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Benoit J, Martin F, Thomas P. Disconjugate paroxysmal oculomotor movements in psychogenic nonepileptic seizures: A video-EEG study of three patients. Epileptic Disord 2024. [PMID: 38808527 DOI: 10.1002/epd2.20232] [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: 12/08/2023] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
Content available: Video
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Affiliation(s)
- Jeanne Benoit
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, Nice, France
- Université Côte d'Azur, CHU Nice, UR2CA-URRIS, Nice, France
| | - Florence Martin
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, Nice, France
| | - Pierre Thomas
- UF EEG-Épileptologie, Service de Neurologie, University Hospitals of Nice, Nice, France
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Hassan J, Taib S, Yrondi A. Structural and functional changes associated with functional/dissociative seizures: A review of the literature. Epilepsy Behav 2024; 152:109654. [PMID: 38281393 DOI: 10.1016/j.yebeh.2024.109654] [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: 10/09/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and cognitive signs, similar to the manifestations observed in epileptic seizures. In recent years, there has been an increase of literature in the field of brain imaging research on functional neurological disorders and, more specifically, on FDS. However, most of the studies have been carried out on limited samples. We propose an update of this review work by performing a systematic review of studies performed since 2017 in the field of neuroimaging in patients with FDS. METHODS We conducted a systematic review of the literature using the PRISMA methodology and reproduced most of the methodological elements of the latest systematic literature review. RESULTS Our work over the last five years has identified 14 articles. It is still difficult to isolate a distinct structure or network specifically involved in the mechanism of FDS. However, certain structures are recurrently involved in imaging studies, notably the amygdala, the orbitofrontal cortex, and the anterior cingulate cortex. CONCLUSION The contribution of neuroimaging may allow a more precise explanation of the disorder for patients, avoiding the stigma frequently associated with this diagnosis. as with other 'conversion' phenomena which have traditionally been considered only as 'medically unexplained'. In the longer term and beyond a better understanding of the physiopathology of the disorder, the challenge of this neuroimaging work would be to identify specific imaging biomarkers for a diagnosis of FDS.
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Affiliation(s)
- Johann Hassan
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Simon Taib
- Service de Psychiatrie, Psychothérapie et Art thérapie CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale (Department of Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France.
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Dye TJ. Clinical Evaluation and Management of Narcolepsy in Children and Adolescents. Semin Pediatr Neurol 2023; 48:101089. [PMID: 38065636 DOI: 10.1016/j.spen.2023.101089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023]
Abstract
While sleepiness is common among children, and particularly adolescents, profound sleepiness in the setting of apparently adequate sleep should prompt consideration of a central disorder of hypersomnolence. These disorders, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, and others, are likely underrecognized in the pediatric population. Narcolepsy in particular should be of interest to child neurologists as the unique signs and symptoms of this disease often prompt evaluation in pediatric neurology clinics. While sleepiness may appear to be a straightforward complaint, its evaluation requires a nuanced approach. Cataplexy, a hallmark of narcolepsy, can be confused for other neurologic conditions, though understanding its various manifestations makes it readily identifiable. Clinicians should be aware of these symptoms, as delay in diagnosis and misdiagnosis are common in childhood narcolepsy. While treatment options have been limited in the past, many new therapeutic options have become available and can result in significant improvement in symptoms. Given the age at presentation, paroxysmal and chronic features, diagnostic modalities, and available treatment options, the field of child neurology is well equipped to see patients with narcolepsy. In this review, I will focus on the presentation, evaluation, and management of pediatric patients with narcolepsy.
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Affiliation(s)
- Thomas J Dye
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary - Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Reilly C, Jette N, Johnson EC, Kariuki SM, Meredith F, Wirrell E, Mula M, Smith ML, Walsh S, Fong CY, Wilmshurst JM, Kerr M, Valente K, Auvin S. Scoping review and expert-based consensus recommendations for assessment and management of psychogenic non-epileptic (functional) seizures (PNES) in children: A report from the Pediatric Psychiatric Issues Task Force of the International League Against Epilepsy. Epilepsia 2023; 64:3160-3195. [PMID: 37804168 DOI: 10.1111/epi.17768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
Limited guidance exists regarding the assessment and management of psychogenic non-epileptic seizures (PNES) in children. Our aim was to develop consensus-based recommendations to fill this gap. The members of the International League Against Epilepsy (ILAE) Task Force on Pediatric Psychiatric Issues conducted a scoping review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) standards. This was supplemented with a Delphi process sent to pediatric PNES experts. Consensus was defined as ≥80% agreement. The systematic search identified 77 studies, the majority (55%) of which were retrospective (only one randomized clinical trial). The primary means of PNES identification was video electroencephalography (vEEG) in 84% of studies. Better outcome was associated with access to counseling/psychological intervention. Children with PNES have more frequent psychiatric disorders than controls. The Delphi resulted in 22 recommendations: Assessment-There was consensus on the importance of (1) taking a comprehensive developmental history; (2) obtaining a description of the events; (3) asking about potential stressors; (4) the need to use vEEG if available parent, self, and school reports and video recordings can contribute to a "probable" diagnosis; and (5) that invasive provocation techniques or deceit should not be employed. Management-There was consensus about the (1) need for a professional with expertise in epilepsy to remain involved for a period after PNES diagnosis; (2) provision of appropriate educational materials to the child and caregivers; and (3) that the decision on treatment modality for PNES in children should consider the child's age, cognitive ability, and family factors. Comorbidities-There was consensus that all children with PNES should be screened for mental health and neurodevelopmental difficulties. Recommendations to facilitate the assessment and management of PNES in children were developed. Future directions to fill knowledge gaps were proposed.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, UK
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinia, New York City, New York, USA
| | | | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Public Health, Pwani University, Kilifi, Kenya
| | | | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Mula
- IMBE, St George's University and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga and Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mike Kerr
- Institute of Psychological Medicine and Clinical Neurosciences Cardiff University, Cardiff, UK
| | - Kette Valente
- Clinical Neurophysiology Sector, University of São Paulo, Clinic Hospital (HCFMUSP), São Paulo, Brazil
| | - Stephane Auvin
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Pediatric Neurology Department, APHP, Robert Debré University Hospital, CRMR epilepsies rares, EpiCare member, Paris, France
- Institut Universitaire de France (IUF), Paris, France
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Vasquez A, Hilliker DR, Wirrell EC. Pediatric psychogenic non-epileptic seizures: A retrospective observational cohort study at a quaternary center. Epilepsy Behav 2023; 146:109359. [PMID: 37499579 DOI: 10.1016/j.yebeh.2023.109359] [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: 05/13/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Psychogenic non-epileptic seizures (PNES) represent a common functional disorder in the pediatric population. We aimed to characterize pediatric PNES by describing their clinical characteristics, PNES semiologies, and healthcare pathway towards and after diagnosis. MATERIAL AND METHODS This was a retrospective, observational chart review of pediatric patients aged 6 to 18 years admitted between December 2020 and December 2021 for spell classification or suspected PNES. Psychogenic non-epileptic seizure diagnosis was made by the capture of a typical event on video electroencephalogram (vEEG). We used descriptive statistics to summarize demographic and clinical characteristics. RESULTS We included 26 patients (18 females, 69.2%) with a mean age (SD) of 13.9 (2.5) years. Pre-morbid neurologic and psychiatric conditions included: epilepsy (23.1%), migraine (46.2%), mild traumatic brain injury (26.9%), anxiety (57.7%), ADHD (34.6%), and depression (30.8%). Six patients (23.1%) had a prior diagnosis of PNES. 14 patients (53.8%) presented with convulsive, and 6 (23.1%) each with non-convulsive and mixed PNES. Patients were seen by a range of providers prior to diagnosis including ED providers (50%), neurologists (53.8%), pediatricians (34.6%), and psychology/psychiatry (11.5%). Emergency department evaluation occurred for 13 patients (50%) on 15 occasions, and six (23.1%) were admitted to the hospital. The median (p25-p75) time from PNES onset to presentation and diagnosis at our institution was 3.5 (1.5-6.2) and 4.1 (3-7) months, respectively. A total of 33 events from the 26 patients were captured on vEEG. The most frequent semiologies in our cohort were rhythmic motor (27.3%) followed by equal frequency (18.2%) of complex motor and dialeptic. Eighteen patients (69.2%) were followed after the PNES diagnosis, for a median (p25-p75) of 17.3 months (6.3-21) with variable outcome. CONCLUSION Pediatric PNES has female predominance and often presents with comorbid psychosocial stressors and psychiatric conditions. High clinical suspicion and early recognition are crucial to decrease healthcare utilization and establish timely diagnosis and treatment.
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Affiliation(s)
- Alejandra Vasquez
- Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Daniel R Hilliker
- Division of Child and Adolescent Psychology and Psychiatry, Mayo Clinic, Rochester, MN, United States
| | - Elaine C Wirrell
- Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
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Yavuz P, Gunbey C, Karahan S, Topcu M, Turanli G, Yalnizoglu D. Non-epileptic paroxysmal events at pediatric video-electroencephalography monitoring unit over a 15-year period. Seizure 2023; 108:89-95. [PMID: 37119582 DOI: 10.1016/j.seizure.2023.04.016] [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: 12/05/2022] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE Non-epileptic paroxysmal events (NEPEs) are common in pediatric patients and may be misdiagnosed as epileptic seizures. We aimed to study the distribution of NEPEs across age groups and with different comorbidities, and to correlate the patients' presenting symptoms with their final diagnosis after video-EEG. METHODS We retrospectively analyzed video-EEG recordings of children aged one month to 18 years who were admitted between March 2005 and March 2020. Patients who experienced any NEPE while under video-EEG monitorization were evaluated in this study. Subjects with concomitant epilepsy were also included. The patients were first divided into 14 groups according to the basic characteristics of symptoms they reported at admission. The events captured on video-EEG were then classified into six NEPE categories based on the nature of the events. These groups were compared according to video-EEG results. RESULTS We retrospectively evaluated 1338 records of 1173 patients. The final diagnosis was non-epileptic paroxysmal event in 226 (19.3%) of 1173 patients. The mean age of the patients was 105.4 ± 64.4 months at the time of the monitoring. The presenting symptoms were motor in 149/226 (65.9%) patients, with jerking being the most common (n = 40, 17.7%). Based on video-EEG, the most common NEPE was psychogenic non-epileptic seizures (PNES) (n = 66, 29.2%), and the most common PNES subtype was major motor movements (n = 19/66, 28.8%). Movement disorders (n = 46, 20.4%) were the second most common NEPE and the most common NEPE (n = 21/60, 35%) in children with developmental delay (n = 60). Other common NEPEs were physiological motor movements during sleep (n = 33, 14.6%), normal behavioral events (n = 31, 13.7%), and sleep disorders (n = 15, 6.6%). Almost half of the patients had a prior diagnosis of epilepsy (n = 105, 46.5%). Following the diagnosis of NEPE, antiseizure medication (ASM) was discontinued in 56 (24.8%) patients. CONCLUSION Non-epileptiform paroxysmal events can be difficult to distinguish from epileptic seizures in children, especially in patients with developmental delay, epilepsy, abnormal interictal EEG, or abnormal MRI findings. Correct diagnosis of NEPEs by video-EEG prevents unnecessary ASM exposure in children and guides appropriate management of NEPEs.
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Affiliation(s)
- Pinar Yavuz
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey
| | - Ceren Gunbey
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey
| | - Sevilay Karahan
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Meral Topcu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey; Retired from Hacettepe University, Ankara, Turkey
| | - Guzide Turanli
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey; Retired from Hacettepe University, Ankara, Turkey
| | - Dilek Yalnizoglu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Ankara, Turkey
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Gigliotti F, Di Santo F, Cesario S, Esposito D, Manti F, Galosi S, Ferrara M, Leuzzi V, Baglioni V. Psychogenic non-epileptic seizures and functional motor disorders in developmental age: A comparison of clinical and psychopathological features. Epilepsy Behav 2023; 140:109117. [PMID: 36804846 DOI: 10.1016/j.yebeh.2023.109117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Psychogenic Non-Epileptic Seizures (PNES) and Functional Motor Disorders (FMDs) commonly represent the main clinical manifestations of Functional Neurological Disorders (FNDs). Despite their high prevalence in pediatric neurological services, literature on this topic is still spare for this population. The present study aimed to deepen the clinical knowledge of a pediatric FNDs sample through a demographic and clinical characterization of the most recurrent clinical patterns during the pediatric age. Moreover, a comparison of neuropsychological and psychopathological profiles of PNES and FMD patients was carried out to identify specific vulnerabilities and therapeutic targets linked with these different clinical manifestations. MATERIALS AND METHODS A total of 43 FNDs patients (age range 7-17 years old) were retrospectively included in our study, enrolled in two subgroups: 20 with FMDs and 23 with PNES diagnosis. They were inpatients and outpatients referred over a period of 5 years and a standardized neurological, neuropsychological (WISC-IV/WAIS-IV), and psychiatric (CDI-2, MASC-2, ADES, DIS-Q, PID-5) evaluation was assessed. RESULTS In PNES patients the most common clinical phenotypes were functional tonic-clonic (52%) and atonic (32%) manifestations while in the FMDs group were gait alterations (60%), functional myoclonus (35%), and tremor (35%). A higher frequency of cognitive impairment was reported in PNES patients with higher anxiety-depressive symptom rates than FMDs patients. CONCLUSIONS Notably, specific neurocognitive and psychopathological profiles were described in PNES and FMDs, highlighting higher cognitive and psychiatric vulnerabilities in PNES, suggesting as well different strategy for therapeutic approaches.
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Affiliation(s)
- F Gigliotti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Di Santo
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Cesario
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - D Esposito
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - F Manti
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - S Galosi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - M Ferrara
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Leuzzi
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - V Baglioni
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Italy.
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Executive Functioning and Social Skills in Children with Epileptic Seizures and Non-Epileptic Seizures. Epilepsy Res 2022; 188:107051. [DOI: 10.1016/j.eplepsyres.2022.107051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
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Wang CY, Hsu TR, Chang KP. Clinical manifestations of psychogenic non-epileptic seizures in children: Experiences from a single center. Pediatr Neonatol 2022; 64:201-207. [PMID: 36153197 DOI: 10.1016/j.pedneo.2021.09.008] [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: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND This study aimed to determine the clinical features of psychogenic non-epileptic seizures (PNES) and to enhance the accuracy of the differential diagnosis of epilepsy. METHODS This retrospective case series included patients diagnosed with PNES between December 2003 and February 2019 at Taipei Veterans General Hospital. We used International Classification of Diseases (10th revision) codes for screening, and relevant medical records were reviewed. Experienced pediatric neurologists diagnosed PNES based on clinical manifestations, and occasionally on confirmatory video-electroencephalography (EEG) or simultaneous scalp-EEG during the paroxysmal attack. General information, clinical manifestations, psychological conditions, and relevant laboratory or imaging test results were collected and analyzed. RESULTS Twenty-six patients (mean age, 13 years 8 months) were evaluated, 9 male and 17 female. Ten patients with PNES had a previously established diagnosis of epilepsy. The duration between symptom onset and diagnosis ranged from 1 to 120 (mean, 21; median, 12) days. Sixteen patients showed possible causative psychosocial stressors. Multiple characteristic features or specific clinical manifestations of PNES-that usually differ from epileptic seizures-were observed in all patients with PNES. CONCLUSION A detailed evaluation of clinical manifestations and medical history is important for the accurate diagnosis of PNES.
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Affiliation(s)
- Chia-Yih Wang
- Department of Pediatrics, New Taipei City Hospital, New Taipei, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Ting-Rong Hsu
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Ping Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, Wei-Gong Memorial Hospital, Miaoli, Taiwan
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Levan A, Fegter O, Gale SD. Social Skills Differences in Children with Epilepsy and Nonepileptic Seizures. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1750303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractResearch has shown that children experiencing epileptic seizures (ES) or non-ESs (NES) exhibit cognitive and behavioral deficits, but no research has examined social skills differences between the two groups. A better understanding of social skills differences between these two groups might allow for the development of more targeted interventions. The purpose of this study was to examine social skills differences between children with ES and children with NES, using the Social Skills Improvement Scale (SSIS). A total of 43 children were recruited from the epilepsy monitoring units at Phoenix Children's Hospital and Primary Children's Medical Center. The epilepsy group consisted of 28 participants (50% female, mean age at testing = 11.79, standard deviation [SD] = 3.12), and the NES group consisted of 15 participants (67% female; mean age at testing = 12.62, SD = 3.33). Parents and children completed the SSIS Rating Scales. No group differences were found between children with ES and children with NES on social skills measures. However, children in both groups rated their social skills as being in the average range, while parents of children in both groups rated their children's social skills as being in the below average range. Limitations to this study and directions for future research are discussed.
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Affiliation(s)
- Ashley Levan
- Department of Psychology, St. Louis Children's Hospital, St. Louis, Missouri, United States
| | - Ollie Fegter
- Department of Psychology, Brigham Young University, Provo, Utah, United States
| | - Shawn D. Gale
- Department of Psychology, Brigham Young University, Provo, Utah, United States
- The Neuroscience Center, Brigham Young University, Provo, Utah, United States
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Özbek O, Berkel C, Isildak Ö, Gürdere MB. HPLC–based methods for the determination of levetiracetam in biological and pharmaceutical samples. J INDIAN CHEM SOC 2022. [DOI: 10.1016/j.jics.2022.100348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Janocko NJ, Morton ML, Groover O, Teagarden DL, Villarreal HK, Merchant S, Ahuruonye N, Rodriguez-Ruiz AA, Drane DL, Karakis I. Translating Phenomenology of Psychogenic Nonepileptic Seizures Into Nosology: Insights From Patients' and Caregivers' Profiles. Neurologist 2022; 27:100-105. [PMID: 34855664 DOI: 10.1097/nrl.0000000000000378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology. METHODS Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables. RESULTS Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures. CONCLUSIONS Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel L Drane
- Departments of Neurology
- Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Neurology, University of Washington, Seattle, WA
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Özbek O, Isildak Ö. Potentiometric PVC Membrane Sensor for the Determination of Anti‐Epileptic Drug Levetiracetam in Pharmaceutical Formulations. ChemistrySelect 2022. [DOI: 10.1002/slct.202103988] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Oguz Özbek
- Science and Technology Application and Research Center Zonguldak Bülent Ecevit University 67600 Zonguldak Turkey
| | - Ömer Isildak
- Department of Chemistry, Faculty of Science and Arts Tokat Gaziosmanpaşa University 60250 Tokat Turkey
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Aggarwal S, Madaan P. Shame, pediatric PNES, and COVID-19. Seizure 2021; 94:90-91. [PMID: 34875543 DOI: 10.1016/j.seizure.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shivali Aggarwal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
Routine electroencephalogram (EEG) has many limitations, especially the inability to capture reported habitual events in question. A prolonged EEG with synchronized video (video-EEG) overcomes some of these limitations by improving the sensitivity, specificity and the diagnostic yield by attempting to record the habitual events when they are frequent and when indicated. Video-EEG is employed commonly for the diagnosis and classification of epilepsy/epilepsy syndromes, to distinguish between seizures and seizures mimickers, for pre-surgical evaluation and in the management of critically ill children. The duration of recording would vary depending on the indication and frequency of events. Ambulatory EEG is another cost effective and convenient alternative in certain circumstances. However, availability of the machines and expertise, accessibility, affordability and labor intensive nature of the procedure limit widespread use in India. This review explores the role of video-EEG in the management of children with epileptic and non-epileptic paroxysmal events with respect to routine clinical practice in India.
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Affiliation(s)
- Lakshminarayanan Kannan
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India.
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Dinesh Nayak
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India
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Title: Functional seizures across the adult lifespan: female sex, delay to diagnosis and disability. Seizure 2021; 91:476-483. [PMID: 34343859 DOI: 10.1016/j.seizure.2021.07.025] [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: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The clinical characteristics of functional seizures may vary based on age-of-onset or age-of-presentation. Description of age-related differences has focused on three categories: pediatric, young-adult, and older-adult. We evaluated how factors continuously varied based on age-of-presentation across the adult lifespan. METHODS Based on cross-sectional data from 365 adult (18 to 88 years old) patients with documented diagnoses of functional seizures, we evaluated how the quantity and prevalence of specific ictal behaviors, historical factors, and comorbidities varied based on patient age-of-presentation using sequential weighted averages. RESULTS Four factors changed prominently with age-of-presentation: female predominance decreased at two inflection points - ages 35 and 62; the prevalence of work disability was higher until age-of-presentation 30 then plateaued at 80%; there was greater delay to diagnosis in older patients; and comorbidities was higher with age-of-presentation, starting from early adulthood. The proportion of patients who presented with functional seizures decreased after 50. Ictal behavior did not substantially vary with age-of-presentation. CONCLUSION The time from onset to diagnosis increased with age-of-presentation, which may be related to increased comorbidities and the misconception that FS do not start in older age. The female predominance decreased nonlinearly with age. By age 30, most patients' seizures already had substantial association with unemployment. These findings emphasize that patients can develop functional seizures at any age. The rapid development of disability relatively early in life, which then stays at a high prevalence rate, demonstrates the need for prompt referral for definitive diagnosis and treatment.
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Mastroianni G, Ascoli M, Gasparini S, Brigo F, Cianci V, Neri S, Russo E, Aguglia U, Ferlazzo E. Therapeutic approach to difficult-to-treat typical absences and related epilepsy syndromes. Expert Rev Clin Pharmacol 2021; 14:1427-1433. [PMID: 34289757 DOI: 10.1080/17512433.2021.1959317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: typical absences (TAs), are brief, generalized epileptic seizures of abrupt onset and termination clinically manifesting with impairment of awareness and associated with 3 Hz spike-wave discharges on EEG. TAs may occur in different idiopathic generalized epilepsies (IGE). Despite treatment with adequate anti-seizure medications (ASMs), TAs may persist in ~25% of subjects. This narrative review focuses on the therapeutic approach to difficult-to-treat TAs occurring in the setting of IGE.Areas covered: a literature search was conducted on the topic of treatment of TAs.Expert opinion: ethosuximide (ESX), valproic acid (VPA) and lamotrigine (LTG), alone or in combination, are considered the first-choice drugs. In women of childbearing potential, VPA should be avoided. Alternative therapies (benzodiazepines, levetiracetam, topiramate, or zonisamide) should be considered in subjects unresponsive to monotherapy after the exclusion of pseudo-drug resistance. Newer ASMs such as brivaracetam and perampanel seem to be promising options. Well-conducted clinical trials aimed to evaluate the efficacy of alternative monotherapy (beyond ESX, VPA or LTG) or combination of ASMs on difficult-to-treat TAs, are warranted.
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Affiliation(s)
- Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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18
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Agarwal R, Gathers-Hutchins L, Stephanou H. Psychogenic non-epileptic seizures in children. Curr Probl Pediatr Adolesc Health Care 2021; 51:101036. [PMID: 34373198 DOI: 10.1016/j.cppeds.2021.101036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychogenic Non-Epileptic Seizures (PNES) are a relatively common condition in children. While their clinical presentation resembles epileptic seizures, the underlying cause for PNES involves a multitude of bio-psychosocial factors. Patients may be misdiagnosed with epilepsy and subjected to unnecessary treatments, often delaying the diagnosis for years. A strong understanding of its symptomatology is essential for diagnosis of PNES. Successful management depends on effective teamwork that involves the neurologist as well as mental health professionals. This paper reviews the various aspects of PNES in children with emphasis on the clinical presentation, diagnosis as well as the underlying psychological basis and treatment.
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Affiliation(s)
- Rajkumar Agarwal
- Division of Neurology, Dayton Children's Hospital, Dayton, Ohio, USA; Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA.
| | - Latisha Gathers-Hutchins
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA; Division of Psychology, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Hara Stephanou
- Department of School Psychology, Doctoral Student, St. John's University, New York City, New York, USA
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19
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Paola LD, LaFrance WC. Psychogenic Nonepileptic Seizures (PNES) classification: still "time for progress". ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:269-271. [PMID: 34133506 DOI: 10.1590/0004-282x-anp-2021-e004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - William Curt LaFrance
- Brown University; Departments of Psychiatry and Neurology, Providence, Rhode Island, USA
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20
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Sullo F, Venti V, Catania R, Smilari P, Greco F, Pustorino E, Fiumara A, Raucci U, Falsaperla R, Marino S, Pavone P. Non-Epileptic Paroxysmal Events: Clinical features and diagnostic differences with epileptic seizures. A Single Tertiary Centre Study. Clin Neurol Neurosurg 2021; 207:106739. [PMID: 34157509 DOI: 10.1016/j.clineuro.2021.106739] [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: 01/18/2021] [Revised: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Non-Epileptic Paroxysmal Events (NEPE) are common clinical manifestations in pediatric age presenting with dysfunction of motor and behavioral activity mimicking features of epileptic seizures. OBJECTIVE To present and analyze number and clinical characteristic of a group of children/adolescents presenting with various types of NEPE; to compare clinical data of this group of NEPE affected children/adolescents with a group of children/adolescents affected by Epileptic Seizures (ES). METHODS The retrospective study was conducted at the Pediatric Clinic of University of Catania, Catania, Italy, in a period ranging from January 2005 and January 2018. Two groups of children/adolescents, aged from 1 month to 15 years, were selected: 312 affected by NEPE and 192 by ES. Number and percentage of the single type of NEPE were reported. Then, demographic characteristics, clinical manifestations, duration of the events, time of diagnosis, and age of onset of each type of NEPE and ES affected children/adolescents were analyzed and compared. Results of statistical analysis of the data were carried out between ES and some type of NEPEs including Sandifer syndrome, breath-holding spells, paroxysmal tremors, vertigo, and syncope. RESULTS Among the group of NEPE, vertigo, type of paroxysmal event clinically not classifiable, syncope, and Sandifer syndrome were the most common events; In the comparative analyzed samples, variability between NEPE and ES was found in the duration of the paroxysmal events, in number of episodes, in lag-time between the onset of symptoms and the diagnosis, and in age of onset. Analyzing clinical data of ES with some type of NEPE, statistical significant results were obtained in vertigo as regards the duration and average duration event, in paroxysmal tremors as number of events, in Sandifer syndrome as lag-time of diagnosis, and finally in all the types of NEPE as regards the age of onset, and loss of consciousness. CONCLUSIONS Analyzing the clinical features of each type of NEPE differences with ES are found. However, globally considered diagnostic differences between NEPE and ES remain difficult, questionable, and unrealizable without the support of correct parental report, direct clinical observations, and video-EEG monitoring.
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Affiliation(s)
- Federica Sullo
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Unit of Pediatrics and Neonatology, Neonatal Intensive Care, and Pediatric Emergency, AUO San Marco-Policlinico, University of Catania, Catania, Italy
| | - Valeria Venti
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberta Catania
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pierluigi Smilari
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Filippo Greco
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elena Pustorino
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agata Fiumara
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Umberto Raucci
- Department of Pediatrics, Hospital Bambin Gesù Roma, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Neonatology, Neonatal Intensive Care, and Pediatric Emergency, AUO San Marco-Policlinico, University of Catania, Catania, Italy
| | - Silvia Marino
- Unit of Pediatrics and Neonatology, Neonatal Intensive Care, and Pediatric Emergency, AUO San Marco-Policlinico, University of Catania, Catania, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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21
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Psychogenic Nonepileptic Seizures in Children and Adolescents. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Thabit MN, Sadek AA, Motawe ES, Ali RAE, Mohamed MM. Non-epileptic paroxysmal events in paediatric patients: A single tertiary centre study in Egypt. Seizure 2021; 86:123-128. [PMID: 33607445 DOI: 10.1016/j.seizure.2021.02.004] [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: 10/19/2020] [Revised: 01/09/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The misdiagnosis of non-epileptic seizures (NES) as epilepsy is one of the most common pitfalls in neuropsychiatric practice. This study aimed to describe the percentage and types of NES among children who were referred for a diagnosis of epilepsy in Upper Egypt. METHODS We recruited a total of 876 patients who were referred to Sohag University Hospital, a tertiary referral centre in Upper Egypt, for the evaluation of suspected epilepsy. Relevant methods for the diagnosis of epilepsy, including medical history and examination, EEG, video-EEG, laboratory investigations, and brain imaging, were performed for all study participants. RESULTS Among the 876 patients who were referred for the diagnosis of suspected epilepsy during the period from June 2017 to October 2018, 171 patients (19.5 %) were diagnosed as having NES. In general, we found that NES in the paediatric age groups did not differ from that reported in various studies across several different populations. The most prevalent NES in our study was breath-holding spells (32.2 %), followed by syncope (17.5 %), psychogenic nonepileptic seizures (12.3 %), motor tics (9.9 %), and benign sleep myoclonus (7.6 %). Other less frequent NES included infantile masturbation (7 %), spasmus nutans (5.3 %), migraine (2.9 %), benign paroxysmal torticollis (2.9 %), night terrors (1.8 %), and shuddering attacks (0.6 %). CONCLUSION Ideally, neurologists should not misdiagnose NES as epilepsy, and whenever the diagnosis of NES is uncertain, an accurate diagnosis should be made using long-term video-EEG monitoring, especially in younger paediatric patients.
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Affiliation(s)
- Mohamed N Thabit
- Department of Neurology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
| | - Abdelrahim A Sadek
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eman S Motawe
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Rasha Abd Elhameed Ali
- Department of Public Health and Community Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Montaser M Mohamed
- Department of Paediatrics, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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23
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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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24
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Hansen AS, Rask CU, Rodrigo-Domingo M, Pristed SG, Christensen J, Nielsen RE. Incidence rates and characteristics of pediatric onset psychogenic nonepileptic seizures. Pediatr Res 2020; 88:796-803. [PMID: 32392575 DOI: 10.1038/s41390-020-0945-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pediatric onset psychogenic nonepileptic seizures (PNES) is a highly disabling disorder and potentially misdiagnosed as epilepsy. Still, knowledge regarding PNES in children and adolescents is limited and data on both incidence and characteristics are scarce. This study investigated the incidence rate (IR) and clinical characteristics of pediatric onset PNES, including possible differences when having comorbid epilepsy. METHODS A population-based study of children and adolescents aged 5-17 years with an incident diagnosis of PNES in the Danish healthcare registries between 1996 and 2014. In total, 386 children and adolescents were included after assessment of diagnostic validity using medical record data. RESULTS The IR increased during the study period with the maximum IR observed in 2014 (7.4 per 100,000 person-years). A history of both neurologic and psychiatric problems as well as negative life events was identified. Comorbid epilepsy was confirmed for 55 cases (14.2%) and was associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. CONCLUSIONS PNES are increasingly diagnosed in children and adolescents, and the clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. These findings provide important information for future healthcare planning in this area. IMPACT This nationwide study is the first to report population-based incidence rates of pediatric onset PNES documenting markedly increasing incidence rates between 1996 and 2014. A history of both neurologic and psychiatric problems as well as negative life events was identified for pediatric onset PNES. Comorbid epileptic seizures were associated with intellectual disabilities, school support and prolonged delay in PNES diagnosis. The clinical profile of both neurologic and psychiatric health problems underscores the need for collaborative pediatric and mental healthcare. The increasing number of children and adolescents diagnosed with PNES is important information for future healthcare planning in this area.
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Affiliation(s)
- Anne S Hansen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Rodrigo-Domingo
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Sofie G Pristed
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - René E Nielsen
- Unit for Psychiatric Research, Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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25
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Radmanesh M, Jalili M, Kozlowska K. Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures. Front Hum Neurosci 2020; 14:339. [PMID: 33192376 PMCID: PMC7477327 DOI: 10.3389/fnhum.2020.00339] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/03/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizures (PNES) have been hypothesized to emerge in the context of neural networks instability. To explore this hypothesis in children, we applied a graph theory approach to examine connectivity in neural networks in the resting-state EEG in 35 children with PNES, 31 children with other functional neurological symptoms (but no PNES), and 75 healthy controls. Methods The networks were extracted from Laplacian-transformed time series by a coherence connectivity estimation method. Results Children with PNES (vs. controls) showed widespread changes in network metrics: increased global efficiency (gamma and beta bands), increased local efficiency (gamma band), and increased modularity (gamma and alpha bands). Compared to controls, they also had higher levels of autonomic arousal (e.g., lower heart variability); more anxiety, depression, and stress on the Depression Anxiety and Stress Scales; and more adverse childhood experiences on the Early Life Stress Questionnaire. Increases in network metrics correlated with arousal. Children with other functional neurological symptoms (but no PNES) showed scattered and less pronounced changes in network metrics. Conclusion The results indicate that children with PNES present with increased activation of neural networks coupled with increased physiological arousal. While this shift in functional organization may confer a short-term adaptive advantage-one that facilitates neural communication and the child's capacity to respond self-protectively in the face of stressful life events-it may also have a significant biological cost. It may predispose the child's neural networks to periods of instability-presenting clinically as PNES-when the neural networks are faced with perturbations in energy flow or with additional demands.
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Affiliation(s)
| | - Mahdi Jalili
- School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney School of Medicine, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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26
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Kutlubaev MA, Mendelevich VD, Dyukova GM, Belousova ED. [The problem of comorbidity of epilepsy and psychogenic paroxysms]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:138-145. [PMID: 32621480 DOI: 10.17116/jnevro2020120051138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of publications over the last two decades is presented. Psychogenic paroxysms develop in approximately 12% of patients with epilepsy. The analysis of social and demographic data, history details, semiological features and results of electrophysiological and neuroimaging studies does not unequivocally support the comorbidity of epilepsy and psychogenic paroxysms. The pathogenetic mechanisms of the development of comorbidity are various and depend on the presence of pharmacoresistance, psychological traumas in the past, intellectual disability etc. Video-EEG-monitoring is the gold standard in the diagnosis of comorbidity of epilepsy and psychogenic paroxysms. Treatment of such cases includes anticonvulsants and cognitive-behavioral therapy.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov,Republican Clinical Hospital, Ufa, Russia.,Bashkir State Medical University, Ufa, Russia
| | | | - G M Dyukova
- Loginov Moscow Clinical Research Practical Center, Moscow, Russia
| | - E D Belousova
- Research Clinical Institute of Pediatric of Pirogov Russian National Research Medical University, Moscow, Russia
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27
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Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol 2020; 11:461. [PMID: 32582005 PMCID: PMC7280483 DOI: 10.3389/fneur.2020.00461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4-4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to "dual diagnosis," is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.
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Affiliation(s)
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Camilla Ferrante
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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28
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School bullying: an increasingly recognized etiology for psychogenic non-epileptic seizures: report of two cases. INTERNATIONAL JOURNAL OF PEDIATRICS AND ADOLESCENT MEDICINE 2020; 6:155-157. [PMID: 31890842 PMCID: PMC6926182 DOI: 10.1016/j.ijpam.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/04/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022] Open
Abstract
Psychogenic non-epileptic seizures (PNES) are seizure-like episodes that are not associated with changes on electroencephalogram. They are the result of a wide range of possible psychological stressors including being a victim of bullying. Currently, reports regarding PNES in bullied patients are lacking. In this case report, we describe two cases; the first is a 10-year-old boy who presented to the emergency room once for visual loss and another for inability to walk. The other is a 12-year-old boy who has experienced recurrent episodes of loss of consciousness. Based on the negative investigations for any other possible diagnosis, and upon the nature of the episodes, a diagnosis of PNES was made after a history of bullying victimization was revealed. This suggests that PNES can result from psychological distress caused by school bullying victimization in children and highlights the importance of screening for bullying in patients with PNES.
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Zhang LP, Jia Y, Huang H, Li DW, Wang YP. Clinical Classifications of Children With Psychogenic Non-epileptic Seizure. Front Pediatr 2020; 8:596781. [PMID: 33569360 PMCID: PMC7868414 DOI: 10.3389/fped.2020.596781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: To analyze the clinical features of children with psychogenic non-epileptic seizures in one tertiary center in China. Methods: Clinical data including medical records and video- electroencephalograph (video-EEG) monitoring records of 88 pediatric PNES patients hospitalized in the pediatric department of Xuanwu Hospital, Beijing, China from April, 2012 to April, 2018 were collected in this study. Demographic information of patients, semiological classification, duration, and frequency of symptoms, risk factors as well as comorbidity were summarized and analyzed. Results: For semiological classification, all PNES related symptoms were divided into different categories: motor symptoms, unresponsiveness, sensory symptoms, visceral symptoms, and abnormal behaviors, among which motor symptoms were the most prevalent form. Risk factors were reviewed and categorized into two groups: persistent factors and predisposing factors, and patients were most frequently affected by the influences of families. The duration and frequency of symptoms varied substantially within PNES patients while the average time of duration was relatively longer than epilepsy as reported previously. Epilepsy was considered as the most frequent comorbidity of PNES and PNES patients misdiagnosed as epilepsy often mistreated with antiseizure medication. Significance: Our study showed that motor PNES are the most frequent seizure type. Family issues were a risk factor for PNES. Epilepsy was the most frequent co-existing neurological comorbidity.
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Affiliation(s)
- Li-Ping Zhang
- Department of Pediatric, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Huang
- Medical Records and Statistics Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu-Ping Wang
- Department of Pediatric, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sawchuk T, Asadi-Pooya AA, Myers L, Valente KD, Restrepo AD, D' Alessio L, Homayoun M, Bahrami Z, Alessi R, Paytan AA, Kochen S, Taha F, Lazar LM, Pick S, Nicholson TR, Buchhalter J. Clinical characteristics of psychogenic nonepileptic seizures across the lifespan: An international retrospective study. Epilepsy Behav 2020; 102:106705. [PMID: 31785480 DOI: 10.1016/j.yebeh.2019.106705] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/12/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. METHODS In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). RESULTS A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). CONCLUSION While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.
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Affiliation(s)
- Tyson Sawchuk
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus.
| | - Ali A Asadi-Pooya
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lorna Myers
- Northeast Regional Epilepsy Group, New York, USA.
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil.
| | - Anilu Daza Restrepo
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - Maryam Homayoun
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bahrami
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rudá Alessi
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - Silvia Kochen
- Buenos Aires University, Epilepsy Center, Ramos Mejía and el Cruce Hospitals, ENyS-IBCN-CONICET, Buenos Aires, Argentina
| | - Firas Taha
- Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA.
| | - Lorraine M Lazar
- Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA.
| | - Susannah Pick
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK.
| | - Jeffrey Buchhalter
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus; University of Calgary, Cumming School of Medicine, Departments of Pediatrics, Canada
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Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martín A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2019; 39:e43-e80. [PMID: 29562291 DOI: 10.1093/eurheartj/ehy071] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Operto FF, Coppola G, Mazza R, Pastorino GMG, Campanozzi S, Margari L, Roccella M, Marotta R, Carotenuto M. Psychogenic nonepileptic seizures in pediatric population: A review. Brain Behav 2019; 9:e01406. [PMID: 31568694 PMCID: PMC6908892 DOI: 10.1002/brb3.1406] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Psychogenic nonepileptic seizures (PNES) are observable abrupt paroxysmal changes in behavior or consciousness that resemble epileptic seizures, but without concurrent electroencephalographic abnormalities. METHODS In this manuscript, we reviewed literature concerning pediatric PNES and focused on those articles published in the last 10 years, in order to try to understand what the state of the art is at the moment, particularly as regards relationship and differential diagnosis with epilepsy. RESULTS Psychogenic nonepileptic seizures have been extensively described in literature mainly in adults and less frequently in children. Despite the potential negative impact of a misdiagnosis (unnecessary investigations and antiepileptic drugs, structured pathological behavioral patterns), in literature there is little information regarding the real prevalence, clinical features, treatment, and outcome of PNES in children and adolescents. CONCLUSION Psychogenic nonepileptic seizures are common but frequently missed entity in pediatric population. Diagnosis could be difficult, especially in those children who have both epileptic and nonepileptic seizures; video EEG and home video can help clinicians in diagnosis. More studies are needed to better classify PNES in children and facilitate diagnosis and treatment.
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Affiliation(s)
- Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giangennaro Coppola
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Roberta Mazza
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Grazia Maria Giovanna Pastorino
- Child Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy
| | - Rosa Marotta
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Semiological classification of psychogenic nonepileptic seizures: A systematic review and a new proposal. Epilepsy Behav 2019; 100:106412. [PMID: 31645005 DOI: 10.1016/j.yebeh.2019.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE A semiological classification of psychogenic nonepileptic seizures (PNES) may help address proper diagnosis and management and also provide standardization for future studies. The aim of the current paper was to systematically review the literature on the proposed classification systems for the semiology of PNES and to provide a new proposal based on the best available evidence. METHODS I searched the electronic database PubMed on May 16, 2019 for articles that included the following search terms: "psychogenic" AND "semiology" or "classification" and also "nonepileptic" AND "semiology" or "classification" and also "pseudoseizure" AND "semiology" or "classification" since 1940. I applied the same methodology using the electronic database Scopus, though I limited the search to the title, abstract, and keywords. RESULTS I could identify 15 classification systems through this search strategy using the electronic database PubMed. Searching the Scopus did not yield any additional relevant papers. CONCLUSION I proposed a new semiological classification system for PNES based on this systematic review. This includes three major classes of motor seizures, nonmotor seizures, and mixed semiology. A universally accepted and appropriate semiological classification system for PNES may lead to better standardization of future studies and may also help in better understanding of the pathophysiological basis of this condition.
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Asadi-Pooya AA, Myers L, Valente K, Sawchuk T, Restrepo AD, Homayoun M, Buchhalter J, Bahrami Z, Taha F, Lazar LM, Paytan AA, D' Alessio L, Kochen S, Alessi R, Pick S, Nicholson TR. Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study. Seizure 2019; 71:56-59. [DOI: 10.1016/j.seizure.2019.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
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Abstract
PURPOSE OF REVIEW This review addresses the scope, evaluation, treatments, and outcomes of patients with nonepileptic episodic events with a focus on psychogenic nonepileptic seizures. Differentiation of the types of events, including a review of terminology, is included, as well as a brief review of special patient populations with these disorders. RECENT FINDINGS There are continued efforts to develop tools to improve the diagnosis of these disorders. A thorough evaluation with trained personnel and physicians knowledgeable in the assessment and treatment of these disorders is important. Although inpatient video-EEG monitoring in an epilepsy monitoring unit remains the gold standard for diagnosis, the assessment of clinical and historical factors is critical and can be useful in expediting the process and improving diagnostic certainty. International efforts have recently assisted in providing guidelines for the evaluation of the psychogenic disorders and may help target educational and other resources to underserved areas. SUMMARY The prompt and accurate diagnosis of nonepileptic episodic events and psychogenic nonepileptic seizures is possible with current technology, and the appropriate and targeted use of evidence-based treatments may help improve patient quality of life and avoid unnecessary disability in patients with these disorders.
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Asadi-Pooya AA, AlBaradie R, Sawchuk T, Bahrami Z, Al Amer A, Buchhalter J. Psychogenic nonepileptic seizures in children and adolescents: An international cross-cultural study. Epilepsy Behav 2019; 90:90-92. [PMID: 30517909 DOI: 10.1016/j.yebeh.2018.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared various clinical characteristics of psychogenic nonepileptic seizures (PNES) between young patients from Iran, Saudi Arabia, and Canada, three nations with significantly different socioeconomic and demographic characteristics. This international cross-cultural comparative study may advance our knowledge and understanding of PNES in children and adolescents across the cultures and borders. METHODS In this retrospective study, we investigated all patients 16 years of age or younger, with PNES admitted to the epilepsy monitoring units at one center in Iran, one center in Saudi Arabia, and one center in Canada. Age, gender, age at seizure onset, seizure semiology, seizure frequency, factors potentially predisposing to PNES, and video-electroencephalography (EEG) recording of all patients were registered routinely and compared between the nations. RESULTS Fifty-one patients were studied (22 from Iran, 14 from Saudi Arabia, and 15 from Canada). Age at the diagnosis was 13.4 ± 2.2 years (range: 8-16 years), and age at the onset of seizures was 12.3 ± 2.7 years (range: 5-16 years). Demographic and clinical characteristics of and associated factors in the patients among the three nations were not significantly different. Twenty-six (51%) patients were taking antiepileptic drugs at the time of diagnosis; the difference was not statistically significant between the nations (13 patients in Iran, 6 in Saudi Arabia, and 7 patients in Canada; P = 0.5). CONCLUSION Young patients with PNES across borders and between cultures share more similarities than differences with regard to their demographic and clinical characteristics.
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Affiliation(s)
- Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Tyson Sawchuk
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada.
| | - Zahra Bahrami
- Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abeer Al Amer
- King Fahd Specialist Hospital, Dammam, Saudi Arabia.
| | - Jeffrey Buchhalter
- Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada; Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Vogrig A, Hsiang JC, Ng J, Rolnick J, Cheng J, Parvizi J. A systematic study of stereotypy in epileptic seizures versus psychogenic seizure-like events. Epilepsy Behav 2019; 90:172-177. [PMID: 30580068 DOI: 10.1016/j.yebeh.2018.11.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to quantify the features of stereotypy in epileptic seizures and compare it with that of stereotypy in psychogenic nonepileptic seizure-like events (PNES) confirmed by video-electroencephalography (VEEG) monitoring. METHODS Video-electroencephalography monitoring records of 20 patients with temporal lobe seizures (TLS) and 20 with PNES were retrospectively reviewed (n = 138 seizures, 48 TLS and 90 PNES). We analyzed the semiology of 59 behaviors of interest for their presence, duration, sequence, and continuity using quantified measures that were entered into statistical analysis. RESULTS We identified discontinuity as the parameter that was clearly distinct between PNES and epileptic TLS events: there were significantly more frequent pauses of behavior (i.e., "on-off" pattern) in PNES compared with TLS (P = 0.012). The frequency of pauses during an event was diagnostic of PNES events. For instance, the presence of 2 "pauses" during an episode determines a 69% probability of the seizure being nonepileptic. Moreover, PNES events had significantly greater duration (143 s) than TLS events (68 s) (excluding outliers, P = 0.002) and greater duration variability from one event to another in the same subject (P = 0.005). SIGNIFICANCE Our work provides the first quantified measure of behavioral semiology during epileptic and nonepileptic seizures and offers novel behavioral measures to differentiate them from each other.
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Affiliation(s)
- Alberto Vogrig
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jen Chun Hsiang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jacqueline Ng
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Joshua Rolnick
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Cheng
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Josef Parvizi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
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Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav 2018; 89:70-78. [PMID: 30384103 DOI: 10.1016/j.yebeh.2018.10.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 11/21/2022]
Abstract
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of individuals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.
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Semiological characteristics of patients with psychogenic nonepileptic seizures: Gender-related differences. Epilepsy Behav 2018; 89:130-134. [PMID: 30415134 DOI: 10.1016/j.yebeh.2018.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are more prevalent among women, and diagnosis may sometimes be delayed by as much as seven years. Understanding the effect of gender on the presentation of a PNES may assist with diagnosis based on semiological details in the clinical setting. Although video-EEG monitoring (VEM) is the gold standard for diagnosing PNES, determining gender-related seizure semiology through careful history may prevent diagnostic delay while waiting for VEM. The aim of this study was to investigate gender-related differences in the semiology of PNES. Patients, all aged at least 16 years, diagnosed with PNES following VEM between December 2005 and November 2016 were included in this study. All patients' medical records and video-EEG-documented PNES were reviewed, and the presence or absence of semiological signs was recorded for each documented attack. Demographic features and semiological signs of PNES were compared between female and male patients. Forty-one patients (31 females, 10 males) aged 27.2 ± 12.2 years (range: 16-65) were included in the study. Mean age at onset of PNES was higher for female patients than males, at 24.3 ± 11.5 versus 17.5 ± 3.2 years (p = 0.005). The median duration of PNES was longer for female patients than males, at 10 min (range: 5 s-120 min) versus 2 min (range: 10 s-60 min) (p = 0.016). The most common symptom was forced eye closure in both genders. No significant gender-specific differences were observed in terms of the type or semiology of PNES. Although there are no major gender-related differences in PNES semiology, our findings highlight the importance of greater caution, especially in male patients, when diagnosing PNES, remembering that onset may also occur at young ages and that a short seizure duration does not exclude PNES.
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Hyperventilation-Induced Non-epileptic Seizures in an Adolescent Boy with Pediatric Medical Traumatic Stress. Harv Rev Psychiatry 2018; 25:180-190. [PMID: 28471819 DOI: 10.1097/hrp.0000000000000131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wilkins SS, Mesraoua B, Palomo GA, Al Hail H, Salam A, Melikyan G, Azar N, Haddad N, Uthman B, Siddiqi M, Elsheikh L, Ali M, Alrabi A, Shuaib A, Deleu D, Asadi-Pooya AA. Characteristics of patients with confirmed epilepsy and psychogenic nonepileptic seizures in Qatar. Epilepsy Behav 2018; 85:218-221. [PMID: 29980425 DOI: 10.1016/j.yebeh.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Middle Eastern country of Qatar opened its first epilepsy monitoring unit (EMU) in late 2015. This study compared demographic and clinical characteristics of patients with confirmed epilepsy to those of patients with confirmed psychogenic nonepileptic seizures (PNES). METHODS Data were collected via retrospective chart review on 113 patients admitted for evaluation to the Qatar national health system EMU between November 2015 and May 2017. RESULTS Seventy-one patients had a confirmed diagnosis (20 had PNES, 46 had epilepsy, 5 had both PNES and epilepsy). Evaluation in 33 patients was inconclusive, and 9 had other medical conditions. Patients with PNES were significantly more likely to be primary Arabic speakers (p = 0.003), and this difference was not explained by education or employment status. The most common referral request in patients with PNES was for recurrent/refractory seizures (p = 0.011), and there was a trend for patients with PNES to have more frequent seizures compared with patients with epilepsy (daily to several per week versus several times a month or less, p = 0.051). Depression was identified in 47% of patients with epilepsy and 65% of patients with PNES, and patients with PNES had higher mean depression scores on the PHQ-9 than patients with epilepsy (p = 0.014). Patients with PNES experienced significantly more fatigue (p = 0.021). Seventy percent of patients with PNES and 50% of patients with epilepsy reported sleep problems. CONCLUSIONS The characteristics of patients with epilepsy and PNES at the EMU in Qatar were generally similar to those found worldwide. Patients with PNES more often suffered from frequent depression, sleep problems, and fatigue than those with epilepsy, but these were significant concerns for both groups.
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Affiliation(s)
| | - Boulenouar Mesraoua
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Gonzalo Alarcón Palomo
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Hassan Al Hail
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Abdul Salam
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Gayane Melikyan
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Nabil Azar
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Naim Haddad
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Bassim Uthman
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | | | | | - Musab Ali
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | | | | | - Dirk Deleu
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Weill Cornell Medicine-Qatar, PO Box 24144, Education City, Doha, Qatar
| | - Ali A Asadi-Pooya
- Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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Madaan P, Gulati S, Chakrabarty B, Sapra S, Sagar R, Mohammad A, Pandey R, Tripathi M. Clinical spectrum of psychogenic non epileptic seizures in children; an observational study. Seizure 2018; 59:60-66. [DOI: 10.1016/j.seizure.2018.04.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022] Open
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S16. The occurrence of nonepileptic events in children with intractable epilepsy: Findings from a single centre prospective audit. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kerr WT, Janio EA, Braesch CT, Le JM, Hori JM, Patel AB, Gallardo NL, Bauirjan J, Chau AM, Hwang ES, Davis EC, Buchard A, Torres-Barba D, D'Ambrosio S, Al Banna M, Cho AY, Engel J, Cohen MS, Stern JM. An objective score to identify psychogenic seizures based on age of onset and history. Epilepsy Behav 2018; 80:75-83. [PMID: 29414562 PMCID: PMC5845850 DOI: 10.1016/j.yebeh.2017.11.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Psychogenic nonepileptic seizure (PNES) is a common diagnosis after evaluation of medication resistant or atypical seizures with video-electroencephalographic monitoring (VEM), but usually follows a long delay after the development of seizures, during which patients are treated for epilepsy. Therefore, more readily available diagnostic tools are needed for earlier identification of patients at risk for PNES. A tool based on patient-reported psychosocial history would be especially beneficial because it could be implemented in the outpatient clinic. METHODS Based on the data from 1375 patients with VEM-confirmed diagnoses, we used logistic regression to compare the frequency of specific patient-reported historical events, demographic information, age of onset, and delay from first seizure until VEM in five mutually exclusive groups of patients: epileptic seizures (ES), PNES, physiologic nonepileptic seizure-like events (PSLE), mixed PNES plus ES, and inconclusive monitoring. To determine the diagnostic utility of this information to differentiate PNES only from ES only, we used multivariate piecewise-linear logistic regression trained using retrospective data from chart review and validated based on data from 246 prospective standardized interviews. RESULTS The prospective area under the curve of our weighted multivariate piecewise-linear by-sex score was 73%, with the threshold that maximized overall retrospective accuracy resulting in a prospective sensitivity of 74% (95% CI: 70-79%) and prospective specificity of 71% (95% CI: 64-82%). The linear model and piecewise linear without an interaction term for sex had very similar performance statistics. In the multivariate piecewise-linear sex-split predictive model, the significant factors positively associated with ES were history of febrile seizures, current employment or active student status, history of traumatic brain injury (TBI), and longer delay from first seizure until VEM. The significant factors associated with PNES were female sex, older age of onset, mild TBI, and significant stressful events with sexual abuse, in particular, increasing the likelihood of PNES. Delays longer than 20years, age of onset after 31years for men, and age of onset after 40years for women had no additional effect on the likelihood of PNES. DISCUSSION Our promising results suggest that an objective score has the potential to serve as an early outpatient screening tool to identify patients with greater likelihood of PNES when considered in combination with other factors. In addition, our analysis suggests that sexual abuse, more than other psychological stressors including physical abuse, is more associated with PNES. There was a trend of increasing frequency of PNES for women during childbearing years and plateauing outside those years that was not observed in men.
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Affiliation(s)
- Wesley T Kerr
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, CA, United States.
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Justine M Le
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Janar Bauirjan
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Albert Buchard
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - David Torres-Barba
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Mona Al Banna
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jerome Engel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Mark S Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Departments of Radiology, Psychology, Biomedical Physics, and Bioengineering, University of California Los Angeles, Los Angeles, CA, United States; California NanoSystems Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - John M Stern
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Kerr WT, Janio EA, Braesch CT, Le JM, Hori JM, Patel AB, Gallardo NL, Bauirjan J, D'Ambrosio SR, Chau AM, Hwang ES, Davis EC, Buchard A, Torres-Barba D, Al Banna M, Barritt SE, Cho AY, Engel J, Cohen MS, Stern JM. Identifying psychogenic seizures through comorbidities and medication history. Epilepsia 2017; 58:1852-1860. [PMID: 28895657 DOI: 10.1111/epi.13888] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Low-cost evidence-based tools are needed to facilitate the early identification of patients with possible psychogenic nonepileptic seizures (PNES). Prior to accurate diagnosis, patients with PNES do not receive interventions that address the cause of their seizures and therefore incur high medical costs and disability due to an uncontrolled seizure disorder. Both seizures and comorbidities may contribute to this high cost. METHODS Based on data from 1,365 adult patients with video-electroencephalography-confirmed diagnoses from a single center, we used logistic and Poisson regression to compare the total number of comorbidities, number of medications, and presence of specific comorbidities in five mutually exclusive groups of diagnoses: epileptic seizures (ES) only, PNES only, mixed PNES and ES, physiologic nonepileptic seizurelike events, and inconclusive monitoring. To determine the diagnostic utility of comorbid diagnoses and medication history to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and age, trained using a retrospective database and validated using a prospective database. RESULTS Our model differentiated PNES only from ES only with a prospective accuracy of 78% (95% confidence interval =72-84%) and area under the curve of 79%. With a few exceptions, the number of comorbidities and medications was more predictive than a specific comorbidity. Comorbidities associated with PNES were asthma, chronic pain, and migraines (p < 0.01). Comorbidities associated with ES were diabetes mellitus and nonmetastatic neoplasm (p < 0.01). The population-level analysis suggested that patients with mixed PNES and ES may be a population distinct from patients with either condition alone. SIGNIFICANCE An accurate patient-reported medical history and medication history can be useful when screening for possible PNES. Our prospectively validated and objective score may assist in the interpretation of the medication and medical history in the context of the seizure description and history.
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Affiliation(s)
- Wesley T Kerr
- Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, California, U.S.A.,Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Justine M Le
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Janar Bauirjan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Shannon R D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Albert Buchard
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - David Torres-Barba
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Mona Al Banna
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Sarah E Barritt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jerome Engel
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A.,Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Brain Research Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Mark S Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, U.S.A.,Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.,Departments of Radiology, Psychology, Biomedical Physics, and Bioengineering, University of California, Los Angeles, Los Angeles, California, U.S.A.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - John M Stern
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Kanemoto K, LaFrance WC, Duncan R, Gigineishvili D, Park S, Tadokoro Y, Ikeda H, Paul R, Zhou D, Taniguchi G, Kerr M, Oshima T, Jin K, Reuber M. PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report. Epilepsia Open 2017; 2:307-316. [PMID: 29588959 PMCID: PMC5862115 DOI: 10.1002/epi4.12060] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/05/2023] Open
Abstract
An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.
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Affiliation(s)
- Kousuke Kanemoto
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - W. Curt LaFrance
- Rhode Island HospitalBrown UniversityProvidenceRhode IslandU.S.A.
| | | | - David Gigineishvili
- Department of Neurology & NeurosurgerySarajishvili Institute of NeurologyTbilisi State UniversityTbilisiGeorgia
| | - Sung‐Pa Park
- Department of NeurologyKyungpook National University School of MedicineDaeguKorea
| | - Yukari Tadokoro
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Hiroko Ikeda
- Department of PediatricsEpilepsy CenterNHO Shizuoka Institute of Epilepsy and Neurological DisordersShizuokaJapan
| | - Ravi Paul
- Department of PsychiatrySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Dong Zhou
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Go Taniguchi
- Department of Neuropsychiatrythe University of TokyoTokyoJapan
| | - Mike Kerr
- Learning Disability PsychiatryCardiff UniversityCardiffUnited Kingdom
| | - Tomohiro Oshima
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Kazutaka Jin
- Tohoku Daigaku Daigakuin Igakukei Kenkyuka IgakubuSendaiMiyagiJapan
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Whitehead K, Kane N, Wardrope A, Kandler R, Reuber M. Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis. Clin Neurophysiol Pract 2017; 2:130-139. [PMID: 30214985 PMCID: PMC6123876 DOI: 10.1016/j.cnp.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/24/2022] Open
Abstract
The gold-standard for the diagnosis of psychogenic non-epileptic seizures (PNES) is capturing an attack with typical semiology and lack of epileptic ictal discharges on video-EEG. Despite the importance of this diagnostic test, lack of standardisation has resulted in a wide variety of protocols and reporting practices. The goal of this review is to provide an overview of research findings on the diagnostic video-EEG procedure, in both the adult and paediatric literature. We discuss how uncertainties about the ethical use of suggestion can be resolved, and consider what constitutes best clinical practice. We stress the importance of ictal observation and assessment and consider how diagnostically useful information is best obtained. We also discuss the optimal format of video-EEG reports; and of highlighting features with high sensitivity and specificity to reduce the risk of miscommunication. We suggest that over-interpretation of the interictal EEG, and the failure to recognise differences between typical epileptic and nonepileptic seizure manifestations are the greatest pitfalls in neurophysiological assessment of patients with PNES. Meanwhile, under-recognition of semiological pointers towards frontal lobe seizures and of the absence of epileptiform ictal EEG patterns during some epileptic seizure types (especially some seizures not associated with loss of awareness), may lead to erroneous PNES diagnoses. We propose that a standardised approach to the video-EEG examination and the subsequent written report will facilitate a clear communication of its import, improving diagnostic certainty and thereby promoting appropriate patient management.
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Affiliation(s)
- Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Nick Kane
- Grey Walter Department of Clinical Neurophysiology, North Bristol NHS Trust, Bristol, UK
| | | | - Ros Kandler
- Department of Clinical Neurophysiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
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The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures. Eur Child Adolesc Psychiatry 2017; 26:1207-1217. [PMID: 28341888 PMCID: PMC5610228 DOI: 10.1007/s00787-017-0976-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) are a common problem in paediatric neurology and psychiatry that can best be understood as atypical responses to threat. Threats activate the body for action by mediating increases in arousal, respiration, and motor readiness. In previous studies, a range of cardiac, endocrine, brain-based, attention-bias, and behavioral measures have been used to demonstrate increases in arousal, vigilance, and motor readiness in patients with PNES. The current study uses respiratory measures to assess both the motor readiness of the respiratory system and the respiratory regulation of CO2. Baseline respiratory rates during clinical assessment and arterial CO2 levels during the hyperventilation component of routine video electroencephalogram were documented in 60 children and adolescents referred for treatment of PNES and in 50 controls. Patients showed elevated baseline respiratory rates [t(78) = 3.34, p = .001], with 36/52 (69%) of patients [vs. 11/28 (39%) controls] falling above the 75th percentile (χ2 = 6.7343; df = 1; p = .009). Twenty-eight (47%) of patients [vs. 4/50 (8%) controls] showed a skewed hyperventilation-challenge profile—baseline PCO2 <36 mmHg, a trough PCO2 ≤ 20 mmHg, or a final PCO2 <36 mmHg after 15 min of recovery—signaling difficulties with CO2 regulation (χ2 = 19.77; df = 1; p < .001). Children and adolescents with PNES present in a state of readiness-for-action characterized by high arousal coupled with activation of the respiratory motor system, increases in ventilation, and a hyperventilation-challenge profile shifted downward from homeostatic range. Breathing interventions that target arousal, decrease respiratory rate, and normalize ventilation and arterial CO2 may help patients shift brain–body state and avert PNES episodes.
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Psychogenic nonepileptic seizures: a concise review. Neurol Sci 2017; 38:935-940. [PMID: 28275874 DOI: 10.1007/s10072-017-2887-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are commonly diagnosed and treated at epilepsy centers; however, their neurobiology is still poorly understood. Diagnosis relies on a multidisciplinary evaluation and is usually based on different combinations of data. They are diagnosed most reliably by recording a seizure while under video-EEG monitoring. Treatment includes multiple phases. Fewer than 40% of adults with PNES are expected to become seizure-free within 5 years after diagnosis. This article presents a concise review of the current literature about the definition, diagnosis, epidemiology, clinical characteristics, treatment, and prognosis of PNES.
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Valente KD, De Paola L, Palmini A, Faveret E, de Araujo-Filho GM, van der Linden H, Bianchin MM, Walz R, Alessi R, Velasco T, Teixeira WA, LaFrance WC. The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education. Epilepsy Behav 2017; 68:78-83. [PMID: 28131930 DOI: 10.1016/j.yebeh.2016.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/29/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022]
Abstract
Previous studies, using surveys, provided an understanding about how health-care providers address patients with PNES. To date, there is limited information on the management of patients with PNES by tertiary referral centers for epilepsy. In this study, we surveyed 11 Brazilian epilepsy center directors about diagnosis, treatment, education and research on PNES. Respondents reported that patients with PNES represented 10-20% of all adult patients recorded by video-EEG (VEEG). All respondents recognized VEEG as the method to confirm the diagnosis, and 81.8% used this approach for confirmation. Most centers had a standard protocol for diagnosis. None of the centers had a particular protocol to treat PNES, but 90.9% had a uniform treatment approach including therapy and educational measures. Psychotherapy was not easily obtained in nine centers (81.8%). Seven (63.3%) centers reported ongoing research projects with PNES. Five centers referred to an educational PNES program discussing diagnosis, but only one reported an educational program for treatment. This study showed a commitment to PNES diagnosis; however, some gaps remain regarding treatment and training, namely implementing a psychotherapy approach for patients and providing educational curricula for clinicians.
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Affiliation(s)
- Kette D Valente
- Department of Psychiatry, Clinics Hospital of the Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.
| | - Luciano De Paola
- Department of Neurology, Clinics Hospital, Federal University of Paraná, Curitiba, PR, Brazil; Comprehensive Epilepsy Center, Hospital N S das Graças, Curitiba, PR, Brazil
| | - Andre Palmini
- Medicine and Health Sciences Post-Graduate Program, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Department of Neurology, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Epilepsy Surgery Program Service, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil
| | - Eduardo Faveret
- Brain Institute - Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | | | | | - Marino M Bianchin
- Basic Research and Advanced Investigations in Neurology, Clinic Hospital of Porto Alegre, Federal University of Rio Grande do Sul, RS, Brazil
| | - Roger Walz
- Applied Neuroscience Center and Epilepsy Center of Santa Catarina (CEPESC), Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rudá Alessi
- Department of Neurology, Medical School - ABC, Santo André, SP, Brazil
| | - Tonicarlo Velasco
- Department of Neurology, Clinics Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - W Curt LaFrance
- Department of Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
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