (ILAE) PNES Task Force. RESULTS Three hundred and sixty responses from 17 Latin American countries were analyzed. Most respondents were neurologists (81%) under 40 years of age (61%). Fifty-seven percent of professionals stated that they personally diagnose PNES, but only 33% stated that they provide follow-up, and only 20% that they recommend treatment. Many participants (54%) characterized themselves as either unfamiliar with the diagnosis or inexperienced in arranging treatment. Most respondents reported having access to brain magnetic resonance imaging (MRI; 88%) and routine electroencephalogram (EEG; 71%), 64% have the access to video-EEG longer than 8 h, and 54% of professionals performed video-EEG to confirm PNES diagnoses. Although cognitive-behavioral therapy was recognized as the treatment of choice (by 82% of respondents), there was little access to it (60%). In contrast, a high proportion of respondents reported using antidepressant (67%), antiseizure (57%), and antipsychotic medications (54%) as treatments for PNES. SIGNIFICANCE This study reveals several deficiencies in the diagnosis and treatment of patients with PNES in Latin America. The barriers are reinforced by lack of knowledge among the specialists and poor healthcare system support. There is inadequate access to prolonged video-EEG and psychotherapy. An inappropriate use of antiseizure medicines seems commonplace, and there are low follow-up rates by neurologists after the diagnosis. Multidisciplinary guidelines are required to improve the approach of patients with PNES.
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Affiliation(s)
- Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia.
| | | | - Yamile Calle-López
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia
| | | | | | - Reydmar López-González
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia
| | | | - Mario Alberto Genel Castillo
- Unidad de Monitoreo de Epilepsia del Instituto de Ciencias Cardiovasculares del Hospital del Prado en Tijuana, Mexico
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Alyssa Denton
- Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - José F Tellez-Zenteno
- Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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36
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Vanek J, Prasko J, Ociskova M, Genzor S, Holubova M, Hodny F, Nesnidal V, Slepecky M, Sova M, Minarikova K. Sleep Disturbances in Patients with Nonepileptic Seizures. Nat Sci Sleep 2021; 13:209-218. [PMID: 33623462 PMCID: PMC7896787 DOI: 10.2147/nss.s289190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures. METHODS Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review. RESULTS Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies. CONCLUSION Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Vlastmil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Milan Sova
- Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic
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Abstract
Functional or psychogenic seizures have proved a diagnostic and therapeutic challenge for centuries. Functional seizures can look and feel similar to epileptic seizures but are instead a common and highly disabling form of functional neurologic disorder, or conversion disorder. Consistent with the biopsychosocial model of mental illness, functional seizures are caused by biological, psychological, and social factors unrelated to epileptic discharges. People with functional seizures do not consciously fake their symptoms. Functional seizures can be differentiated from epileptic seizures through the clinical history, features of the seizures themselves, and electroencephalography findings. Psychotherapy is effective in treating functional seizures.
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38
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Gagny M, Grenevald L, El-Hage W, Chrusciel J, Sanchez S, Schwan R, Klemina I, Biberon J, de Toffol B, Thiriaux A, Visseaux JF, Martin ML, Meyer M, Maillard L, Hingray C. Explanatory factors of quality of life in psychogenic non-epileptic seizure. Seizure 2020; 84:6-13. [PMID: 33254100 DOI: 10.1016/j.seizure.2020.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Previous studies showed that patients with Psychogenic Non-Epileptic Seizures (PNES) have poor quality of life (QoL). This study explored the explicative factors of the QoL at the time of diagnosis and monitored changes over the two years of follow-up. METHODS We evaluated 107 participants with a diagnosis of Psychogenic Non-Epileptic Seizure (PNES), every 6 months for 24 months. Quality of life (QoL) was evaluated using the QOLIE-31 and SF-36 scales (respectively specific and generic scales of QoL). Positive evolution of QoL was defined by the increase in the score of overall QoL using QOLIE-31 sub-scale from baseline to the last interview of the patient. We also collected for each patient data on psychiatric dimensions (childhood abuse, history of traumatic events, post-traumatic stress disorder (PTSD), depression, anxiety, alexithymia, and dissociation), clinical evolution of seizures and the number of mental health consultations. RESULTS According to the QOLIE-31 and the SF-36, depression (p ≤ 0.001), anxiety (p < 0.001), alexithymia (p ≤ 0.001), and dissociation (p ≤ 0.004) were related to QoL at the time of the diagnosis. According to SF-36 (mental and physical), PTSD was also significantly associated with QoL (p < 0.05). The number of seizures or the co-occurrence of epilepsy did not influence QoL. Positive evolution of QoL was linked to the number of consultations for mental health issues (p = 0.02). SIGNIFICANCE Post-traumatic dimensions (PTSD, dissociation), alexithymia and psychiatric comorbidities (depression and anxiety disorders) seem to alter QoL in people with PNES. The current study suggests that mental health care improves QoL of patients with PNES.
