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Viola V, Bisulli F, Cornaggia CM, Ferri L, Licchetta L, Muccioli L, Mostacci B. Personality disorders in people with epilepsy: a review. Front Psychiatry 2024; 15:1404856. [PMID: 38800062 PMCID: PMC11116589 DOI: 10.3389/fpsyt.2024.1404856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Epileptologists and psychiatrists have long observed a correlation between epilepsy and personality disorders (PDs) in their clinical practice. We conducted a comprehensive PubMed search looking for evidence on PDs in people with epilepsy (PwE). Out of over 600 results obtained without applying any time restriction, we selected only relevant studies (both analytical and descriptive) limited to English, Italian, French and Spanish languages, with a specific focus on PDs, rather than traits or symptoms, thus narrowing our search down to 23 eligible studies. PDs have been investigated in focal epilepsy (predominantly temporal lobe epilepsy - TLE), juvenile myoclonic epilepsy (JME) and psychogenic non-epileptic seizures (PNES), with heterogeneous methodology. Prevalence rates of PDs in focal epilepsy ranged from 18 to 42% in surgical candidates or post-surgical individuals, with Cluster C personality disorders or related traits and symptoms being most common. In JME, prevalence rates ranged from 8 to 23%, with no strong correlation with any specific PDs subtype. In PNES, prevalence rates ranged from 30 to 60%, with a notable association with Cluster B personality disorders, particularly borderline personality disorder. The presence of a PD in PwE, irrespective of subtype, complicates treatment management. However, substantial gaps of knowledge exist concerning the neurobiological substrate, effects of antiseizure medications and epilepsy surgery on concomitant PDs, all of which are indeed potential paths for future research.
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Affiliation(s)
- Veronica Viola
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | | | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
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Sobregrau P, Baillès E, Radua J, Carreño M, Donaire A, Setoain X, Bargalló N, Rumià J, Sánchez Vives MV, Pintor L. Design and validation of a diagnostic suspicion checklist to differentiate epileptic from psychogenic nonepileptic seizures (PNES-DSC). J Psychosom Res 2024; 180:111656. [PMID: 38615590 DOI: 10.1016/j.jpsychores.2024.111656] [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: 02/05/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Psychogenic non-epileptic seizures (PNES) are complex clinical manifestations and misdiagnosis as status epilepticus remains high, entailing deleterious consequences for patients. Video-electroencephalography (vEEG) remains the gold-standard method for diagnosing PNES. However, time and economic constraints limit access to vEEG, and clinicians lack fast and reliable screening tools to assist in the differential diagnosis with epileptic seizures (ES). This study aimed to design and validate the PNES-DSC, a clinically based PNES diagnostic suspicion checklist with adequate sensitivity (Se) and specificity (Sp) to discriminate PNES from ES. METHODS A cross-sectional study with 125 patients (n = 104 drug-resistant epilepsy; n = 21 PNES) admitted for a vEEG protocolised study of seizures. A preliminary PNES-DSC (16-item) was designed and used by expert raters blinded to the definitive diagnosis to evaluate the seizure video recordings for each patient. Cohen's kappa coefficient, leave-one-out cross-validation (LOOCV) and balance accuracy (BAC) comprised the main validation analysis. RESULTS The final PNES-DSC is a 6-item checklist that requires only two to be present to confirm the suspicion of PNES. The LOOCV showed 71.4% BAC (Se = 45.2%; Sp = 97.6%) when the expert rater watched one seizure video recording and 83.4% BAC (Se = 69.6%; Sp = 97.2%) when the expert rater watched two seizure video recordings. CONCLUSION The PNES-DSC is a straightforward checklist with adequate psychometric properties. With an integrative approach and appropriate patient history, the PNES-DSC can assist clinicians in expediting the final diagnosis of PNES when vEEG is limited. The PNES-DSC can also be used in the absence of patients, allowing clinicians to assess seizure recordings from smartphones.
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Affiliation(s)
- Pau Sobregrau
- Psychology Faculty, University of Barcelona (UB), Barcelona 08007, Spain; Psychiatry Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain.
| | - Eva Baillès
- Psychiatry Department, Vall d'Hebron (VHIR), Barcelona 08035, Spain
| | - Joaquim Radua
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona, Barcelona (HCP) 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona, Barcelona (HCP) 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain
| | - Xavier Setoain
- Diagnostic Imaging Center, University Hospital Clinic of Barcelona, Barcelona (HCP), Barcelona 08036, Spain
| | - Núria Bargalló
- Diagnostic Imaging Center, University Hospital Clinic of Barcelona, Barcelona (HCP), Barcelona 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona, Barcelona (HCP) 08036, Spain; Epilepsy Unit, Neurology Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain
| | - María V Sánchez Vives
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain; Cognition Department, Development and Educational Psychology, Faculty of Psychology, University of Barcelona (UB), Barcelona 08007, Spain
| | - Luis Pintor
- Psychiatry Department, University Hospital Clinic of Barcelona (HCP), Barcelona 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), University Hospital Clinic of Barcelona, Barcelona 08036, Spain; Clinical Institute of Neurosciences, University Hospital Clinic of Barcelona, Barcelona (HCP) 08036, Spain
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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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Campbell MC, Smakowski A, Rojas-Aguiluz M, Goldstein LH, Cardeña E, Nicholson TR, Reinders AATS, Pick S. Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis. BJPsych Open 2022; 9:e2. [PMID: 36451595 PMCID: PMC9798224 DOI: 10.1192/bjo.2022.597] [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] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Malcolm C Campbell
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Central and North West London NHS Foundation Trust, London, UK
| | - Abigail Smakowski
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Etzel Cardeña
- Center for Research on Consciousness and Anomalous Psychology (CERCAP), Department of Psychology, Lund University, Lund, Sweden
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Lanzillotti AI, Sarudiansky M, Lombardi NR, Korman GP, D Alessio L. Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders. Neuropsychiatr Dis Treat 2021; 17:1825-1838. [PMID: 34113112 PMCID: PMC8187153 DOI: 10.2147/ndt.s286710] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/01/2021] [Indexed: 01/22/2023] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES.
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Affiliation(s)
- Alejandra Inés Lanzillotti
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Mercedes Sarudiansky
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | | | - Guido Pablo Korman
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Luciana D Alessio
- Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Buenos Aires, Argentina.,Buenos Aires University, Medicine School, Cell Biology and Neuroscience Institute (IBCN)- National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Pick S, Rojas-Aguiluz M, Butler M, Mulrenan H, Nicholson TR, Goldstein LH. Dissociation and interoception in functional neurological disorder. Cogn Neuropsychiatry 2020; 25:294-311. [PMID: 32635804 DOI: 10.1080/13546805.2020.1791061] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: We aimed to examine susceptibility to dissociation and the impact of dissociation on interoceptive processing in individuals with functional neurological disorder (FND). We hypothesised that dissociative states would be elevated and interoceptive accuracy and awareness impaired at baseline in people with FND, and that such differences would be exacerbated following acute dissociation. Methods: Nineteen adults with FND were compared to 20 healthy controls. A modified heart-beat tracking task measured interoceptive accuracy and awareness (confidence) before and after a validated dissociation induction procedure. An exteroceptive processing control task was included. Mann-Whitney tests and r-values (effect size) were computed for between-group comparisons. Results: The FND group displayed elevated dissociation at baseline (p = 0.001, r = 0.528) compared to controls which increased following dissociation-induction (p < 0.001, r = 0.663). Interoceptive accuracy did not differ between groups at baseline (p = 0.967, r = 0.009); however, the FND group had lower accuracy scores post-induction (p = 0.021, r = 0.379). A negative correlation (trend) between change scores for dissociation and interoceptive accuracy was noted (rs = -0.411, p = 0.057). Confidence ratings on interoceptive and exteroceptive processing tasks were lower in the FND group (p-values < 0.05 or <0.01, r-values 0.331-0.489). Conclusions: Individuals with FND experienced greater susceptibility to dissociation, metacognitive deficits and impaired interoceptive accuracy than controls after acute dissociation.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Morgan Butler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Heather Mulrenan
- GKT School of Medical Education, King's College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Giussani G, Erba G, Bianchi E, Beghi E. Self-Report questionnaires for the diagnosis of psychogenic non-epileptic seizures in clinical practice. A comprehensive review of the available instruments. Seizure 2020; 79:30-43. [DOI: 10.1016/j.seizure.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
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Wang AD, Leong M, Johnstone B, Rayner G, Kalincik T, Roos I, Kwan P, O’Brien TJ, Velakoulis D, Malpas CB. Distinct psychopathology profiles in patients with epileptic seizures compared to non-epileptic psychogenic seizures. Epilepsy Res 2019; 158:106234. [DOI: 10.1016/j.eplepsyres.2019.106234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
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Indranada AM, Mullen SA, Duncan R, Berlowitz DJ, Kanaan RA. The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis. Seizure 2018; 59:108-115. [DOI: 10.1016/j.seizure.2018.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022] Open
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Sarudiansky M, Lanzillotti AI, Areco Pico MM, Tenreyro C, Scévola L, Kochen S, D'Alessio L, Korman GP. What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach. Seizure 2017; 51:14-21. [PMID: 28755568 DOI: 10.1016/j.seizure.2017.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To analyse the methods of reasoning with regard to patients' experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Explanatory models and prototypes were identified from the patients' narratives. Four patients related their suffering regarding psychosocial causes -family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people's "attacks" (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy. CONCLUSION Patients' psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services.
