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Roberts NA, Villarreal LD, Burleson MH. Socioemotional self- and co-regulation in functional seizures: comparing high and low posttraumatic stress. Front Psychiatry 2023; 14:1135590. [PMID: 37255682 PMCID: PMC10225681 DOI: 10.3389/fpsyt.2023.1135590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023] Open
Abstract
Functional seizures (FS) are seizure-like symptoms without electroencephalogram (EEG)-based epileptic activity. Those with FS often show emotion-related dysfunction and disrupted interpersonal relationships, in which posttraumatic stress disorder symptoms (PTS) may play a role. We sought to better understand trauma comorbidities and socioemotional processes in FS, including affectionate touch, a form of social connection linked to emotion regulation and awareness. We administered questionnaires online to a community sample of 89 trauma-exposed FS participants (FS diagnoses were self-reported), 51 with and 38 without clinical-level PTS (FS-PTShi, FS-PTSlo) and 216 seizure-free matched trauma-exposed controls (TCs), 91 with and 125 without clinical-level PTS (TC-PTShi, TC-PTSlo) per the Posttraumatic Stress Disorder Symptom Checklist (PCL). As hypothesized, both FS-PTShi and FS-PTSlo reported more emotional avoidance (Brief Experiential Avoidance Questionnaire), more emotion regulation difficulties (Difficulties in Emotion Regulation Scale), and more perceived stress (Perceived Stress Scale) than PTS-matched counterparts. FS-PTShi also reported less reappraisal (Emotion Regulation Questionnaire), more loneliness (UCLA Loneliness Scale), and less frequent affectionate touch (Physical Affection Scale) during waking and surrounding sleep than TC-PTShi, whereas FS-PTSlo and TC-PTSlo did not differ. Neither FS group differed from PTS-matched controls in emotion suppression (Emotion Regulation Questionnaire) or comfort with social touch (Social Touch Questionnaire). Among FS, FS-PTShi reported more difficulties than FS-PTSlo on nearly all measures (non-significant trend for social support). Findings underscore potential synergistic effects of FS and PTS clinical symptoms in shaping experiences of one's emotions and social world, suggesting fostering meaningful connections with others, including via affectionate touch, is an important treatment target.
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Dal Pasquale BG, Teive HAG, von der Heyde MD, Dal Pasquale LFA. Management of Functional Seizures and Functional Movement Disorder: A Cross-Sectional Comparative Study. Neuropsychiatr Dis Treat 2022; 18:2121-2131. [PMID: 36172265 PMCID: PMC9512033 DOI: 10.2147/ndt.s383552] [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: 07/29/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Functional neurological disorders (FND) are conditions that cause to alterations in nervous system functions. They are disabling and impair the quality of life of patients but that are potentially reversible provided they have specific management. Functional seizures (FS) and functional movement disorder (FMD) are among the most common subtypes. Studies suggest a strong overlap between FS and FMD; however, there are still no cross-sectional studies that compare the management between these two conditions. Thus, our focus was to carry out a research that compares how these two subtypes of FND are being managed, in addition to assessing rates of understanding and acceptance of a diagnosis of FND. METHODS It is a cross-sectional study with data collected from medical records and interviews with two patients' groups (FS and FMD) treated from a FND clinic of the public health system of Brazil. RESULTS From 105 medical records of patients with FND analyzed, 60 participants were eligible and agreed to participate in this research, being FS (n = 31) and FMD (n = 29). Statistically significant differences (p < 0.05) were found in the use of antiseizure (FS > FMD), opioids (FMD > FS), multi-professional follow-up (FMD > FS) and rates of understanding and acceptance of an FND diagnosis (FMD > FS). Similarities were found in sociodemographic profiles, medical follow-up, psychiatric comorbidities and use of antidepressants, anxiolytics, antipsychotics and mood stabilizers between two conditions. CONCLUSION More similarities than differences in management were found between FS and FMD. Similarities may be related to overlaps in sociodemographic and clinical characteristics between the two groups. Differences may be related to specific issues of each patient and condition. Regardless of the group, patients who perform psychotherapeutic follow-up have higher rates of understanding and acceptance of an FND diagnosis.
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Affiliation(s)
- Bruno Gabriel Dal Pasquale
- Postgraduate Program in Internal Medicine and Health Sciences, Hospital of Clinics Complex, Federal University of Paraná, Curitiba, Brazil
| | - Hélio Afonso Ghizoni Teive
- Movement Disorders Sector, Neurology Service, Department of Internal Medicine, Hospital of Clinics Complex, Federal University of Paraná, Curitiba, Brazil
| | - Marcelo Daudt von der Heyde
- Postgraduate Program in Internal Medicine and Health Sciences, Hospital of Clinics Complex, Federal University of Paraná, Curitiba, Brazil
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Functional Movement Disorder and Functional Seizures: What have we learned from different subtypes of functional neurological disorders? Epilepsy Behav Rep 2021; 18:100510. [PMID: 35198951 PMCID: PMC8844274 DOI: 10.1016/j.ebr.2021.100510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Functional seizures (FS) and functional movement disorders (FMD) are the most common manifestations of functional neurological disorders. FMD and FS may have similarities in etiology and pathophysiology. FMD and FS share disabling comorbidities of chronic pain, fatigue, and cognitive symptoms. Neuroimaging has demonstrated structural and functional changes in emotional and motor planning pathways in FND. A multidisciplinary approach and psychotherapy are the treatments for FMD and FS, respectively.
The objective of this paper is to compare and contrast FMD and FS, and highlight important differences in etiology and the clinical approach towards these two entities. While patients with FMD often experience abnormal movements on a daily basis, FS is characterized by paroxysmal events. Both patient populations share psychiatric and environmental comorbidities, but patients with FS may have increased anxiety and neuroticism and a higher percentage of childhood trauma. Functional MRI scans have demonstrated impaired executive control over motor behavior in both groups. FMD responds well to multidisciplinary rehabilitation-oriented treatment, while psychotherapy remains the mainstay of treatment for FS. For practicing clinicians, recognizing commonalities and differences in patients with FMD and FS is important to develop the most appropriate treatment plan.
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Saxena A, Perez DL. A transdiagnostic and biopsychosocial-informed perspective across functional seizures and functional movement disorder. Epilepsy Behav 2021; 117:107749. [PMID: 33509632 DOI: 10.1016/j.yebeh.2020.107749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Aneeta Saxena
- Division of Epilepsy, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Functional Neurological Disorder Clinical and Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - David L Perez
- Functional Neurological Disorder Clinical and Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rather MA, Cavanna AE. Nonepileptic attack disorder and functional movement disorder: A clinical continuum? Epilepsy Behav 2020; 106:107028. [PMID: 32203928 DOI: 10.1016/j.yebeh.2020.107028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
Nonepileptic attack disorder (NEAD) and functional movement disorder (FMD) are functional neurological disorders commonly seen in neuropsychiatry services. Although their initial referral pathways involve epileptologists (NEAD) and specialists in movement disorders (FMD), these conditions are currently classified as two possible manifestations of a single underlying conversion disorder. We set out to compare the characteristics of patients with NEAD and patients with FMD in order to quantify the degree of overlap between these patient groups. We retrospectively reviewed comprehensive clinical data from 146 consecutive patients with functional neurological disorders (NEAD: n = 117; FMD: n = 29) attending a specialist Neuropsychiatry Clinic run by a single Consultant in Behavioral Neurology. The two clinical groups were directly compared with regard to demographic and clinical characteristics, as well as somatic and psychiatric presentations. The results showed that in most features, there were no significant differences between patients with NEAD and patients with FMD. However, patients with NEAD reported an earlier age at onset (p = 0.033) and a higher proportion of acute onset (p = 0.037), alterations of consciousness (p = 0.001), and headache (p = 0.042), whereas patients with FMD reported a higher prevalence of childhood abuse (p = 0.008), as well as mobility problems (p = 0.007) and comorbid functional symptoms (dysarthria, p = 0.004; dizziness, p = 0.035; weakness, p = 0.049). Despite different phenotypic presentations, NEAD and FMD might represent a clinical continuum, with relevant implications in terms of both diagnostic strategies and treatment approaches.
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Affiliation(s)
- Mohammad Amir Rather
- Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK; School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK.
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Functional Neurological Disorder Responds Favorably to Interdisciplinary Rehabilitation Models. PSYCHOSOMATICS 2019; 60:556-562. [PMID: 31399207 DOI: 10.1016/j.psym.2019.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Functional neurological disorder (FND) is difficult to treat and costly. Interdisciplinary chronic pain rehabilitation programs (iCPRPs) are multidimensional functional restoration interventions for pain; their impact on FND specifically has not been assessed. OBJECTIVE The purpose of this study was to assess iCPRP's impact on functioning in FND. METHODS Data were examined retrospectively from an Institutional Review Board-approved registry capturing admission and discharge data from patients participating in an outpatient iCPRP. Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach. RESULTS Forty-nine FND patients completed care and showed pre-measures and postmeasures. Statistically significant reductions in subjective measures of pain-related disability (46.40-20.91; P < 0.001, d = 1.92), depression (20.38-4.81; P < 0.001, d = 1.53), anxiety (15.09-6.29; P < 0.001, d = 1.18), and stress (21.96-9.70; P < 0.001, d = 1.21) scores were observed. Statistically significant changes in objective measures of mean timed up and go scores (decreased from 15.96 to 8.87 s), stair climbing test scores (increased from 40.98 to 71.93 steps), and mean 6-minute walk test scores (increased from 0.21 to 0.30 miles) were also observed across the group. CONCLUSIONS While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for FND treatment. Clinical and investigational implications are explored.
