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Gargiulo ÁJ, Colombini A, Trovato A, Oddo S, Puddington M, D Alessio L. Comparative study of perceived invalidating environment and stress coping strategies between patients with drug resistant epilepsy and functional dissociative seizures. Seizure 2024; 119:128-134. [PMID: 38852274 DOI: 10.1016/j.seizure.2024.05.018] [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: 02/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated perceived invalidating environment during childhood and stress-coping strategies in patients with; functional dissociative seizures (FDS, n=26), drug-resistant epilepsy patients with no psychiatric comorbidity (DREnc, n=23), and drug-resistant epilepsy patients with psychiatric comorbidity (DREpc, n=34). DESIGN/METHODS We performed a cross-sectional study. Patients underwent Video Electroencephalography to confirm the diagnosis and completed a psychiatric assessment supported by clinical instruments. Invalidating environment and stress coping were studied through the ICES and CAE questionaries, respectively. A series of multinomial logistic regression analyses were performed with the explored variables. RESULTS The maternal negative response model predicted a higher probability of FDS condition. A chaotic family type increased the likelihood of DREpc instead of FDS. DREpc and FDS patients displayed many different behaviors to cope with stress other than trying to solve the problem, the most used strategy in the DREnc group. Parental invalidation was higher in DREpc than in FDS. CONCLUSIONS Our results deepen the data provided by previous studies indicating that multiple variables of biosocial origin have significant effects on these groups of patients. The presence of an invalidating environment may predict FDS but also the presence of psychiatric disorders among DRE. Psychotherapeutic strategies to enhance these variables might be necessary for this population.
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Affiliation(s)
- Ángel Jm Gargiulo
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina; Centro Integral de Salud Mental Argentino (CISMA), Argentina.
| | - Ana Colombini
- Centro Integral de Salud Mental Argentino (CISMA), Argentina
| | | | - Silvia Oddo
- Centro de Epilepsia Hospital Ramos Mejía y Hospital El Cruce, Enys-CONICET, Argentina
| | - Martín Puddington
- Departamento de Ciencias de la Salud y Seguridad Social, Universidad Nacional de Tres de Febrero, Argentina
| | - Luciana D Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina
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Kustov G, Zhuravlev D, Zinchuk M, Popova S, Tikhonova O, Yakovlev A, Rider F, Guekht A. Maladaptive personality traits in patients with epilepsy and psychogenic non-epileptic seizures. Seizure 2024; 117:77-82. [PMID: 38342044 DOI: 10.1016/j.seizure.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective. METHODS The cohort study included 77 consecutive inpatients with active epilepsy aged 36-55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables. RESULTS Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism. SIGNIFICANCE The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE.
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Affiliation(s)
- G Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - D Zhuravlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - M Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation.
| | - S Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - O Tikhonova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - A Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - F Rider
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya st., 43, Moscow 115419, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Vijay M, Reuber M. An update on psychogenic nonepileptic seizures. Curr Opin Neurol 2024; 37:121-126. [PMID: 38235768 DOI: 10.1097/wco.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW The understanding of psychogenic nonepileptic seizures (PNES) has advanced steadily over recent decades. This update summarizes new insights from the last three years. RECENT FINDINGS The process of diagnosing PNES has shifted from the exclusion of epilepsy to one based on the recognition of typical clinical features. While the diagnosis cannot rely on any single feature in isolation, a range of semiological features characterising PNES are now recognised and a number of studies hint at the potential for machine learning and AI to improve the diagnostic process. Advances in data processing and analysis may also help to make sense of the heterogeneity of PNES populations demonstrated by recent studies focussing on aetiology and patient subgroups. It is now clear that PNES are associated with high rates of mental and physical comorbidities and premature death, highlighting that they are only one manifestation of a complex disorder extending beyond the nervous system and the seizures themselves. SUMMARY PNES are now understood as a manifestation of dysfunction in interacting brain networks. This understanding provides an explanation for the psychopathological and semiological heterogeneity of PNES patient populations. New insights into medical comorbidities and increased rates of premature death call for more research into associated pathological processes outside the nervous system.
