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Carney PW, Brown H, Lewis AK, Taylor NF, Harding KE. Two thirds of patients may not need routine 12-month specialist review in an epilepsy clinic: A cross-sectional study of clinic appointments. Epilepsy Behav 2024; 159:110022. [PMID: 39216467 DOI: 10.1016/j.yebeh.2024.110022] [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: 06/18/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Timely access to specialist outpatient clinics can be difficult to achieve as outpatient services are often oversubscribed leading to unacceptable wait times. New patients, or those with emergent issues may wait for appointments whilst existing patients are booked in for routine reviews "just in case" there is a problem, using considerable clinic resources. We investigated routine 12-month review appointments to assess whether these appointments changed patient management. METHODS The medical records of 100 randomly selected adult patients attending annual review appointments over 12 months at a publicly-funded specialist outpatient epilepsy clinic in Melbourne, Australia were audited. Demographic and clinical data as well as information about the content of each appointment were analysed to determine whether the appointment resulted in changes to epilepsy management (eg medication change), administrative actions (eg drivers license approval) or the provision of information or education. Logistic regression was performed to assess what clinical factors were associated with changes in patient care arising from the 12-month review appointment. RESULTS Almost half (47%) of appointments resulted in no change to patient care and 37% had only administrative outcomes, such as the completion of a regulatory driving report. Only 16% of appointments resulted in a change in medical management. The only factor that independently predicted a change in medical management was the occurrence of a seizure in the previous year. The only factor independently associated with not having any change in medical management or administrative action was having an unknown seizure type. CONCLUSIONS/ SIGNIFICANCE Only a small number of patients experience a change in medical management when attending a 12-month epilepsy clinic appointment, with a need for management change associated with the presence of ongoing seizure. Outpatient services should limit the use of routine annual follow up to those patients most likely to need intervention or support, creating "just in time" capacity for timely access to review as issues arise.
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Affiliation(s)
- Patrick W Carney
- Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128; Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, VIC 3128, Australia; The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, Heidelberg, VIC 3084, Australia.
| | | | - Annie K Lewis
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
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Keita G, Traoré J, Coulibaly SP, Traoré K, Maiga BH, Dara EA, Koné M, Kamaté Z, Diarra OS, Diakité K, Coulibaly S, Diallo SH, Maiga YM. [Hospital frequency of non-epileptic psychogenic seizures in Bamako]. Pan Afr Med J 2024; 47:148. [PMID: 38933437 PMCID: PMC11204986 DOI: 10.11604/pamj.2024.47.148.42711] [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: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 06/28/2024] Open
Abstract
Diagnosing a non-epileptic seizure is difficult in the absence of a video electroencephalogram. The expert commission of the international league against epilepsy proposes a diagnostic approach allowing the diagnosis to be made according to a degree of certainty with or in the absence of a video electroencephalogram. Our objective was to determine the hospital frequency of psychogenic non-epileptic seizures in the absence of video-electroencephalogram. Using the outpatient registry, we identified patients followed for epilepsy with two normal interictal electroencephalographies, between January 2020 and October 2021. A review of the patients' medical records and an assessment of the validity of the diagnosis were carried out. Out of 64 patients evaluated with normal interictal electroencephalogram, 19 were included as suffering from psychogenic non-epileptic seizures, i.e. 26.68%. The average age was 23.94 +/- 9.4 years. Women represented 68.4%. Patients followed in neurology represented 84%. A history of childhood trauma was found in (47.4%). The first crisis was preceded by stressful events in 47.36%. Post-traumatic stress disorder was the most represented with 73.7% of cases. The average age was 20.95 +/- 9.8 years for the first crisis and the average duration of evolution of the crises was 3 years +/- 2 years. This study illustrates the possibility of making a presumptive diagnosis of psychogenic non-epileptic seizure in the absence of video-electroencephalogram.
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Affiliation(s)
- Gaoussou Keita
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Joseph Traoré
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Souleymane Papa Coulibaly
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie de Bamako, Bamako, Mali
- Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Kadiatou Traoré
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | | | - Eloi Aperou Dara
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Mahamadou Koné
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Zoua Kamaté
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Ousmane Soma Diarra
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Kassim Diakité
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
| | - Souleymane Coulibaly
- Département de Psychiatrie, Centre Hospitalier Universitaire Point G, Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie de Bamako, Bamako, Mali
- Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Seybou Hassane Diallo
- Faculté de Médecine et d'Odontostomatologie de Bamako, Bamako, Mali
- Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Département de Neurologie, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
| | - Youssoufa Mamadou Maiga
- Faculté de Médecine et d'Odontostomatologie de Bamako, Bamako, Mali
- Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Département de Neurologie, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
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Yaraki PT, Yu YJ, AlKhateeb M, Mirsattari SM. Longitudinal Comparison of PNES spell and ASM reduction in PNES Patients with and without Epilepsy Discharged from an Epilepsy Monitoring Unit. Epilepsy Res 2024; 201:107319. [PMID: 38422801 DOI: 10.1016/j.eplepsyres.2024.107319] [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: 11/26/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To examine trends of Antiseizure Medication (ASM) reduction and discontinuation, as well as Psychogenic Non-Epileptic Seizure (PNES) spell reduction and resolution in patients with PNES, with and without comorbid epileptic seizures (ES). METHODS A retrospective analysis was conducted on data from 145 patients with PNES, including 109 with PNES alone and 36 with PNES plus comorbid epilepsy. Patients were admitted to the Epilepsy Monitoring Unit (EMU) between May 2000 and April 2008, with follow-up clinical data collected until September 2015. Clinical records were thoroughly examined, encompassing the period preceding the PNES diagnosis until either loss to follow-up or September 2015. A subsequent chart review was conducted by two neurologists, covering the period following the diagnosis of PNES until either loss to follow-up or September 2015, which ever came first. RESULTS Patients with PNES alone had higher rates of ASM reduction for all variables of ASM reduction measured compared to those with comorbid epilepsy (all at p < 001). Among patients with PNES alone, reductions in ASMs were observed after EMU discharge, but an uptick and plateau were seen in later follow-up years (100% of patients free of ASMs at years 2-3, 20% on at least one ASM by year 7). This pattern differs greatly in PNES + ES patients, in which the only time point at which any patient was able to discontinue all ASMs was at EMU discharge (4.5% of patients), with all patients taking at least one ASM for every other follow-up time point. Reductions in PNES spell frequency did not differ significantly between the two groups (for example PNES spells reduced at final FU 47.2% vs 42.9%, p = 0.65). In both groups, despite an initial drop in variables of PNES spell reduction and resolution in the early years post discharge, there is an eventual rebound and plateau (for example in PNES only patients, 33.9% of patients having no resolution in 1st year FU, which rises to 78% at years 4-5, and plateus around 52.8% at more than 7 years follow-up.) SIGNIFICANCE: This study contributes to the growing body of research focused on improving the current approach to management and prognostic outlook of PNES. Although PNES only patients had higher rates of ASM reduction, the uptick and plateau observed in later years highlights the challenges in managing PNES. Similarly, the continued persistence and rebound of PNES spells underline the continued poor prognostic outcomes associated with this condition.
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Affiliation(s)
- Pouyan Tavakoli Yaraki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yeyao Joe Yu
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, 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, Diagnostic Imaging, Biomedical Imaging and Psychology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Villagrán A, Lund C, Duncan R, Ingvar Lossius M. Adverse life events in patients with functional seizures: Assessment in clinical practice and association with long-term outcome. Epilepsy Behav 2023; 148:109456. [PMID: 37804600 DOI: 10.1016/j.yebeh.2023.109456] [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: 07/06/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND A history of adverse life events (ALE) is a risk factor for functional seizures (FS). Their influence on long-term outcome remains unclear. International guidelines recommend assessing ALE in patients presenting with associated disorders. It is not clear to what extent patients evaluated for FS are regularly asked about ALE. OBJECTIVES We hypothesised that the presence of ALE would relate to worse outcome at follow-up and, that the rate of detection of ALE in clinical work-up would be inferior to that based on self-report questionnaires. METHODS 53 patients with FS from the National Centre for Epilepsy in Norway, aged 16-62 years were included. Symptom severity, health-related quality of life (HRQoL), and antecedent ALE were assessed at baseline. Medical records were examined for disclosure of ALE. At a mean of 70.45 (SD 29.0, range 22-130) months after inclusion, participants were inquired about FS status, FS-related health care utilization and HRQoL. FINDINGS A history of emotional abuse documented in the medical record was an independent risk factor for worse HRQoL at follow-up. Prevalence of ALE documented in medical records was lower compared with rates measured by a self-report questionnaire. CONCLUSIONS These findings indicate an association between antecedent ALE and HRQoL years after diagnosis. A substantial proportion of the adverse life events by a self-report questionnaire had not been documented in the clinical records. CLINICAL IMPLICATIONS The supplemental use of a self-report questionnaire in the diagnostic work-up of patients with FS may be valuable for detecting ALE.
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Affiliation(s)
- Antonia Villagrán
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Caroline Lund
- Department of Neurohabilitation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; National Centre for Rare Epilepsy-Related Disorders, Oslo University Hospital, Oslo, Norway
| | - Roderick Duncan
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Kanemoto K, Tadokoro Y, Motooka H, Kawasaki J, Horinouchi T, Tsuji T, Fukuchi T, Tomohiro O. Prospective multicenter cohort study of possible psychogenic nonepileptic seizure cases-Results at 1-year follow-up examinations. Epilepsia Open 2023; 8:134-145. [PMID: 36509699 PMCID: PMC9978061 DOI: 10.1002/epi4.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The primary purpose of this prospective multicenter study was to examine clinical and demographic feature differences according to the diagnostic level of psychogenic nonepileptic seizures (PNES) and then clarify whether prognosis may also differ accordingly. METHODS Two hundred forty-two consecutive patients strongly suspected of having PNES attacks were invited to participate, of whom 52 did not consent or contact was lost. At the 1-year follow-up examination, PNES diagnosis was reconsidered in nine patients. In 96 patients, the diagnostic level remained the same (P-group), with that in 43 considered to be clinically established (CE-group) and in 42 documented (D-group). The Qolie-10 and NDDI-E questionnaires were examined at both the study entry and the follow-up examination. RESULTS Multiple regression analysis of quality of life (QoL) score (n = 173; R2 = 0.374; F = 7.349; P < 0.001) revealed NDDI-E score (t = -6.402; P < 0.001), age of PNES onset (t = -3.026; P = 0.003), and ethnic minority status (t = 3.068; P = 0.003) as significant contributors. At entry, the P-group showed the lowest PNES attack frequency (P < 0.000), the lowest rate of antiseizure, antidepressant, and antipsychotic medication (P < 0.000; P = 0.031; P = 0.013, respectively), and the lowest proportion of psychosis (P = 0.046). At follow-up, PNES attack frequency (P < 0.000), number of admittances to emergency room (P < 0.000), and scores for QoL (P < 0.000) as well as depression (P = 0.004) were found to be significantly improved together with other collateral indicators, such as rate of antiseizure medication prescription (P = 0.001) and psychiatric symptoms (P = 0.03). Multiple regression analysis of a sample limited to patients with intellectual disability (ID) (n = 44; R2 = 0.366; F = 4.493; P = 0.002) revealed continued psychotherapy at follow-up (t = 2.610, P = 0.013) and successful reduction in antiseizure medication (t = 2.868; P = 0.007) as positively related with improved QoL. SIGNIFICANCE Clinical and the socio-psychological constellation of possible, clinically established, and documented PNES were found to differ greatly. Unexpectedly, significant effects of the continuous psychotherapeutic intervention were confirmed in PNES patients with ID.
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Affiliation(s)
| | | | | | | | - Toru Horinouchi
- Department of Psychiatry & Neurology, Hokkaido University, Sapporo, Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama University, Wakayama, Japan
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Leroy A, Tarrada A, Garcin B, Hingray C. Crisi psicogene non epilettiche (funzionali/dissociative). Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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The effect of attachment style on long-term outcomes in psychogenic nonepileptic seizures: Results from a prospective study. Epilepsy Behav 2022; 135:108890. [PMID: 36037581 DOI: 10.1016/j.yebeh.2022.108890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Insecure and fearful attachment styles have been reported in psychogenic nonepileptic seizures (PNES). We have investigated associations between long-term clinical outcome in PNES, parenting and attachment styles and demographic, clinical, and neuropsychiatric factors. MATERIAL AND METHODS Patients aged at least 16 years and with documented PNES, according to criteria from the International League Against Epilepsy, were prospectively recruited to this study. They were assessed at baseline to determine clinical characteristics, experience of attachment and perceptions of experienced parenting styles, trauma history, dissociation, and health-related quality of life. At a mean of 70.45 (SD 29.0, range 22-130) months after inclusion, participants were contacted by telephone and asked about their current medical status and psychiatric/psychological interventions. RESULTS Of 53 patients included in the study, 51 (96 %) provided follow-up data. Most (84.9 %) patients were female, and the mean age of PNES onset was 25.6 years. At follow-up, 20 patients (39 %) were free of PNES. Those patients that had achieved PNES freedom at follow-up had lower levels of attachment anxiety (p = 0.01) and reported to have experienced their fathers as less controlling (p = 0.02) and their mothers as more caring (p = 0.04) at baseline compared with those patients still suffering from PNES. Seizure freedom at follow-up was predicted by male gender, younger age at PNES onset, and less attachment anxiety. CONCLUSION In our cohort from a tertiary epilepsy center the long-term prognosis of PNES is poor. Attachment anxiety is a risk factor for persistent PNES. It may be of therapeutic relevance to assess attachment patterns in patients with PNES.
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Factors associated with comorbid epilepsy in patients with psychogenic nonepileptic seizures: A large cohort study. Epilepsy Behav 2022; 134:108780. [PMID: 35753900 DOI: 10.1016/j.yebeh.2022.108780] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) occur in 12-22% of cases and the diagnosis of both simultaneous disorders is challenging. We aimed to identify baseline characteristics that may help distinguish patients with PNES-only from those with comorbid epilepsy. METHODS We performed a longitudinal cohort study on those patients diagnosed with PNES in our epilepsy monitoring unit (EMU) between May 2001 and February 2011, prospectively followed up until September 2016. Patients were classified into PNES-only, PNES + possible or probable epilepsy, and PNES + definite epilepsy based on the clinical, vEEG, and neuroimaging data. Demographic and basal clinical data were obtained from chart review. Multiple regression models were performed to identify significant predictors of PNES + definite epilepsy, excluding patients with only possible or probable epilepsy for this specific analysis. RESULTS One-hundred and ninety four patients with PNES-only, 30 with PNES + possible or probable epilepsy and 47 with PNES + definite epilepsy were included. 73.8% were female and the mean age at EMU admission was 37.4 ± standard deviation 13.5 years. Patients with PNES + definite epilepsy most likely had never worked, had history of febrile seizures, structural brain lesions, developmental disabilities, and maximum reported seizure duration between 0.5 and 2 min. Patients with PNES-only were on fewer anti-seizure medications (ASM), reported more frequently an initial minor head trauma, seizures longer than 10 min, and a higher number of neurological and medical illnesses - being migraine (18.1%), other types of headaches (18.5%), and asthma (15.5%) the most prevalent ones. All p < 0.05. On the hierarchical regression analysis, history of febrile seizures, developmental disabilities, brain lesions, longest reported seizure duration between 0.5 and 2 min, and lack of neurological comorbidity, remained as significant predictors of PNES + epilepsy. The model's performance of a 5-fold cross-validation analysis showed an overall accuracy of 84.7% to classify patients correctly. CONCLUSIONS Some demographic and clinical characteristics may support the presence of comorbid epilepsy in patients with PNES, being unemployment, the presence of brain lesions, developmental disabilities, history of febrile seizures, seizure duration and lack of comorbid headaches the most relevant ones.
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Lopez MR, LaFrance WC. Treatment of Psychogenic Nonepileptic Seizures. Curr Neurol Neurosci Rep 2022; 22:467-474. [PMID: 35674871 DOI: 10.1007/s11910-022-01209-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Psychogenic nonepileptic seizures (PNES) are the most common Functional Neurological Disorder/Conversion Disorder subtype. Significant advances have been made related to diagnosis, neurobiology, and treatment. In this review, we summarize updates in diagnosis and management over the past 3 years. RECENT FINDINGS Although evidence is mixed for the treatment of PNES, psychotherapeutic modalities remain a powerful instrument to empower patients and reduce seizures. A multidisciplinary, holistic approach is beneficial. While seizure freedom in all patients may not be the achieved endpoint in this chronic, paroxysmal disorder, quality of life can be improved with treatment. Additional treatment modalities and further research are needed for patients who are refractory to current treatment. Evidence-based therapies exist for PNES, and recent findings represent an increased understanding of the clinical and neurophysiologic aspects of PNES.
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Affiliation(s)
- M Raquel Lopez
- University of Miami, 1120 NW 14th St., Miami, FL, 33136, USA.
- VA Miami Health Care System, Miami, FL, USA.
| | - W Curt LaFrance
- Rhode Island Hospital, Brown University, Providence, RI, USA
- VA Providence Health Care System, Providence, RI, USA
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To the emergency room and back again: Circular healthcare pathways for acute functional neurological disorders. J Neurol Sci 2022; 437:120251. [DOI: 10.1016/j.jns.2022.120251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
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Sakurai H, Kanemoto K. Quality of life for patients with psychogenic nonepilepsy seizures in comparison with age- and gender-matched patients with epilepsy - Cross-sectional study. Epilepsy Behav 2022; 128:108539. [PMID: 35124523 DOI: 10.1016/j.yebeh.2021.108539] [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: 09/29/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS Patients with psychogenic nonepileptic seizures (PNES), and age- and gender-matched patients with epilepsy (PWE) who utilized an out-patient service were compared regarding quality of life (QoL) and self-reported symptoms of depression. Additionally, the impact of miscellaneous clinical variables including symptoms of depression on QoL in patients with PNES and PWE in real-world settings was assessed. SUBJECTS AND METHODS Adult patients who had a diagnosis of definite or documented PNES based on LaFrance's criteria (PNES group, n = 62), or of epilepsy based on results of clinical and EEG procedures (Epilepsy group, n = 61) were enrolled. To assess QoL and evaluate depression, the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), respectively, were administered. RESULTS Comparisons between the groups revealed a shorter duration of illness and fewer number of attacks in patients with PNES as compared to the Epilepsy group (p < 0.0001; p = 0.0003, respectively). There was no significant difference between the groups revealed by the QOLIE-10 (p = 0.141), while the patients with PNES tended to have higher NDDI-E scores (p = 0.068). Multiple regression analysis of QOLIE-10 results in the PNES group revealed that NDDI-E score was the sole significant contributor (β = -0.425 p = 0.001). In contrast, NDDI-E score as well as attack frequency had a significant impact on QOLIE-10 results in the Epilepsy group (β = -0.283 p = 0.026; β = -0.272 p = 0.031, respectively). CONCLUSION In PWE and patients with PNES who utilized an out-patient service, QoL did not differ significantly between those groups. For treating PNES, psychosocial factors may be a more appropriate indicator of therapeutic goal than attack frequency.
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Massot-Tarrús A, Joe Yu Y, AlKhateeb M, Mirsattari SM. Predicting outcome of patients with psychogenic nonepileptic seizures after diagnosis in an epilepsy monitoring unit. Epilepsy Behav 2021; 120:108004. [PMID: 33984657 DOI: 10.1016/j.yebeh.2021.108004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify predictors of Psychogenic NonEpileptic Seizure (PNES) improvement and anti-seizure medication (ASM) discontinuation in patients with PNES only. METHODS This is a retrospective study of a consecutively enrolled cohort of 271 patients diagnosed with PNES by video-EEG (vEEG) telemetry in our Epilepsy Monitoring Unit (EMU) between May 2000 and February 2010. Patients with any possibility of past or present comorbid epilepsy based on clinical, EEG, and neuroimaging, or less than one year of follow-up after discharge were excluded. RESULTS A total of 109 subjects were included. The mean age at PNES onset was 33 (range 6-89), mean age at EMU admission was 38.3 (16-89.8), 70.6% were female mean video-EEG length was 6.1 days, and the median time of final follow-up 3.3 (CI 1.6-6.4) years. 51/108 patients (47.2%) reported a PNES decrease and 29 (26.8%) experienced PNES resolution. 59/73 (81.9%) subjects on ASM at the time of EMU admission were able to discontinue them by the final visit. On univariate analysis, patients whose PNES frequency improved were significantly younger at time of admission, more likely married or cohabiting, less likely unemployed, less likely to have migraine, and had a higher frequency of PNES. On hierarchical regression analysis, younger age and employment remained significant predictors of PNES improvement and resolution. Patients who achieved ASM discontinuation had significantly more children and subsequent EMU visits, were less likely to have history of minor head trauma immediately preceding PNES onset and structural brain lesions, experienced a greater reduction of ASMs during the EMU admission, and had a greater improvement of their PNES frequency at the final visit (p ≤ 0.05). On hierarchical regression analysis, higher number of children, absence of structural brain lesions, fewer ASMs at EMU discharge, and improvement of PNES frequency remained significant predictors of ASM discontinuation. CONCLUSION The outcome of PNES is positively correlated with earlier age of diagnosis in an EMU, especially in patients with better social resources. Furthermore, discontinuation of ASM is more likely if the process is initiated during the EMU stay and in the absence of structural brain lesions.
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Affiliation(s)
- Andreu Massot-Tarrús
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Yeyao Joe Yu
- Department of Clinical Neurological Sciences, 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, Western University, London, Ontario, Canada; Psychology, Western University, London, Ontario, Canada
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O'Neal MA, Baslet GC, Polich GR, Raynor GS, Dworetzky BA. Functional Neurologic Disorders: The Need for a Model of Care. Neurol Clin Pract 2021; 11:e152-e156. [PMID: 33842084 DOI: 10.1212/cpj.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Neurologists are commonly consulted for patients with a functional neurologic disorder. Best practices as to their diagnosis and treatment have been established, and multiple academic centers have programs in place for their treatment. However, given the number of patients suffering from this condition, a comprehensive model of care that can be broadly implemented needs to be developed and applied beyond specialized academic programs.
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Bompaire F, Barthelemy S, Monin J, Quirins M, Marion L, Smith C, Boulogne S, Auxemery Y. PNES Epidemiology: What is known, what is new? EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2019.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A South African review of routinely-collected health data of psychogenic nonepileptic seizure patients referred to psychiatrists in Johannesburg. Epilepsy Behav 2021; 114:107578. [PMID: 33268018 DOI: 10.1016/j.yebeh.2020.107578] [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: 08/10/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
Patients with psychogenic nonepileptic seizures (PNES) are often referred to psychiatrists for treatment of functional neurological symptom disorder (FNSD). However, not all patients with FNSD have an identified psychiatric comorbidity [1]. The aim of this observational study was to characterize the clinical and psychiatric features of patients with PNES from Johannesburg, South Africa, where a high frequency of PNES has been reported [2], and compare these findings to other reports. We hypothesized that patient outcomes regarding treatment adherence and episode frequency would improve when treated within a closed multidisciplinary team. The data included a retrospective record review of patients diagnosed with PNES from an epilepsy monitoring unit and referred for psychiatric assessment and treatment between November 2013 and July 2017. Fifty-nine cases met the criteria for the study. There were 7 male and 52 female participants, aged between 14 and 72 years (M = 33.76, SD = 13.88). The most frequently reported comorbid symptoms were anxiety (90%); dissociative symptoms (51%); headaches (76%) and gastrointestinal symptoms (36%). Important patient characteristics included past substance abuse (76%); impaired attachment (86%); past trauma (69%) and sexual trauma (29%). Generalized anxiety disorder (76%), major depressive disorder (64%) and PTSD (22%) were the most prevalent psychiatric diagnoses. After receiving psychiatric treatment, 47% of patients experienced a decrease in the frequency of episodes, while 86% became aware of the precipitants of their episodes. Psychiatric data can valuably inform current theories of PNES management. This study contributes to the understanding of comorbid, aetiological, and prognostic factors that are crucial to refining coherent models that will guide practice.
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Walther K, Volbers B, Erdmann L, Kurzbuch K, Lang JD, Mueller TM, Reindl C, Schwarz M, Schwab S, