The impact of sexual abuse on psychopathology of patients with psychogenic nonepileptic seizures

Exacerbation of Psychogenic Non-epileptic Seizures Related to the Diagnosis and Disease Burden of Epilepsy: A Case Report

Psychogenic non-epileptic seizures (PNES), which closely resemble epileptic seizures (ES), are typically triggered by psychological distress and represent the most prevalent form of conversion disorder encountered in clinical practice. Multiple physical conditions can both precipitate and sustain PNES episodes. Epilepsy, a common neurological disorder, imposes significant emotional and physical burdens, frequently resulting in elevated levels of anxiety and depression. This case report details the clinical course of a 19-year-old female whose PNES was exacerbated by the diagnosis and disease burden of epilepsy. The patient's background of childhood trauma, bullying, and sexual abuse likely predisposed her to the development of PNES. Upon receiving a diagnosis of epilepsy, characterized by focal seizures originating from the left parietal region, the patient experienced increased anxiety and required frequent hospitalizations. Despite adjustments to her treatment regimen, including the administration of levetiracetam (LEV) and lacosamide (LCM), her seizures persisted. Comprehensive evaluations, comprising electroencephalography (EEG) and single-photon emission computed tomography (SPECT), indicated the coexistence of epilepsy and PNES. Although surgical intervention was initially considered, it was ultimately deemed unnecessary, which subsequently alleviated the patient's anxiety. Psychoeducation highlighting the manageability of her epilepsy with ongoing pharmacotherapy significantly reduced her PNES episodes. This case emphasizes the critical role of addressing the psychosocial burden associated with an epilepsy diagnosis, as these factors may exacerbate PNES. It also underscores the importance of a holistic treatment approach that integrates psychological support with medical management.

Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis

BACKGROUND

Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking.

AIMS

To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations.

METHOD

We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263).

RESULTS

Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case-control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66-1.14, I² = 70%) and neurological controls (g = 0.56, 95% CI 0.19-0.92, I² = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65-1.22, I² = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI -0.18 to 1.00, I² = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25-2.34, I² = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations.

CONCLUSIONS

Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.

Orbito-frontal thinning together with a somatoform dissociation might be the fingerprint of PNES

OBJECTIVE

To investigate neuroanatomical changes in patients with psychogenic nonepileptic seizures (PNES) compared to major depressive disorder (MDD) and healthy controls.

METHODS

Forty-two drug-naïve PNES subjects and 25 patients with MDD, matched for demographic characteristics and level of depression (as measured by Beck Depression Inventory-II, BDI-II), were consecutively recruited. Patients performed an extensive neuropsychiatric assessment including: Hamilton Anxiety Rating Scale, Traumatic Experience Checklist, Dissociative Experiences Scale, Toronto Alexithymia Scale and Somatoform Dissociation Questionnaire (SDQ-20). All patients, together with 78 healthy matched controls, underwent 3T brain MRI followed by surface-based morphometry.

RESULTS

Cortical thickness analysis revealed significant cortical thinning in bilateral medial orbitofrontal cortex (OFC) and left rostral anterior cingulate cortex (ACC) in patients with MDD compared to subjects with PNES and controls. Interestingly, increased thickness of the right pars triangularis was found in PNES subjects compared to controls. PNES showed higher scores in SDQ-20 (p < 0.001) compared to MDD, which was corroborated by neuroimaging data, where somatoform dissociation scores correlated with morphological changes in the left medial OFC.

CONCLUSION

Our results show selective cortical thinning over the medial OFC in patients with PNES compared to wider regions of thinning in patients with MDD. Somatoform dissociation was the only psychopathological assessment significantly different in PNES and MDD.