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Affiliation(s)
| | - Markus Reuber
- Department of Neurology
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Whitfield A, Leighton E, Boagey H, Oto M. Dual diagnosis of epilepsy and dissociative seizures: Prescription patterns, feasibility and safety of rationalising antiseizure medication. Epilepsy Behav 2024; 152:109661. [PMID: 38277845 DOI: 10.1016/j.yebeh.2024.109661] [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: 11/15/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Patients with a dual-diagnosis of epilepsy and dissociative seizures (DS) have received far less attention than those with single pathology. Anti-seizure medication (ASM) prescription patterns and safety of rationalisation have not been reviewed. METHODS We undertook a retrospective cohort study of all patients with a dual-diagnosis admitted to the Scottish Epilepsy Centre between 2012-2020. ASM frequencies were compared across admission, discharge and follow-up and emergency hospital attendances compared a year before and after admission. Demographic data, seizure characteristics and mortality data were also reviewed. RESULTS Across the 139 patients included in our study, ASM frequency at follow-up was significantly lower than on admission (mean 2.51 vs 2.14, Z = -2.11 p = 0.035, r = -0.215). Total hospital attendances in the year following admission were significantly lower than in the year before (mean 1.27 vs 0.77, Z = 2.306, p = 0.021, r = -0.262). Those with inactive epilepsy had their medications reduced to a greater extent that those with active epilepsy. 44 patients had their ASM frequency reduced during admission with a similar trend of reduced hospital attendances (mean 1.29 vs 0.43 Z = -3.162 p = 0.002). There was one epilepsy related death. CONCLUSIONS Clinicians should consider the development of co-morbid DS in patients with epilepsy not responding to an escalation of ASM, especially if presenting with a new seizure type. Patients with a dual-diagnosis of epilepsy and DS, particularly those with well controlled epilepsy, are likely overtreated with ASM. Medication review in a tertiary epilepsy centre allows for safe rationalisation of ASM and likely contributes to the need for fewer hospital attendances.
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Affiliation(s)
- Andrew Whitfield
- Department of Neurology, St George's University Hospital, London, UK.
| | - Emma Leighton
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Heather Boagey
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Maria Oto
- Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK; William Quarrier Scottish Epilepsy Centre, Glasgow, UK
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Mueller C, Sharma AA, Szaflarski JP. Peripheral and Central Nervous System Biomarkers of Inflammation in Functional Seizures: Assessment with Magnetic Resonance Spectroscopy. Neuropsychiatr Dis Treat 2023; 19:2729-2743. [PMID: 38077237 PMCID: PMC10710262 DOI: 10.2147/ndt.s437063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024] Open
Abstract
Purpose Inflammation may link trauma to clinical symptoms in functional seizures (FS). We compared brain temperature and metabolites in FS, psychiatric (PCs) and healthy controls (HCs) and quantified their associations with serum biomarkers of inflammation and clinical symptoms. Patients and Methods Brain temperature and metabolites were measured with whole-brain magnetic resonance spectroscopic imaging (MRSI) and compared between groups in regions of interest and the whole brain. Relationships with inflammatory biomarkers and symptoms were assessed with Pearson correlations. Results Brain temperature was higher in FS than HCs in the orbitofrontal cortex (OFC) and anterior cingulate gyrus (ACG) and lower in the occipital cortex and frontal lobe. PCs showed lower temperatures than HCs in the frontal lobe including precentral gyrus and in the cerebellum. Myo-inositol (MINO) was higher in FS than HCs in the precentral gyrus, posterior temporal gyrus, ACG and OFC, and choline (CHO) was higher in the occipital lobe. CHO was higher in PCs than HCs in the ACG and OFC, and N-acetylaspartate (NAA) was higher in the ACG. There were no significant correlations with the serum inflammatory biomarkers. In FS, brain temperature correlated with depression, quality of life, psychological symptoms, and disability, CHO correlated with disability, and MINO correlated with hostility, disability, and quality of life. Conclusion Some of the previously identified neuroimaging abnormalities in FS may be related to comorbid psychiatric symptoms, while others, such as abnormalities in sensorimotor cortex, occipital regions, and the temporo-parietal junction may be specific to FS. Overlapping MINO and temperature increases in the ACG and OFC in FS suggest neuroinflammation.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayushe A Sharma
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Departments of Neurology, Neurobiology, and Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Roze E, Hingray C, Degos B, Drapier S, Tyvaert L, Garcin B, Carle-Toulemonde G. [Functional neurological disorders: A clinical anthology]. L'ENCEPHALE 2023:S0013-7006(23)00084-2. [PMID: 37400338 DOI: 10.1016/j.encep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
Functional neurological disorders have a broad phenotypic spectrum and include different clinical syndromes, which are sometimes associated to each other or appear consecutively over the course of the disease. This clinical anthology provides details on the specific and sensitive positive signs that are to be sought in the context of a suspected functional neurological disorder. Beside these positive elements leading to the diagnosis of functional neurological disorder, we should keep in mind the possibility of an associated organic disorder as the combination of both organic and functional disorders is a relatively frequent situation in clinical practice. Here we describe the clinical characteristics of different functional neurological syndromes: motor deficits, abnormal hyperkinetic and hypokinetic movements, voice or speech disorders, sensory disorders, and functional dissociative seizures. The clinical examination and the identification of positive signs play a critical role in the diagnosis of functional neurological disorder. Knowledge of the specific signs associated with each phenotype render possible to make an early diagnosis. For that matter, it contributes to the improvement of patient care management. It allows to a better engagement in an appropriate care pathway, which influence their prognosis. Highlighting and discussing positive signs with patients can also be an interesting step in the process of explaining the disease and its management.