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Affiliation(s)
- Mercedes Sarudiansky
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | - Alejandra Inés Lanzillotti
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | - María Marta Areco Pico
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
| | | | - Laura Scévola
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Mental Health Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Silvia Kochen
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Luciana D'Alessio
- ENyS, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina
| | - Guido Pablo Korman
- CAEA, CONICET, Buenos Aires, Argentina; Epilepsy Centre, Ramos Mejía and El Cruce Hospital, Argentina; Facultad de Psicología, Universidad de Buenos Aires, Argentina
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11
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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: 179] [Impact Index Per Article: 22.4] [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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Erro R, Brigo F, Trinka E, Turri G, Edwards MJ, Tinazzi M. Psychogenic nonepileptic seizures and movement disorders: A comparative review. Neurol Clin Pract 2016; 6:138-149. [PMID: 27104066 DOI: 10.1212/cpj.0000000000000235] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are usually investigated and managed separately by different neurology subspecialists. We review the main epidemiologic and clinical features of both PNES and PMD, aiming to highlight their similarities and differences and to see whether a common framework for these disorders exists. RECENT FINDINGS Data from the literature show that there is a profound overlap between PNES and PMD, which would argue for a larger unifying pathophysiology with variable phenotypic manifestations. SUMMARY Collaborative and integrated research among epileptologists, movement disorders experts, psychiatrists, psychologists, and physiotherapists may increase our collective knowledge about the pathophysiologic mechanisms of PNES and PMD and therefore improve outcomes for these patients.
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Affiliation(s)
- Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
| | - Francesco Brigo
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
| | - Eugen Trinka
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
| | - Giulia Turri
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
| | - Mark J Edwards
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
| | - Michele Tinazzi
- Sobell Department of Motor Neuroscience and Movement Disorders (RE, MJE), University College London (UCL) Institute of Neurology, UK; Dipartimento di Neuroscienze, Biomedicina e Movimento (RE, FB, GT, MT), Università di Verona; Divisione di Neurologia (FB), Ospedale "Franz Tappeiner," Merano, Italy; Department of Neurology (ET), Christian Doppler Klinik, Paracelsus Medical University; and Centre for Cognitive Neuroscience (ET), Salzburg, Austria
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Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy. Epilepsy Behav 2016; 56:123-30. [PMID: 26874243 DOI: 10.1016/j.yebeh.2015.12.037] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Psychogenic nonepileptic seizures (PNESs) are closely linked with psychological distress, but their etiology is not well-understood. We reviewed psychiatric comorbidity in PNESs and epileptic seizures (ESs) with an aim to assist understanding, diagnosis, and management of PNESs. METHODS A search of Web of Science, MEDLINE (PubMed), PsycINFO, and Scopus identified 32 relevant studies on the prevalence of psychiatric comorbidity in PNESs. We used meta-analysis to compare psychiatric comorbidity between PNESs and ESs. RESULTS Samples with PNESs had high rates of psychiatric comorbidity overall (53-100%), notably including posttraumatic stress disorder (PTSD), depression, and personality and anxiety disorders. Compared with ESs, samples with PNESs had more psychiatric comorbidity overall (RR: 1.30, 95% CI: 1.14-1.48, p<0.0001) with significantly elevated risks found for PTSD, personality disorder, and anxiety but not depression. CONCLUSIONS Psychiatric disorders are more common in PNESs than ESs. Because of methodological limitations of available studies, causality cannot be established; prospective longitudinal designs are required.
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Scévola L, Teitelbaum J, Oddo S, Centurión E, Loidl CF, Kochen S, D Alessio L. Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: a study of an Argentine population. Epilepsy Behav 2013; 29:155-60. [PMID: 23969203 DOI: 10.1016/j.yebeh.2013.07.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/11/2013] [Accepted: 07/13/2013] [Indexed: 12/01/2022]
Abstract
Epidemiological data show that up to 20-30% of patients with psychogenic nonepileptic seizures (PNESs), resembling drug-resistant epilepsy (DRE), are referred to tertiary epilepsy centers. Furthermore, both disorders present high psychiatric comorbidity, and video-EEG is the gold standard to make differential diagnoses. In this study, we described and compared the clinical presentation and the frequency of psychiatric disorders codified in DSM IV in two groups of patients, one with PNESs and the other with DRE, admitted in a tertiary care epilepsy center of Buenos Aires, Argentina. We included 35 patients with PNESs and 49 with DRE; all were admitted in the video-EEG unit in order to confirm an epilepsy diagnosis and determine surgical treatment possibilities. All patients underwent a neurological and psychiatric assessment, according to standardized protocol (SCID I and II; DSM IV criteria). Student's t test was performed to compare continuous variables and Chi square test to compare qualitative variables. In this study, 33 (67%) patients with DRE and 35 (100%) patients with PNESs met criteria for at least one disorder codified in Axis I of DSM IV (p=0.003). Differences in the frequency of psychiatric disorder presentation were found between groups. Anxiety disorders (16.32% vs 40%; p=0.015), trauma history (24.5% vs 48.57%; p=0.02), posttraumatic stress disorder (4.08% vs 22.85%; p=0.009), and personality cluster B disorders (18.37% vs 42.86%; p=0.02) were more frequent in the group with PNESs. Psychotic disorders were more frequent in the group with DRE (20.4% vs 2.85%; p=0.019). Depression was equally prevalent in both groups. Standardized psychiatric assessment provides information that could be used by the mental health professional who receives the referral in order to improve quality of care and smooth transitions to proper PNES treatment, which should include a multidisciplinary approach including neurology and psychiatry.
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Affiliation(s)
- Laura Scévola
- Epilepsy Center Ramos Mejía Hospital, Cell Biology and Neuroscience Institute (IBCN), Buenos Aires University (UBA)-CONICET, Buenos Aires, Argentina; Psychiatry Division, Ramos Mejía Hospital, Buenos Aires, Argentina.
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LaFrance WC, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach. Epilepsia 2013; 54:2005-18. [PMID: 24111933 DOI: 10.1111/epi.12356] [Citation(s) in RCA: 512] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
- W. Curt LaFrance
- Division of Neuropsychiatry and Behavioral Neurology; Rhode Island Hospital; Providence Rhode Island U.S.A
- Departments of Psychiatry and Neurology (Research); Alpert Medical School of Brown University; Providence Rhode Island U.S.A
| | - Gus A. Baker
- Walton Centre for Neurology and Neurosurgery; University Department of Neurosciences; University of Liverpool; Liverpool Merseyside United Kingdom
| | - Rod Duncan
- Department of Neurology; Christchurch Hospital; Christchurch New Zealand
| | - Laura H. Goldstein
- Department of Psychology; King's College London; Institute of Psychiatry; London United Kingdom
| | - Markus Reuber
- Academic Neurology Unit; University of Sheffield; Royal Hallamshire Hospital; Sheffield United Kingdom
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Myers L, Perrine K, Lancman M, Fleming M, Lancman M. Psychological trauma in patients with psychogenic nonepileptic seizures: trauma characteristics and those who develop PTSD. Epilepsy Behav 2013; 28:121-6. [PMID: 23708490 DOI: 10.1016/j.yebeh.2013.03.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The first objective of this study was to examine and describe the demographic, psychiatric, and trauma characteristics of our sample with PNESs as a whole. Subsequently, a comparison between traumatized and nontraumatized patients with PNESs was performed with regard to descriptive and trauma characteristics and general psychopathology symptoms. Lastly, we analyzed the predictive value in distinguishing patients with "likely" vs. "not likely" PTSD utilizing a model derived from our patients' psychometric test results. METHODS We collected and tallied demographic and psychiatric information and trauma characteristics on 61 patients with PNESs who had confirmed or denied having experienced trauma in their lifetime. We then studied this group with the Trauma Symptom Inventory-2 (TSI-2) and the Minnesota Multiphasic Personality Inventory-2RF (MMPI-2RF). Traumatized patients were subsequently classified as "PTSD likely" and "PTSD not likely" based on TSI-2 criteria and compared on demographic, psychiatric, and trauma characteristics and MMPI-2RF scores. RESULTS Our study revealed that 45 out of 61 (73.8%) patients reported experiencing at least one traumatic event in their lifetime. Approximately 40% reported physical or sexual abuse followed in percentage size by loss of a significant other, psychological abuse, witnessing the abuse of others, and medical trauma. Traumatized vs. nontraumatized and "PTSD likely" and "PTSD not likely" patients differed significantly on several clinical variables, as well as MMPI-2RF scores. Scores from TSI-2 produced a model that accurately predicted "no PTSD" in 21/26 (80.77%) subjects who denied a history of PTSD and "PTSD" in 5/6 subjects (83.33%) who endorsed a history of PTSD. CONCLUSION This study showed that overall exposure to psychological trauma is much more prevalent in patients with PNESs than in the general population with an inordinately high exposure to sexual and physical abuse as well as a variety of other types of abuse. Psychopathology was identified in the group with PNESs as a whole with discrete distinctions in clinical symptoms and characteristics of the traumatized as well as the "PTSD likely" subgroups. These findings contribute useful information in understanding intragroup differences in what is increasingly appearing to be a heterogeneous psychiatric condition composed of distinguishable subgroups.
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Affiliation(s)
- Lorna Myers
- Northeast Regional Epilepsy Group, 820 Second Avenue, Suite 6C, New York, NY 10017, USA.
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17
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Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC, LaFrance WC. Depression and epilepsy, pain and psychogenic non-epileptic seizures: clinical and therapeutic perspectives. Epilepsy Behav 2012; 24:169-81. [PMID: 22632407 DOI: 10.1016/j.yebeh.2012.01.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/11/2022]
Abstract
The clinical manifestations of depression in people with epilepsy (PWE) are pleomorphic, often associated with anxiety symptoms and anxiety disorders. The ongoing debate of whether the clinical presentation of depression in PWE is unique to this neurologic disorder is reviewed. Comorbid depression can impact the recruitment of PWE for pharmacologic trials with antiepileptic drugs (AEDs). Yet, the impact of depression on the response of the seizure disorder to pharmacotherapy with AEDs and its impact on worse adverse events may bias the interpretation of the trial findings, particularly when depressed patients are included in the AED trials. PWE have a greater suicidal risk than the general population. This risk is mediated by multiple factors, and recent data from the FDA have imputed a potential pathogenic role to all AEDs. The recognition of patients at risk is reviewed. Yet, the validity of the FDA data has been questioned, and the status of this controversial question is analyzed. As in the case of epilepsy, depression and pain syndromes have a relatively high comorbidity. The negative impact of depression on pain is reminiscent of that of depression in PWE; furthermore, the high comorbidity may be also associated with the existence of common pathogenic mechanisms. Neurologists and in particular, epileptologists establish the diagnosis of psychogenic non-epileptic seizures (PNES) in whom a comorbid depressive disorder is very often identified. The role of depression in the course of PNES and its treatment are discussed. Scarce data are available on the treatment of depression in PWE. Thus, clinicians have had to adopt data from patients with primary depressive disorders. We outline a consensus strategy on the identification and treatment of depressive disorders in adult and pediatric patients with epilepsy.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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18
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Young AMH, Stoker TB. Audio-induced psychogenic non-epileptic seizures. Scott Med J 2012; 57:60. [PMID: 22408222 DOI: 10.1258/smj.2011.011278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 45-year-old woman presented with vague attacks, which consisted of headaches, confusion and sleepiness. An electroencephalograph was normal, but subsequent scans revealed the presence of a right-sided convexity meningioma. This was excised and complications led to the removal of an infected bone flap in a separate procedure the following year. Various types of 'seizures' resulted from the operation. These were described to involve both tonic-clonic and absence seizures. This continued for 18 years, unaffected by medication, until a specialist diagnosed pseudo-epilepsy, by fortune of a hospital fire alarm. The patient began a psychological intervention programme including cognitive-behavioural therapy, which has significantly reduced episodes. In conclusion, psychogenic non-epileptic seizures may develop after intracranial neurosurgery undertaken for indications other than the control of refractory epileptic seizures. A diagnosis of psychogenic non-epileptic seizures should be considered in patients who develop refractory seizures after neurosurgery and managed appropriately.
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Affiliation(s)
- A M H Young
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0SP, UK.
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Nežádal T, Hovorka J, Herman E, Němcová I, Bajaček M, Stichová E. Psychogenic non-epileptic seizures: our video-EEG experience. Neurol Res 2011; 33:694-700. [PMID: 21756548 DOI: 10.1179/1743132811y.0000000003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of our study was to assess the number of psychogenic non-epileptic seizures (PNES) in our patients with a refractory seizure disorder, to determine the 'typical' PNES semiology using video-EEG monitoring and describe other PNES parameters. METHODS We evaluated prospectively 596 patients with pharmacoresistant seizures. All these patients underwent continuous video-EEG monitoring. In consenting patients, we used suggestive seizure provocation. We assessed seizure semiology, interictal EEG, brain MRI, psychiatric co-morbidities, personality profiles, and seizure outcome. RESULTS In the sample of 596 monitored patients, we detected 111 (19.3%) patients with PNES. Of the 111 patients with PNES, 86.5% had spontaneous and 76.5% had provoked seizures. The five most typical symptoms were: initially closed eyelids (67.6%), rapid tremor (47.7%), asynchronous limb movement (37.8%), preictal pseudosleep (33.3%), and side-to-side head movement (32.4%). Interictal EEG was rated as abnormal in 46.2% and with epileptiform abnormality in 9%. Brain MRI was abnormal in 32 (28.8%) patients. Personality disorders (46.8%), anxiety (39.6%), and depression (12.6%) were the most frequent additional psychiatric co-morbidities. PNES outcome after at least 2 years is reported; 22.5% patients was seizure-free; one-third had markedly reduced seizure frequency. We have not seen any negative impact of the provocative testing on the seizure outcome. DISCUSSION Video-EEG monitoring with suggestive seizure provocation supported by clinical psychiatric and psychological evaluation significantly contributes to the correct PNES diagnosis, while interictal EEG and brain MRI are frequently abnormal. Symptoms typical for PNES, as opposed to epileptic seizures, could be distinguished.
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Affiliation(s)
- Tomáš Nežádal
- Department of Neurology, Epileptology and Neuropsychiatry, Na Františku Hospital, Prague, Czech Republic
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Psychogenic nonepileptic seizures after head injury: a case report. Case Rep Med 2009; 2009:712813. [PMID: 19859582 PMCID: PMC2766503 DOI: 10.1155/2009/712813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 08/21/2009] [Indexed: 11/18/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNESs) are diagnosed when disruptive
changes in behaviour, thinking, or emotion resemble epileptic seizures (ESs), but
no paroxysmal discharges are seen on electroencephalogram (EEG) and do not originate from
another medical illness. The gold standard for PNES diagnosis is video electroencephalogram (Video-EEG).
PNESs are defined by modern psychiatry as conversion and dissociative
disorders but these disorders may coexist with many others psychiatric
disorders, including depression, posttraumatic stress disorder, and personality
disorders. It is well known that epileptic seizures are a frequent and well-studied
complication of traumatic head injury (THI). However, THI may also generate
psychic symptoms including PNES. In this paper we describe a patient
who developed PNES after THI in a bus accident and received a diagnosis of
refractory epilepsy for 24 years until she underwent Video-EEG.
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Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 2008; 12:622-35. [PMID: 18164250 DOI: 10.1016/j.yebeh.2007.11.006] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 11/18/2007] [Indexed: 10/22/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient. Emphasizing the clinical picture throughout, the first part of this article is intended to "look and look again" at what we know about the epidemiology, semiology, clinical context, treatment, and prognosis of PNES. The second part is dedicated to the questions that remain to be answered. It argues that the most important reason our understanding of PNES remains limited is the focus on the visible manifestations of PNES or the seizures themselves. In contrast, subjective seizure manifestations and the biographic or clinical context in which they occur have been relatively neglected.