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A Case of Functional Dystonia with Associated Functional Neurological Symptoms: Diagnostic and Therapeutic Challenges. Harv Rev Psychiatry 2018. [PMID: 28650853 DOI: 10.1097/hrp.0000000000000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Psychogenic Nonepileptic Seizures (PNES) as a Network Disorder - Evidence From Neuroimaging of Functional (Psychogenic) Neurological Disorders. Epilepsy Curr 2018; 18:211-216. [PMID: 30254510 DOI: 10.5698/1535-7597.18.4.211] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kanaan RAA, Duncan R, Goldstein LH, Jankovic J, Cavanna AE. Are psychogenic non-epileptic seizures just another symptom of conversion disorder? J Neurol Neurosurg Psychiatry 2017; 88:425-429. [PMID: 28235779 DOI: 10.1136/jnnp-2017-315639] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Psychogenic non-epileptic seizures (PNES) are classified with other functional neurological symptoms as 'Conversion Disorder', but there are reasons to wonder whether this symptomatology constitutes a distinct entity. METHODS We reviewed the literature comparing PNES with other functional neurological symptoms. RESULTS We find eight studies that directly examined this question. Though all but one found significant differences-notably in presenting age, trauma history, and dissociation-they were divided on whether these differences represented an important distinction. CONCLUSION We argue that the aetiological and mechanistic distinctions they support, particularly when bolstered by additional data, give reason to sustain a separation between these conditions.
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Affiliation(s)
- Richard A A Kanaan
- Department of Psychiatry, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia .,Departments of Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Roderick Duncan
- Department of Neurology, University of Otago, Christchurch, New Zealand
| | - Laura H Goldstein
- Departments of Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
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Bajestan SN, LaFrance WC. Clinical Approaches to Psychogenic Nonepileptic Seizures. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:422-431. [PMID: 31975822 DOI: 10.1176/appi.focus.20160020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are a subtype of conversion disorder (also called functional neurological symptom disorder in DSM-5). Patients with PNES are high utilizers of health care and can have disability levels similar to those of patients with epilepsy. PNES is a common, complex neuropsychiatric somatoform disorder at the interface of neurology and psychiatry disciplines and is largely overlooked and avoided by mental health providers. Despite advances in establishing accurate diagnosis and evidence-based treatments, recent knowledge about PNES has not been well translated into clinical practice. Long diagnostic delays have been associated with poor prognosis. Recent advances in possible neurophysiological biomarkers include functional MRI studies that show abnormalities in emotional, cognitive, executive, and sensorimotor neurocircuits. Although the gold standard for diagnosis is video electroencephalograph, this test is underused by psychiatrists. The International League Against Epilepsy proposed a staged approach to PNES diagnosis using history, semiologic features, and EEG. Thorough psychiatric assessment can identify relevant biopsychosocial and predisposing, precipitating, and perpetuating factors, as well as assess the comorbid psychiatric disorders, which can inform a treatment plan. Clear and thoughtful delivery of diagnosis is the first step in treatment. Regular follow-up with the patient's neurologist, in addition to treatment by mental health professionals familiar with somatic symptom disorders, is recommended. Psychotherapy is the mainstay of treatment, and randomized clinical trials using cognitive-behavioral therapies reveal significant reduction in seizures and other psychiatric symptoms. After centuries, mental health providers now have access to the tools to diagnose and effectively treat PNES and other conversion disorders.
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Affiliation(s)
- Sepideh N Bajestan
- Dr. Bajestan is with the Neuropsychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. LaFrance is with the Departments of Psychiatry and Neurology, Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence. Send correspondence to Dr. LaFrance (e-mail: )
| | - W Curt LaFrance
- Dr. Bajestan is with the Neuropsychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. LaFrance is with the Departments of Psychiatry and Neurology, Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence. Send correspondence to Dr. LaFrance (e-mail: )
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Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review. Clin Psychol Rev 2016; 45:157-82. [PMID: 27084446 DOI: 10.1016/j.cpr.2016.01.003] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
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Affiliation(s)
- Richard J Brown
- 2nd Floor Zochonis Building, Brunswick Street, School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Castro LHM. Functional disorders continue to pose diagnostic and therapeutic challenges to neurologists. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:745-6. [PMID: 25337723 DOI: 10.1590/0004-282x20140181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022]
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