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Affiliation(s)
- Marion Gagny
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
| | - Louise Grenevald
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France.
| | - Jan Chrusciel
- Pôle Information Médicale évaluation Performance, CH de Troyes, Troyes, France.
| | - Stéphane Sanchez
- Pôle Information Médicale évaluation Performance, CH de Troyes, Troyes, France.
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Université de Strasbourg, Strasbourg, France.
| | - Irina Klemina
- CHU de Nancy, Département de Neurologie, Nancy, France.
| | | | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France.
| | | | | | | | - Mylène Meyer
- CHU de Nancy, Département de Neurologie, Nancy, France.
| | - Louis Maillard
- CHU de Nancy, Département de Neurologie, Nancy, France; Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; CHU de Nancy, Département de Neurologie, Nancy, France.
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39
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Flewelling KD, Koehler A, Shaffer J, Dill EJ. Correlates of health-related quality of life in youth with psychogenic non-epileptic seizures. Seizure 2020; 83:203-207. [PMID: 33227658 DOI: 10.1016/j.seizure.2020.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Few studies have examined factors associated with health-related quality of life (HRQoL) in youth with psychogenic non-epileptic seizures (PNES). In adults, internalizing symptoms such as depression have been shown to be more closely associated with HRQoL than seizure frequency, however, this has not been studied in samples of youth. Investigations into these areas are needed in order to enhance our understanding of the impact of this condition on children and adolescents and inform future clinical intervention. METHODS The current study includes 37 youth and one of their parents who attended a clinic visit for treatment of PNES. Children and parents completed measures of psychological functioning, and medical data were extracted from patient charts. RESULTS Parent-reported anxiety (B=-0.45, p = 0.05) and depression (B=-0.60, p = 0.01) were related to parent-report of HRQoL; self-report of depression was related to self-reported HRQoL (B=-0.90, p < 0.001). Seizure frequency, somatic complaints, and social problems were not related to HRQoL in this sample. CONCLUSIONS Internalizing symptoms, not seizure frequency, are associated with poorer overall functioning in youth with PNES. Interventions focused on improving anxiety and depression in addition to seizure cessation may contribute to improved HRQoL in youth with PNES more so than those focused on seizure cessation alone.
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Affiliation(s)
- Kassie D Flewelling
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States; Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
| | - Angelina Koehler
- Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - Jonathan Shaffer
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States
| | - Edward J Dill
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver CO, 80217-3364, United States
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Tolchin B, Baslet G, Martino S, Suzuki J, Blumenfeld H, Hirsch LJ, Altalib H, Dworetzky BA. Motivational Interviewing Techniques to Improve Psychotherapy Adherence and Outcomes for Patients With Psychogenic Nonepileptic Seizures. J Neuropsychiatry Clin Neurosci 2020; 32:125-131. [PMID: 31466516 DOI: 10.1176/appi.neuropsych.19020045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are a highly disabling disorder frequently encountered by neurologists, psychiatrists, and emergency medicine physicians. There is accumulating evidence for the efficacy of psychological therapies, yet the majority of patients do not complete treatment. A range of health care system-based, clinician-based, and patient-based barriers to treatment exists, including stigma, poor clinician-patient communication, and patient ambivalence about the diagnosis and treatment of PNES. These barriers frequently lead to treatment nonadherence. Motivational interviewing (MI) is a patient-centered counseling style targeting ambivalence about behavior change, which has been shown to be effective in improving psychotherapy adherence and outcomes among patients with PNES. The authors review MI processes and techniques that may be useful to health care providers helping patients with PNES and other functional neurological disorders to engage in psychotherapy. The authors examine common challenges arising during MI for patients with PNES, including somatic symptoms distracting from clinician-patient communication, ambivalence about making concrete plans for treatment, and psychiatric comorbidities. Strategies for overcoming these obstacles are reviewed, including the use of complex reflections to enhance patient engagement; the use of an ask-tell-ask format and specific, measurable, achievable, relevant, and time-limited (SMART) goals to facilitate treatment planning; and close collaboration between the neurology and psychotherapy teams.
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Affiliation(s)
- Benjamin Tolchin
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Gaston Baslet
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Steve Martino
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Joji Suzuki
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Hal Blumenfeld
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Lawrence J Hirsch
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Hamada Altalib
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
| | - Barbara A Dworetzky
- The Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, Conn. (Tolchin, Blumenfeld, Hirsch, Altalib); Neurology Service, Epilepsy Center of Excellence, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Conn. (Tolchin, Altalib); the Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston (Tolchin, Dworetzky); the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet, Suzuki); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Martino); and Psychology Service, VA Connecticut Healthcare System, West Haven, Conn. (Martino)
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Walther K, Volbers B, Erdmann L, Kurzbuch K, Lang JD, Mueller TM, Reindl C, Schwarz M, Schwab S, Hamer HM. Psychosocial long-term outcome in patients with psychogenic non-epileptic seizures. Seizure 2020; 83:187-192. [PMID: 33181426 DOI: 10.1016/j.seizure.2020.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate psychosocial long-term outcome in patients diagnosed with psychogenic nonepileptic seizures (PNES) and to predict outcome of PNES, economic status, and quality of life (QoL) at follow-up. METHODS Patients diagnosed with PNES in the video-EEG-monitoring unit at our Epilepsy center between 2002-2016 were contacted by phone 1-16 years after communicating the diagnosis. Patients underwent a structured interview asking for current PNES status, psychosocial situation (economic status, marital status, setting of living, driving), depression, and QoL. RESULTS Of 70 PNES patients without comorbid epilepsy (age: 41.1 ± 13.5 years; 74 % female, follow-up: 5.2 ± 4.2 years), 23 patients (33 %) reported to be free of PNES during the last 12 months. Patients with cessation of PNES were younger at PNES onset (p < .01) and diagnosis (p < .01) and had a higher education (p < .05). At follow-up, the proportion of economically active patients only increased in individuals with cessation of PNES (p < .001) while an increased number of patients with persisting PNES relied on governmental support (p < .001). Cessation of PNES was associated with better mood (p < .01) and QoL (p < .001). In multiple regression models, cessation of PNES was only predicted by younger age at onset, while good economic outcome was determined by younger age and good economic status at diagnosis and cessation of PNES at follow-up. Good QoL at follow-up was predicted by low depressive symptoms, freedom of PNES, and economic activity at follow-up. CONCLUSION Long-term outcome in patients with PNES remains to be poor and the majority of patients continue to have PNES. Cessation of PNES was associated with good economic outcome, mood, and QoL.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Bastian Volbers
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Laura Erdmann
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Johannes D Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tamara M Mueller
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Caroline Reindl
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Avalos JC, Silva BA, Tevés Echazu MF, Rosso B, Besocke AG, Del Carmen Garcia M. Quality of life in patients with epilepsy or psychogenic nonepileptic seizures and the contribution of psychiatric comorbidities. Epilepsy Behav 2020; 112:107447. [PMID: 32947249 DOI: 10.1016/j.yebeh.2020.107447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Epilepsy is a common neurological disorder, and psychogenic nonepileptic seizures (PNES) is an important differential diagnosis. Psychiatric comorbidities are prevalent among people with epilepsy (PWE). Additionally, lower quality of life (QoL) in people with PNES compared with PWE was reported with higher rates of general psychiatric comorbidity. Although there are previous studies evaluating the QoL in patients with epilepsy, this study is unique and compelling because it represents a study comparing PNES and PWE on QoL, depression, and anxiety in a Spanish-speaking group of Argentine patients. The aim of this study was to analyze self-reported anxiety and depression in PWE and PNES and to establish the impact on QoL. METHODS This is a cross-sectional study; QoL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31). To study anxiety and depression, the Hospital Anxiety and Depression Scale (HADS) was administered. Clinical and complementary data were recorded. RESULTS Psychogenic nonepileptic seizures scored significantly higher in anxiety and depression and with lower levels of QoL compared with PWE. Anxiety and depression had a negative correlation with QoL. CONCLUSION Nonepileptic seizures have an even greater impact on QoL than epileptic seizures, and this could be influenced by psychiatric comorbidities. These findings corroborate what other studies in English-speaking nations that have found regarding the impact of psychopathology on QoL in those with PNES and further support the importance of assessing for psychiatric comorbidities to tailor treatment.
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Affiliation(s)
- Juan Carlos Avalos
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | | | - Maria F Tevés Echazu
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Bárbara Rosso
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
| | - Ana Gabriela Besocke
- Epilepsy Center, Department of Neurology, Italian Hospital, Buenos Aires, Argentina.
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Nicholson TR, Carson A, Edwards MJ, Goldstein LH, Hallett M, Mildon B, Nielsen G, Nicholson C, Perez DL, Pick S, Stone J, Aybek S, Baslet G, Bloem BR, Brown RJ, Chalder T, Damianova M, David AS, Epstein S, Espay AJ, Garcin B, Jankovic J, Joyce E, Kanaan RA, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer C, Morgante F, Myers L, Reuber M, Rommelfanger K, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins G, Tijssen MAJ, Tinazzi M. Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities. J Neuropsychiatry Clin Neurosci 2020; 32:33-42. [PMID: 31865871 DOI: 10.1176/appi.neuropsych.19060128] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
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Affiliation(s)
- Timothy R Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Alan Carson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark J Edwards
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Laura H Goldstein
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark Hallett
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Bridget Mildon
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Glenn Nielsen
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Clare Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - David L Perez
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Susannah Pick
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Jon Stone
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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Read J, Jordan H, Perdue I, Purnell J, Murray J, Chalder T, Reuber M, Stone J, Goldstein LH. The experience of trial participation, treatment approaches and perceptions of change among participants with dissociative seizures within the CODES randomized controlled trial: A qualitative study. Epilepsy Behav 2020; 111:107230. [PMID: 32640411 PMCID: PMC7581898 DOI: 10.1016/j.yebeh.2020.107230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nested within a large, multicenter randomized controlled trial (RCT) for people with dissociative seizures (DS), the study used purposive sampling to explore participants' experience of participating in an RCT, their experience of DS-specific cognitive behavioral therapy (CBT) and another component of the RCT, Standardized Medical Care (SMC) and their perceptions of and reflections on seizure management and change. METHODS A qualitative study using semistructured interviews was conducted with 30 participants in an RCT (the COgnitive behavioral therapy vs standardized medical care for adults with Dissociative non-Epileptic Seizures (CODES) Trial) investigating the effectiveness of two treatments for DS. Key themes and subthemes were identified using thematic framework analysis (TFA). RESULTS Analysis yielded three overarching themes: taking part in a treatment trial - "the only thing out there", the experience of treatment techniques that were perceived to help with seizure management, and reflections on an "unpredictable recovery". CONCLUSIONS People with DS are amenable to participating in a psychotherapy RCT and described a largely positive experience. They also described the applicability of aspects of DS-specific CBT and SMC in the management of their DS, received within the confines of the CODES trial. Factors that appeared to account for the variability in response to treatment delivery included individual preferences for the nature of sessions, the nature of therapeutic relationships, readiness to discuss trauma, other aspects of emotional avoidance, and whether therapy provided something new.
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Affiliation(s)
- Julie Read
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - James Purnell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
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Salinsky M, Binder L, Storzbach D, Parko K, Rutecki P, Goy E, Tadrous-Furnanz S. Validity testing in veterans with epileptic seizures and psychogenic nonepileptic seizures. Epilepsy Behav 2020; 111:107246. [PMID: 32650290 DOI: 10.1016/j.yebeh.2020.107246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Identification of clinically meaningful subgroups among patients with psychogenic nonepileptic seizures (PNES) or epileptic seizures (ES) is of potential value for assessing prognosis and predicting therapeutic response. Invalid performance on validity tests has been associated with noncredible complaints and worse cognitive test scores, and may be one such classification criteria. We studied invalid performance in Veterans with PNES or ES, and the association of invalid performance with cognitive test scores and subjective complaints. METHODS Patients were consecutive admissions to three veterans affairs (VA) epilepsy monitoring units. Evaluations included two validity tests: the Test of Memory Malingering (TOMM); and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) over-reporting validity scales. We compared the frequency of invalid performance on the TOMM or MMPI-2-RF in patients diagnosed with PNES vs. ES. We evaluated the association of invalid performance with scores on the Repeatable Battery for Assessment of Neuropsychological Status (RBANS), and four subjective symptom measures including the Beck Depression Inventory-II, and Quality of Life in Epilepsy-31. RESULTS Invalid TOMM performance was found in 25.3% of Veterans diagnosed with PNES and 10.8% of those with ES (p = .03). Invalid reporting on the MMPI-2-RF was found in 35.9% of the PNES group vs. 15.3% of the ES group (p = .01). Effects of valid vs. invalid reporting on external measures were similar for ES and PNES groups. Patients with invalid vs. valid TOMM performance had lower scores on the RBANS (p < .001). Patients with invalid performance had greater complaints on all subjective measures, with largest effect sizes for the MMPI-2-RF validity scales (p < .001). SIGNIFICANCE In Veterans admitted for evaluation of poorly controlled seizures, invalid performance on validity tests was not uncommon. Cognitive test results and subjective reports from patients with invalid performance may not be credible. These observations have implications for the analysis of clinical trials, where primary and secondary outcomes often rely on self-report measures.
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Affiliation(s)
- Martin Salinsky
- VA Portland Health Care System, Portland, OR, United States of America; Oregon Health & Science University, Portland, OR, United States of America.
| | - Laurence Binder
- Oregon Health & Science University, Portland, OR, United States of America
| | - Daniel Storzbach
- VA Portland Health Care System, Portland, OR, United States of America
| | - Karen Parko
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Paul Rutecki
- William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI, United States of America
| | - Elizabeth Goy
- VA Portland Health Care System, Portland, OR, United States of America
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Adherence to mental health care and caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures: Longitudinal follow-up study. Seizure 2020; 80:227-233. [PMID: 32659654 DOI: 10.1016/j.seizure.2020.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed to describe the quality of adherence to mental health care follow-up and the mental health caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures (PNES). METHODS We conducted an ancillary study of a multicenter prospective study. Patients (n = 108) received a standardized diagnostic explanation of PNES following video-EEG. They were referred to their community mental health centers or to a private psychiatrist/psychologist, who received written information about PNES and the study. Data collected about adherence to care (follow-up started or not, consensual and those who withdrew non-consensually, ongoing follow-up) were cross-tabulated from patients and care structures by telephone at 6, 12, 18 and 24 months after diagnosis. At M24, we collected reasons for stopping follow-up by phone using a predefined 9-item questionnaire. We also assessed the perception of the caregiver-patient relationship among patients who started follow-up and their mental health caregivers with a simple questionnaire based on five dimensions: feeling comfortable, continuity of care, content of therapy sessions, effectiveness of therapy sessions, and the patient's overall assessment of the follow-up. RESULTS From M6 to M24, ongoing follow-up decreased from 64.8 to 25.8%, while the "not following initial recommandations" group of patients (those who never started follow-up and those who withdrew non-consensually) increased from 35.2 to 64.9%. We found two main reasons for stopping follow-up: lack of interest and feeling better. Adherent patients had an overall more positive view of their therapy than caregivers. CONCLUSION Only a third of PNES patients adhered to a mental health care program and felt comfortable in the caregiver-patient relationship. Solutions need to be found to help patients understand the interest of follow-up therapy and help mental health caregivers improve their feeling of competence.
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Pick S, Anderson DG, Asadi-Pooya AA, Aybek S, Baslet G, Bloem BR, Bradley-Westguard A, Brown RJ, Carson AJ, Chalder T, Damianova M, David AS, Edwards MJ, Epstein SA, Espay AJ, Garcin B, Goldstein LH, Hallett M, Jankovic J, Joyce EM, Kanaan RA, Keynejad RC, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer CW, Mildon B, Morgante F, Myers L, Nicholson C, Nielsen G, Perez DL, Popkirov S, Reuber M, Rommelfanger KS, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins GT, Stone J, Tijssen MA, Tinazzi M, Nicholson TR. Outcome measurement in functional neurological disorder: a systematic review and recommendations. J Neurol Neurosurg Psychiatry 2020; 91:638-649. [PMID: 32111637 PMCID: PMC7279198 DOI: 10.1136/jnnp-2019-322180] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David G Anderson
- Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Selma Aybek
- Department of Neurology, University Hospital Bern & University of Bern, Bern, Switzerland
| | - Gaston Baslet
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | | | - Richard J Brown
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Alan J Carson
- Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Damianova
- Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - Steven A Epstein
- Department of Psychiatry, Georgetown University, Washington, District of Columbia, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Béatrice Garcin
- Department of Neurology, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, Île-de-France, France
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Eileen M Joyce
- University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Richard A Kanaan
- Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Roxanne C Keynejad
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kasia Kozlowska
- Discipline of Psychiatry and Child and Adolescent Health, The Children's Hospital at Westmead, Sydney Medical School, Sydney, New South Wales, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | - Anthony E Lang
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Alex Lehn
- Mater Neurosciences Centre, Brisbane, Queensland, Australia
| | - Sarah Lidstone
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | | | - Francesca Morgante
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - Lorna Myers
- Northeast Regional Epilepsy Group, New York, New York, USA
| | - Clare Nicholson
- Therapy Services, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Glenn Nielsen
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - David L Perez
- Departments of Neurology and Psychiatry, Therapy Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Karen S Rommelfanger
- Departments of Neurology and Psychiatry and Behavioral Sciences, Emory Centre for Ethics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Tereza Serranova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Paul Shotbolt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jon Stone
- Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells. Epilepsy Behav 2020; 102:106649. [PMID: 31759316 DOI: 10.1016/j.yebeh.2019.106649] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs). METHODS In this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL. RESULTS Of the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p < 0.01; BDI-II: p < 0.01) but similar QOL to PWE (p = 0.78). Using hierarchal multiple regression, symptoms of anxiety and depression were significant predictors of lower QOL in PWE but not in patients with PNES. There was no difference in QOL in those with ETLE and TLE. CONCLUSIONS Our findings suggest that self-reported anxiety and depression symptoms are common in patients admitted to level 4 EMUs regardless of diagnosis and play an important role in predicting QOL in PWE. Our findings emphasize the importance of routinely screening all EMU patients for psychiatric comorbidity.
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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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Cullingham T, Kirkby A, Sellwood W, Eccles FJR. Avoidance in nonepileptic attack disorder: A systematic review and meta-analyses. Epilepsy Behav 2019; 95:100-111. [PMID: 31030077 DOI: 10.1016/j.yebeh.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Avoidance is the active process of trying to escape from or not experience situations, places, thoughts, or feelings. This can be done through behavioral or cognitive strategies, or more broadly, a combination of both, utilized in an attempt to disengage from private experiences referred to as experiential avoidance (EA). Avoidance is considered important in the development and maintenance of nonepileptic attack disorder (NEAD). This review aimed to understand avoidance in NEAD and evaluate its role as a contributory factor. METHODS Fourteen articles were identified by searching Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE Complete, PsycINFO, and EMBASE and were combined in a narrative synthesis. Six of these articles were included in a meta-analysis comparing levels of EA for individuals with NEAD and healthy controls (HC), and four were included in a meta-analysis comparing EA in NEAD to epilepsy comparisons (EC). CONCLUSIONS Experiential avoidance appears to be a strategy that is used by a high proportion of the population with NEAD. The group with NEAD utilized significantly more avoidance compared with both the HC and EC. However, further research is needed to understand the extent and types of avoidance that are relevant.
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Affiliation(s)
- Tasha Cullingham
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK.
| | - Antonia Kirkby
- Department of Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK
| | - William Sellwood
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK
| | - Fiona J R Eccles
- Division of Health Research, University of Lancaster, Bailrigg, Lancaster University, LA1 4YW, UK
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