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Mammì A, Bova V, Martino I, Sammarra I, Ferlazzo E, Pascarella A, Abelardo D, Marsico O, Torino C, Cianci V, Viola G, Pecoraro V, Beghi M, Gambardella A, Pujia A, Aguglia U, Gasparini S. Functional seizures and binge eating disorder: A cross-sectional study. Epilepsy Behav 2024; 158:109943. [PMID: 39002280 DOI: 10.1016/j.yebeh.2024.109943] [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: 03/20/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation's link to binge eating, and to explore psychological characteristics of FS individuals. METHOD Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders. RESULTS We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet 'Perseveration' predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people. DISCUSSION This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.
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Affiliation(s)
- Anna Mammì
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Iolanda Martino
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Domenico Abelardo
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Claudia Torino
- IFC-CNR, National Research Council - Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Giulia Viola
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Valeria Pecoraro
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Antonio Gambardella
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
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Mueller SG, Garga N, Garcia P, Rossi S, Vu A, Neylan T, Laxer KD. The imprint of dissociative seizures on the brain. Neuroimage Clin 2024; 43:103664. [PMID: 39226702 PMCID: PMC11403518 DOI: 10.1016/j.nicl.2024.103664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/26/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Increased resting state functional connectivity between regions involved in emotion control with regions with other specializations, e.g. motor control (emotional hyperconnectivity) is one of the most consistent imaging findings in persons suffering from dissociative seizures (DS). The overall goal of this study was to better characterize DS-related emotional hyperconnectivity using dynamic resting state analysis combined with brainstem volumetry to investigate 1. If emotional hyperconnectivity is restricted to a single state. 2. How volume losses within the modulatory and emotional motor subnetworks of the neuromodulatory system influence the expression of the emotional hyperconnectivity. METHODS 13 persons with dissociative seizures (PDS) (f/m:10/3, mean age (SD) 44.6 (11.5)) and 15 controls (CON) (f/m:10/5, mean age (SD) 41.7 (13.0)) underwent a mental health test battery and structural and functional imaging at 3 T. Deformation based morphometry was used to assess brain volume loss by extracting the mean Jacobian determinants from 457 brain, forebrain and brainstem structures. The bold signals from 445 brainstem and brain rois were extracted with CONN and a dynamic fMRI analysis combined with graph and hierarchical analysis was used to identify and characterize 9 different brain states. Welch's t tests and Kendall tau tests were used for group comparisons and correlation analyses. RESULTS The duration of Brain state 6 was longer in PDS than in CON (93.1(88.3) vs. 23.4(31.2), p = 0.01) and positively correlated with higher degrees of somatization, depression, PTSD severity and dissociation. Its global connectivity was higher in PDS than CON (90.4(3.2) vs 86.5(4.2) p = 0.01) which was caused by an increased connectivity between regions involved in emotion control and regions involved in sense of agency/body control. The brainstem and brainstem-forebrain modulatory and emotional motor subnetworks of the neuromodulatory system were atrophied in PDS. Atrophy severity within the brainstem-forebrain subnetworks was correlated with state 6 dwell time (modulatory: tau = -0.295, p = 0.03; emotional motor: tau = -0.343, p = 0.015) and atrophy severity within the brainstem subnetwork with somatization severity (modulatory: tau = -0.25, p = 0.036; emotional motor: tau = -0.256, p = 0.033). CONCLUSION DS-related emotional hyperconnectivity was restricted to state 6 episodes. The remaining states were not different between PDS and CON. The modulatory subnetwork synchronizes brain activity across brain regions. Atrophy and dysfunction within that subnetwork could facilitate the abnormal interaction between regions involved in emotion control with those controlling sense of agency/body ownership during state 6 and contribute to the tendency for somatization in PDS. The emotional motor subnetwork controls the activity of spinal motoneurons. Atrophy and dysfunction within this subnetwork could impair that control resulting in motor symptoms during DS. Taken together, these findings indicate that DS have a neurophysiological underpinning.
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Affiliation(s)
- S G Mueller
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA; Dept of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - N Garga
- VA Epilepsy Center of Excellence, VAMC, San Francisco, CA, USA; Dept. of Neurology, University of California, San Francisco, CA, USA
| | - P Garcia
- Dept. of Neurology, University of California, San Francisco, CA, USA
| | - S Rossi
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA
| | - A Vu
- Center for Imaging of Neurodegenerative Diseases, VAMC, San Francisco, CA, USA; Dept of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - T Neylan
- VA Mental Health, VAMC San Francisco, CA, USA
| | - K D Laxer
- Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA
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Milligan F, Whittingham C, Granitsitotis V, Simpson H, Woodfield J, Carson A, Stone J, Hoeritzauer I. Chronic idiopathic urinary retention: Comorbidity and outcome in 102 individuals. J Psychosom Res 2024; 181:111663. [PMID: 38643683 DOI: 10.1016/j.jpsychores.2024.111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Chronic Idiopathic urinary retention is poorly understood. One small study suggests higher than expected rates of functional neurological disorder and pain comorbidity which may have implications for understanding the disorder. We investigated the frequency of functional neurological disorder, chronic pain other medical and psychiatric comorbidity, triggers of urinary retention, results of urodynamic assessment, medication history, management, and outcome in patients with chronic idiopathic urinary retention. METHODS A consecutive retrospective electronic notes analysis was undertaken of patients with chronic idiopathic urinary retention presenting to a secondary care urology clinic between Jan 2018-Jan 2021, with follow-up to their most recent urological appointment. RESULTS 102 patients were identified (mean age of 41.9 years, 98% female). 25% had functional neurological disorder (n = 26), most commonly limb weakness (n = 19, 19%) and functional seizures (n = 16, 16%). Chronic pain (n = 58, 57%) was a common comorbidity. Surgical and medical riggers to urinary retention were found in almost half of patients (n = 49, 48%). 81% of patients underwent urodynamic assessment (n = 83). Most frequently no specific abnormality was reported (n = 30, 29%). Hypertonic urethral sphincter was the most identified urodynamic abnormality (n = 17, 17%). We noted high levels of opioid (n = 50, 49%) and benzodiazepine (n = 27, 26%) use. Urinary retention resolved in only a small number of patients (n = 6, 6%, median follow up 54 months), in three cases spontaneously. CONCLUSION This preliminary data suggests idiopathic urinary retention is commonly comorbid with functional neurological disorder, and chronic pain, suggesting shared mechanisms.
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Affiliation(s)
- Fintan Milligan
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | | | - Voula Granitsitotis
- Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Urology, Royal Victoria Hospital Kirkcaldy, UK.
| | - Helen Simpson
- Department of Urology, Western General Hospital, UK.
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
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Van Patten R, Mordecai K, LaFrance WC. The role of neuropsychology in the care of patients with functional neurological symptom disorder. J Int Neuropsychol Soc 2024:1-8. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. METHODS A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. RESULTS Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. CONCLUSIONS Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | | | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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5
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Lewis EC, Jaeger A, Girn M, Omene E, Brendle M, Argento E. Exploring psychedelic-assisted therapy in the treatment of functional seizures: A review of underlying mechanisms and associated brain networks. J Psychopharmacol 2024; 38:407-416. [PMID: 38654554 PMCID: PMC11102649 DOI: 10.1177/02698811241248395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Functional seizures (FS), the most common subtype of functional neurological disorder (FND), cause serious neurological disability and significantly impact quality of life. Characterized by episodic disturbances of functioning that resemble epileptic seizures, FS coincide with multiple comorbidities and are treated poorly by existing approaches. Novel treatment approaches are sorely needed. Notably, mounting evidence supports the safety and efficacy of psychedelic-assisted therapy (PAT) for several psychiatric conditions, motivating investigations into whether this efficacy also extends to neurological disorders. Here, we synthesize past empirical findings and frameworks to construct a biopsychosocial mechanistic argument for the potential of PAT as a treatment for FS. In doing so, we highlight FS as a well-defined cohort to further understand the large-scale neural mechanisms underpinning PAT. Our synthesis is guided by a complexity science perspective which we contend can afford unique mechanistic insight into both FS and PAT, as well as help bridge these two domains. We also leverage this perspective to propose a novel analytic roadmap to identify markers of FS diagnostic specificity and treatment success. This endeavor continues the effort to bridge clinical neurology with psychedelic medicine and helps pave the way for a new field of psychedelic neurology.
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Affiliation(s)
- Evan Cole Lewis
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Manesh Girn
- Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Madeline Brendle
- Numinus Wellness Inc., Vancouver, BC, Canada
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Elena Argento
- Numinus Wellness Inc., Vancouver, BC, Canada
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
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Starbrink M, Eikeseth S, Eldevik S, Edervall J. Experimental assessment of seizure-like behaviors in a girl with Rett syndrome. Epilepsy Behav Rep 2024; 26:100666. [PMID: 38681818 PMCID: PMC11052899 DOI: 10.1016/j.ebr.2024.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Contextual events are recognized to affect seizure-like behaviors, yet there is limited research on procedures assessing contextual control. This study aimed to examine the utilization of a brief experimental precursor functional analysis within a clinical team assessment. Furthermore, the study explored if telehealth supervision could guide a parent administered replication of the functional analysis. The participants were a young female with Rett syndrome and a history of epilepsy as well as non-epileptic seizures and her mother. The functional analysis procedures consisted of the systematic alternations of contextual conditions that were hypothesized to either prevent or evoke seizure-like behaviors. The primary outcome measure was the occurrence of behavioral precursors that were identified to consequently signal subsequent seizure-like behaviors. In addition, procedure fidelity and interobserver agreement data were obtained alongside parent rating of the procedure's social validity. The clinical functional analysis clearly suggested that the seizure-like behaviors served the function of access to attention and preferred activities. A parent administered functional analysis replicated clinical functional analysis findings. The parent's fidelity to procedures was high and scores in social validity were excellent. The results show that functional analysis procedures could provide essential information in assessment of non-epileptic seizures. Strengths and limitations are discussed.
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Affiliation(s)
- Magnus Starbrink
- Oslo Metropolitan University. P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway1
- Swedish National Center for Rett Syndrome and Related Disorders, Box 601, 832 23 Frösön, Sweden2
| | - Svein Eikeseth
- Oslo Metropolitan University. P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway1
| | - Sigmund Eldevik
- Oslo Metropolitan University. P.O. Box 4 St. Olavs Plass, N-0130 Oslo, Norway1
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Leroy A, Derambure P, Hingray C, El-Hage W, Warembourg I, Vaiva G, Amad A. Right temporoparietal junction transcranial direct current stimulation in the treatment of functional dissociative seizures: a case series. Eur Arch Psychiatry Clin Neurosci 2024; 274:83-86. [PMID: 36602649 DOI: 10.1007/s00406-022-01533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/03/2022] [Indexed: 01/06/2023]
Abstract
Functional dissociative seizures (FDSs) are clinical events that resemble epileptic seizures but are not associated with abnormal brain electrical discharges or other physiological problems. In this pilot case series, ten adults with FDSs were recruited from our psychiatry department after being referred by a neurologist who made the diagnosis of FDS based on video EEG results. Each subject received ten sessions of cathodal tDCS focused on the right temporoparietal junction. A significant decrease in weekly seizure frequency was seen in all participants between baseline (30.2 ± 70.3 events) and 1 month after tDCS treatment (0.2 ± 0.3events) (p = 0.006). Main predisposing factors were unchanged after treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France.
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France.
- Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000, Lille, France.
| | - Philippe Derambure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Department of Clinical Neurophysiology, 59000, Lille, France
| | - Coraline Hingray
- Pôle Universitaire de Psychiatrie adulte du Grand Nancy, CPN, Laxou, France
- CNRS CRAN, UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- CHRU de Tours, Pôle de Psychiatrie et d'addictologie, Tours, France
| | - Isabelle Warembourg
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
| | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
- Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000, Lille, France
| | - Ali Amad
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience and Cognition Centre (U-1172), Plasticity and SubjectivitY Team, CURE Platform, 59000, Lille, France
- General Psychiatry Department, CHU Lille, Fontan Hospital, 59037, Lille Cedex, France
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ALKhaldi NA, Paredes-Aragón E, Kim DD, Yu YJ, ALKhateeb M, Mirsattari SM. Psychogenic non-epileptic seizures with and without epilepsy: Exploring the influence of co-existing psychiatric disorders on clinical characteristics and outcomes. Epilepsy Res 2024; 199:107279. [PMID: 38101178 DOI: 10.1016/j.eplepsyres.2023.107279] [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: 08/29/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Psychogenic non-epileptic seizures (PNES) are commonly associated with co-existing psychiatric disorders. The relationship between psychiatric factors and PNES episodes with and without epilepsy remains understudied. We reviewed co-existing psychiatric disorders in PNES-only, PNES with epilepsy aiming to examine whether these co-existing disorders associated with PNES clinical presentation and long-term outcomes. METHODS We conducted a retrospective, longitudinal cohort study of patients with PNES diagnosed at our EMU from May 2000 to April 2008, with follow-up clinical data until September 2015. We categorized patients into three groups: PNES-only, PNES+ definite epilepsy, and PNES+ possible/probable epilepsy. RESULTS In total, 271 patients with PNES were identified: 194 had PNES-only, 30 had PNES+ possible or probable epilepsy, and 47 had PNES+ definite epilepsy. No significant differences were observed in the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, or suicidal thoughts among the three groups. Similarly, no differences in co-existing psychiatric disorders characteristics were discovered among patients grouped by various durations and frequencies of PNES episodes. At EMU admission, for PNES-only patients total of 130/194 patients (67%) were on ASMs, and 64/194 (32.9%) were not. PNES-only not on ASM were the most likely to report at least two of the three main psychiatric disorders (depression, anxiety, and PTSD; p = 0.01). At the final follow-up, 68/130 (52.3%) and 92/130 (70.8%) patients were able to discontinue or reduce their ASM intake, respectively, with no significant differences in co-existing psychiatric disorders among them (p < 0.001). Overall, 51.6% or 31.3% of patients reported reduced or resolved PNES episodes, respectively. Further, this reduction and resolution of PNES episode were not affected by any psychological variable. CONCLUSIONS Co-existing psychiatric disorders prevalence did not differ between patients with PNES-only and those with coexisting epilepsy. Further, co-existing psychiatric disorders characteristics did not reliably predict PNES episode duration, frequency, reduction, or resolution. For patients with PNES-only, the presence of co-existing psychiatric disorders did not predict the rate at which ASMs could be reduced or discontinued.
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Affiliation(s)
- Norah A ALKhaldi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
| | - Elma Paredes-Aragón
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neurological Emergencies Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - David Dongkyung Kim
- Adult Neurodevelopmental and Geriatric Psychiatry Division, Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yeyao Joe Yu
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mashael ALKhateeb
- Neurology Section, Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Van Patten R, Bellone JA. The neuropsychology of functional neurological disorders. J Clin Exp Neuropsychol 2023; 45:957-969. [PMID: 38441076 DOI: 10.1080/13803395.2024.2322798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Center for Neurorestoration & Neurotechnology, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - John A Bellone
- Department of Behavioral Health, Kaiser Permanente, San Bernardino, CA, USA
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10
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Sone D. White Matter Structural Connectivity and Its Impact on Psychogenic Non-Epileptic Seizures: An Evidence-Based Review. Neuropsychiatr Dis Treat 2023; 19:1573-1579. [PMID: 37457838 PMCID: PMC10349606 DOI: 10.2147/ndt.s402378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Psychiatric non-epileptic seizure (PNES), also known as a form of functional neurological disorders (FND), is a common but still underrecognized disorder presenting seizure-like symptoms and no electrophysiological abnormality. Despite the significant burden of this disorder, the neurobiological mechanisms are not clearly understood, which hinders the development of better diagnosis and treatment. In the recent neuroimaging research on PNES, brain network analysis has become a relevant topic beyond conventional methodologies. The human brain is a highly intricate system of interconnected regions that collaborate to facilitate a wide range of cognitive and behavioral functions. White matter tracts, which are comprised of bundles of axonal fibers, are the primary means by which information is transmitted between different brain regions. As such, comprehending the organization and structure of the brain's white matter network is critical for gaining insight into its functional architecture. This review article aims to provide an overview of the brain mechanisms underlying PNES, with a special focus on analyzing brain networks.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
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Carle-Toulemonde G, Hingray C, Alaoui OM, Aybek S, Mouchabac S, Garcin B. [Overview of care management principles in functional neurological disorders]. L'ENCEPHALE 2023:S0013-7006(23)00089-1. [PMID: 37400336 DOI: 10.1016/j.encep.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
After more than twenty years of academic research on functional neurological disorders (FND) throughout the world, a standardized care management strategy has emerged to allow a more adapted care offer to patients with FND, as close as possible to their experience and their needs. With regard to this special issue on FND in collaboration with L'Encéphale and at the initiative of the Neuropsychiatry section of the AFPBN (French Association of Biological Psychiatry and Neuropsychopharmacology), we would like to suggest a summary of all topics discussed in more detail in each article of this special issue, in order to facilitate its reading. We therefore cover the following themes: the initial contact with a patient with FND, the diagnostic process in favor of a positive diagnosis, the physiological, neural and psychological basis of FND, the diagnostic announcement (and its intangibles), the therapeutic patient education in FND, the general principles of therapeutic management through a personalized and multidisciplinary care program, and the validated therapeutic tools available according to the symptoms identified. This article is designed to be of broad interest on FND, supported by tables and figures showing the key points of all these steps, to keep an educational purpose at most. We hope that through this special issue, each health professional will be able to grasp this knowledge and this framework of care as easily and quickly as possible, in order to participate in the standardization of the care offer.
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Affiliation(s)
- Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupery, 29, rue Émile-Lecrivain, 31400 Toulouse, France.
| | - Coraline Hingray
- Pôle universitaire du Grand Nancy, CPN/unité neuropsychiatrique, CHRU de Nancy, Nancy, France
| | - Othman Mounir Alaoui
- Service de neurologie, Assistance publique-Hôpitaux de Paris, CHU d'Avicenne, 93000 Bobigny, France
| | - Selma Aybek
- Département de neurologie, unité de médecine psychosomatique, hôpital universitaire de Bern Inselspital, université de Bern, Bern, Suisse
| | - Stéphane Mouchabac
- Sorbonne université, hôpital de la Pitié-Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), institut du cerveau et de la moelle (ICM), Inserm, CNRS, Paris, France
| | - Béatrice Garcin
- Service de neurologie, Assistance publique-Hôpitaux de Paris, CHU d'Avicenne, 93000 Bobigny, France
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Asadi-Pooya AA, Brigo F, Trinka E, Lattanzi S, Adel Kishk N, Karakis I, Ristic AJ, Alsaadi T, Alkhaldi M, Turuspekova ST, Aljandeel G, Al-Asmi A, Contreras G, Daza-Restrepo A, Kutlubaev MA, Guekht A, Calle-López Y, Jusupova A, San-Juan D, Khachatryan SG, Gigineishvili D, Mesraoua B, Dubenko A, Mirzaei Damabi N. A global survey on the attitudes of neurologists and psychiatrists about functional/psychogenic/dissociative/nonepileptic-seizures/attacks, in the search of its name. Epilepsy Behav 2023; 145:109292. [PMID: 37321160 DOI: 10.1016/j.yebeh.2023.109292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE We conducted an observational study to investigate the opinions of neurologists and psychiatrists all around the world who are taking care of patients with seizures [epilepsy and functional seizures (FS)]. METHODS Practicing neurologists and psychiatrists from around the world were invited to participate in an online survey. On 29th September 2022, an e-mail including a questionnaire was sent to the members of the International Research in Epilepsy (IR-Epil) Consortium. The study was closed on 1st March 2023. The survey, conducted in English, included questions about physicians' opinions about FS and anonymously collected data. RESULTS In total, 1003 physicians from different regions of the world participated in the study. Both neurologists and psychiatrists identified "seizures" as their preferred term. Overall, the most preferred modifiers for "seizures" were "psychogenic" followed by "functional" by both groups. Most participants (57.9%) considered FS more difficult to treat compared to epilepsy. Both psychological and biological problems were considered as the underlying cause of FS by 61% of the respondents. Psychotherapy was considered the first treatment option for patients with FS (79.9%). CONCLUSION Our study represents the first large-scale attempt of investigating physicianś attitudes and opinions about a condition that is both frequent and clinically important. It shows that there is a broad spectrum of terms used by physicians to refer to FS. It also suggests that the biopsychosocial model has gained its status as a widely used framework to interpret and inform clinical practice on the management of patients.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute Neuroscience Christian-Doppler Medical Centre, Paracelsus Medical University, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria; Member of the European Referencenetwork EpiCARE, European; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology,Hall in Tirol, Austria.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
| | - Nirmeen Adel Kishk
- Department of Neurology, Cairo University Epilepsy Unit (CUEU), School of Medicine, Cairo University, Cairo, Egypt.
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Aleksandar J Ristic
- Clinic for Neurology, Clinical Center of Serbia, Medical Faculty University of Belgrade, Serbia.
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, and Khalifa University, Abu Dhabi, UAE.
| | - Modhi Alkhaldi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 34212, Dammam, Saudi Arabia.
| | - Saule T Turuspekova
- Department of Nervous Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq.
| | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Oman.
| | | | - Anilu Daza-Restrepo
- Neurosciences and Complex Systems Unit (ENyS), Epilepsy Unit, CONICET, Hosp. El Cruce "N. Kirchner", Univ. Nat. A. Jauretche (UNAJ), F. Varela, Prov. Buenos Aires, Argentina.
| | - Mansur A Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa., Russia.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Yamile Calle-López
- Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Hospital Universitario San Vicente Fundación, Medellín, Colombia.
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan.
| | - Daniel San-Juan
- Epilepsy Clínic. National Institute of Neurology and Neurosurgery, México City, Mexico.
| | - Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.
| | - David Gigineishvili
- Institute of Neurology, Javakhishvili Tbilisi State University, Department of Neurology & Neurosurgery, Tbilisi, Georgia.
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | - Andriy Dubenko
- Institute of Neurology, Psychiatry and Narcology of NAMS, Ukraine.
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13
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Coey P, Nic Craith I, McQuaid L, D'Alton P, O'Connor C. Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people's illness representations? An experimental vignette study. Epilepsy Behav 2023; 142:109186. [PMID: 37028150 DOI: 10.1016/j.yebeh.2023.109186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public's representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18-25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants' illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study's first insights into the dynamics of lay responses to PNES.
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Affiliation(s)
- Phillip Coey
- Paediatric Psychology Department, Children's Health Ireland at Crumlin, Dublin 12, Ireland; School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | | | - Léa McQuaid
- School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Paul D'Alton
- School of Psychology, University College Dublin, Dublin 4, Ireland; Psychology Department, St. Vincent's University Hospital, Dublin 4, Ireland
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14
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Milano BA, Moutoussis M, Convertino L. The neurobiology of functional neurological disorders characterised by impaired awareness. Front Psychiatry 2023; 14:1122865. [PMID: 37009094 PMCID: PMC10060839 DOI: 10.3389/fpsyt.2023.1122865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
We review the neurobiology of Functional Neurological Disorders (FND), i.e., neurological disorders not explained by currently identifiable histopathological processes, in order to focus on those characterised by impaired awareness (functionally impaired awareness disorders, FIAD), and especially, on the paradigmatic case of Resignation Syndrome (RS). We thus provide an improved more integrated theory of FIAD, able to guide both research priorities and the diagnostic formulation of FIAD. We systematically address the diverse spectrum of clinical presentations of FND with impaired awareness, and offer a new framework for understanding FIAD. We find that unraveling the historical development of neurobiological theory of FIAD is of paramount importance for its current understanding. Then, we integrate contemporary clinical material in order to contextualise the neurobiology of FIAD within social, cultural, and psychological perspectives. We thus review neuro-computational insights in FND in general, to arrive at a more coherent account of FIAD. FIAD may be based on maladaptive predictive coding, shaped by stress, attention, uncertainty, and, ultimately, neurally encoded beliefs and their updates. We also critically appraise arguments in support of and against such Bayesian models. Finally, we discuss implications of our theoretical account and provide pointers towards an improved clinical diagnostic formulation of FIAD. We suggest directions for future research towards a more unified theory on which future interventions and management strategies could be based, as effective treatments and clinical trial evidence remain limited.
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Affiliation(s)
- Beatrice Annunziata Milano
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
- Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michael Moutoussis
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
| | - Laura Convertino
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- *Correspondence: Laura Convertino,
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15
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Lloyd M, Winton-Brown TT, Hew A, Rayner G, Foster E, Rychkova M, Ali R, Velakoulis D, O'Brien TJ, Kwan P, Malpas CB. Multidimensional psychopathological profile differences between patients with psychogenic nonepileptic seizures and epileptic seizure disorders. Epilepsy Behav 2022; 135:108878. [PMID: 35998513 DOI: 10.1016/j.yebeh.2022.108878] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early differential diagnosis of psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) remains difficult. Self-reported psychopathology is often elevated in patients with PNES, although relatively few studies have examined multiple measures of psychopathology simultaneously. This study aimed to identify differences in multidimensional psychopathology profiles between PNES and ES patient groups. METHOD This was a retrospective case-control study involving patients admitted for video-EEG monitoring (VEM) over a two-year period. Clinicodemographic variables and psychometric measures of depression, anxiety, dissociation, childhood trauma, maladaptive personality traits, and cognition were recorded. Diagnosis of PNES or ES was determined by multidisciplinary assessment and consensus opinion. General linear mixed models (GLMMs) were used to investigate profile differences between diagnostic groups across psychometric measures. A general psychopathology factor was then computed using principal components analysis (PCA) and differences between groups in this 'p' factor were investigated. RESULTS 261 patients (77 % with ES and 23 % with PNES) were included in the study. The PNES group endorsed greater symptomatology with GLMM demonstrating a significant main effect of group (η2p = 0.05) and group by measure interaction (η2p = 0.03). Simple effects analysis indicated that the PNES group had particularly elevated scores for childhood trauma (β = 0.78), dissociation (β = 0.70), and depression (β = 0.60). There was a high correlation between psychopathology measures, with a single p factor generated to explain 60 % variance in the psychometric scores. The p factor was elevated in the PNES group (β = 0.61). ROC curve analysis indicated that these psychometric measures had limited usefulness when considered individually (AUC range = 0.63-0.69). CONCLUSION Multidimensional psychopathological profile differences exist between patients with PNES and ES. Patients with PNES report more psychopathology overall, with particular elevations in childhood trauma, dissociation, and depression. Although not suitable to be used as a standalone screening tool to differentiate PNES and ES, understanding of these profiles at a construct level might help triage patients and guide further psychiatric examination and enquiry.
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Affiliation(s)
- Michael Lloyd
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia.
| | - Toby T Winton-Brown
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Anthony Hew
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Richmond, Victoria, Australia; Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | - Genevieve Rayner
- Department of Neurology, Alfred Health, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Emma Foster
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Maria Rychkova
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Charles B Malpas
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
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16
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Koreki A, Eccles J, Garfinkel S, Critchley H, Cope S, Agrawal N, Edwards M, Yogarajah M. Hypermobility in patients with functional seizures: Toward a pathobiological understanding of complex conditions. Epilepsy Behav 2022; 132:108710. [PMID: 35580524 DOI: 10.1016/j.yebeh.2022.108710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Functional seizures (FS), otherwise known as psychogenic nonepileptic seizures (PNES), are a common symptom presenting to neurology and epilepsy clinics. There is a pressing need for further research to understand the neurobiology of FS to develop mechanistically targeted treatments. Joint hypermobility is an expression of variation in connective tissue structure along a spectrum, and it has received increasing attention in functional neurological disorders, but there is lack of evidence of its relevance in FS. METHODS In the present study, forty-two patients with FS and a non-clinical comparison group of 34 age/sex-matched controls were recruited. Joint hypermobility of all participants was quantified using the Beighton scale. RESULTS In our sample, 24 (57%) patients with FS, and 7 (21%) of the comparison group met criteria for joint hypermobility (p = 0.002). Our statistical model revealed that patients with FS showed a significant degree of hypermobility compared to the comparison group (odds ratio = 11.1; Confidence interval: 2.1-78.0, p = 0.008), even after controlling age, sex, anxiety, and depression. CONCLUSION We found a significant association between FS and joint hypermobility, which was independent of anxiety and depression.
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Affiliation(s)
- Akihiro Koreki
- Neurosciences Research Centre, St George's University of London, London, UK; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Jessica Eccles
- Brighton and Sussex Medical School, Sussex University, UK
| | | | - Hugo Critchley
- Brighton and Sussex Medical School, Sussex University, UK
| | - Sarah Cope
- Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK
| | - Mark Edwards
- Neurosciences Research Centre, St George's University of London, London, UK; Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK
| | - Mahinda Yogarajah
- Neurosciences Research Centre, St George's University of London, London, UK; Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK; Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, National Hospital for Neurology and Neurosurgery, UCLH, Epilepsy Society, UK.
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17
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Hingray C, Ertan D, Reuber M, Lother A, Chrusciel J, Tarrada A, Michel N, Meyer M, Klemina I, Maillard L, Sanchez S, El‐Hage W. Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles. Epilepsia 2022; 63:1500-1515. [PMID: 35305025 PMCID: PMC9790427 DOI: 10.1111/epi.17230] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis. METHODS We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics), and psychopathological data (psychiatric comorbidities, dissociation, and alexithymia) through psychiatric interviews and standardized scales. Clusters were identified by the Partitioning Around Medoids method. The similarity of patients was computed using Gower distance. The clusters were compared using analysis of variance, chi-squared, or Fisher exact tests. RESULTS Three patient clusters were identified in this exploratory, hypothesis-generating study and named on the basis of their most prominent characteristics: A "No/Single Trauma" group (31.4%), with more male patients, intellectual disabilities, and nonhyperkinetic seizures, and a low level of psychopathology; A "Cumulative Lifetime Traumas" group (42.6%), with clear female predominance, hyperkinetic seizures, relatively common comorbid epilepsy, and a high level of psychopathology; and A "Childhood Traumas" group (26%), commonly with comorbid epilepsy, history of childhood sexual abuse (75%), and posttraumatic stress disorder, but also with a high level of anxiety and dissociation. SIGNIFICANCE Although our cluster analysis was undertaken without any a priori hypothesis, the nature of the trauma history emerged as the most important differentiator between three common FDS disorder subtypes. This subdifferentiation of FDS disorders may facilitate the development of more specific therapeutic programs for each patient profile.
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Affiliation(s)
- Coraline Hingray
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance,Nancy Psychotherapeutic CenterUniversity Hospital Center for Adult Psychiatry of Greater NancyLaxouFrance
| | - Deniz Ertan
- National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance,Clinical Research UnitTeppe InstituteTain‐l’HérmitageFrance
| | - Markus Reuber
- Academic Neurology UnitRoyal Hallamshire HospitalUniversity of SheffieldSheffieldUK
| | | | - Jan Chrusciel
- Public Health and Performance Territorial CenterTroyes Hospital CenterTroyesFrance
| | - Alexis Tarrada
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance
| | - Nathalie Michel
- La Conception Hospital, Marseille University HospitalsPublic Assistance–Marseille HospitalsMarseilleFrance
| | - Mylene Meyer
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance
| | - Irina Klemina
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance
| | - Louis Maillard
- Department of NeurologyNancy Regional University Hospital CenterNancyFrance,National Center for Scientific ResearchResearch Center for Automatic ControlMixed Unit of Research 7039University of LorraineNancyFrance
| | - Stephane Sanchez
- Public Health and Performance Territorial CenterTroyes Hospital CenterTroyesFrance
| | - Wissam El‐Hage
- Mixed Unit of Research 1253iBrainNational Institute of Health and Medical ResearchUniversity of ToursToursFrance,Psychiatry Center, Tours Regional University Hospital CenterToursFrance
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