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Affiliation(s)
- Emmanuel Roze
- Hôpital Salpêtrière, DMU neurosciences, Assistance publique des Hôpitaux de Paris, Paris, France; Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France
| | | | - Bertrand Degos
- Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France; Centre de recherche interdisciplinaire en biologie (CIRB), Collège de France, CNRS UMR7241/Inserm U1050, Université PSL, Paris, France
| | - Sophie Drapier
- Département de neurologie, CHU de Rennes, CIC Inserm 1414, Rennes, France
| | - Louise Tyvaert
- Centre de psychothérapie du CHRU de Nancy, Nancy, France
| | - Béatrice Garcin
- Inserm, CNRS, Institut du Cerveau, Sorbonne Université, Paris, France; Hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint Denis (HUPSSD), Assistance publique des Hôpitaux de Paris, Sorbonne Paris Nord, réseau NS-PARK/FCRIN, Bobigny, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, 29, rue Émile-Lecrivain, 31400 Toulouse, France.
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Cassady M, Baslet G. Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature. Seizure 2023; 110:220-230. [PMID: 37433243 DOI: 10.1016/j.seizure.2023.06.020] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023] Open
Abstract
Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5. It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state". These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.
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Affiliation(s)
- Maureen Cassady
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gargiulo ÁJ, Sarudiansky M, Videla A, Lombardi N, Korman GP, Oddo S, D Alessio L. Perceived stress, resilience, and stress coping in patients with drug resistant epilepsy and functional dissociative seizures. Seizure 2022; 101:141-148. [PMID: 36027685 DOI: 10.1016/j.seizure.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Depression and anxiety are psychiatric disorders related to chronic stress, commonly found in patients with drug-resistant epilepsy (DRE) and functional dissociative seizures (FDS). The present study compares the levels of perceived stress, resilience, and the styles of stress coping among patients with DRE (n=60), FDS (n=28), and controls (n=31). METHODS We performed a cross-sectional study. All patients underwent Video Electroencephalography to confirm the diagnosis and completed the psychiatric assessment (SCID I and II of DSM IV) supported by several instruments validated in Spanish. RESULTS FDS scored higher in perceived stress (p = 0.004) with lower levels of resilience compared to controls (p = 0.01). Stress coping subscales show higher scores in negative self-focus and hostility in patients with FDS compared to controls (p=0.003). Similarly, DRE patients scored higher in perceived stress (p = 0.001), and presented lower levels of resilience (p = 0.004) with higher levels of hostility compared to controls (p=0.02). However, no significant differences were found between FDS and DRE on stress coping variables. Anxiety scores and depression rates were higher in the FDS group compared to DRE (p=0.008) and higher in DRE compared to controls (p<0.05). A positive correlation between depression and perceived stress was found (r = 0.6, p=0.0001). CONCLUSIONS Our results delineate a more detailed picture of the psychological profile of this population, emphasizing the importance of stress factors in patients with FDS and DRE. Combined intervention strategies which enhance stress coping may be appropriate to direct treatment and psychotherapy.
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Affiliation(s)
- Ángel Jm Gargiulo
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía.
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires (UBA), Facultad de Psicología- CONICET, Buenos Aires, Argentina
| | - Alejandro Videla
- Jefe de departamento de neumonología del Hospital Universitario Austral (HUA), Buenos Aires, Argentina
| | - Nicolás Lombardi
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Guido P Korman
- Universidad de Buenos Aires (UBA), Facultad de Psicología- CONICET, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Silvia Oddo
- Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
| | - Luciana D Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias)-CONICET, Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía
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