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Affiliation(s)
- Markus Reuber
- Academic Neurology Unit, University of Sheffield/Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK.
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22
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Lacey C, Cook M, Salzberg M. The neurologist, psychogenic nonepileptic seizures, and borderline personality disorder. Epilepsy Behav 2007; 11:492-8. [PMID: 18054130 DOI: 10.1016/j.yebeh.2007.09.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 09/06/2007] [Accepted: 09/07/2007] [Indexed: 01/08/2023]
Abstract
Patients with psychogenic nonepileptic seizures (PNES) are common in tertiary epilepsy centers, emergency departments, and neurological practices. Psychiatric discussion of patients with PNES has emphasized the role of trauma and dissociation. Personality disorder has been considered, but its extensive implications for neurological management have not been fully appreciated. We propose that the most difficult aspects of management stem not from the convulsive episodes, but from the personality disorder that frequently accompanies them. Although it is not the neurologist's role to treat personality disorder, the conduct of the physician-patient relationship can have potent consequences for good or ill on the outcome. We present a brief guide to current concepts of personality disorder; discuss the literature concerning its association with PNES, and offer practical guidelines for the conduct of the neurologist-patient relationship. This perspective offers resolutions to longstanding controversies, including how to communicate the diagnosis, discontinuing medication, and ongoing neurological contact.
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Affiliation(s)
- Cameron Lacey
- Centre for Clinical Neuroscience and Neurological Research, St. Vincent's Hospital Melbourne, Melbourne, Australia.
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Sharpe D, Faye C. Non-epileptic seizures and child sexual abuse: A critical review of the literature. Clin Psychol Rev 2006; 26:1020-40. [PMID: 16472897 DOI: 10.1016/j.cpr.2005.11.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 10/25/2022]
Abstract
Non-epileptic seizures have received a substantial amount of attention in the psychiatric and medical literature, but comparatively little attention from psychologists. Non-epileptic seizures resemble epileptic seizures but lack the physiological symptoms of genuine epilepsy and are psychological in origin. Many authors have emphasized the role that child sexual abuse may play in the etiology of this disorder. In the present paper, we provide a review of 34 studies examining this relationship, followed by a meta-analysis of 19 effect sizes. While our statistical results support the professed link between child sexual abuse and non-epileptic seizures, we suggest that because of research design limitations, it is premature to draw any definitive conclusions regarding a relationship. Eight of these research design limitations are identified and discussed (e.g., the absence of comparison groups; an explicit and public definition of child sexual abuse). Alternatives to a traditional psychoanalytic perspective that emphasizes the role of child sexual abuse in the etiology of NES are presented. Specific recommendations for future research are made and psychologists are strongly encouraged to play a more active role in both researching and treating non-epileptic seizures.
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Affiliation(s)
- Donald Sharpe
- Psychology Department, University of Regina, Regina, SK, Canada S4S 0A2.
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Lobello K, Morgenlander JC, Radtke RA, Bushnell CD. Video/EEG monitoring in the evaluation of paroxysmal behavioral events: duration, effectiveness, and limitations. Epilepsy Behav 2006; 8:261-6. [PMID: 16337436 DOI: 10.1016/j.yebeh.2005.10.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Revised: 10/07/2005] [Accepted: 10/14/2005] [Indexed: 11/21/2022]
Abstract
To establish the number of monitoring days needed to distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) in adult patients admitted for video/EEG monitoring (VEM), we performed a retrospective chart review on 199 consecutive admissions for behavioral event diagnosis with VEM. Of the 199 adult patients admitted for VEM, 83.9% (n = 167) had a clinical event during admission, and a definitive diagnosis was made in 75.9% (n = 151). Of patients who had clinical events, 87.7% (n = 143) had their first event on admission day 1 or 2. Factors associated with ES (vs PNES) included an abnormal baseline EEG (P < 0.001), an abnormal brain MRI (P = 0.01), and history of events lasting less than 1minute (P = 0.01). There was no association between time to first event and discharge diagnosis. VEM differentiated between ES and PNES in the majority of adult patients evaluated. Most behavioral events were characterized within 2 days of admission.
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Affiliation(s)
- Kasia Lobello
- Division of Neurology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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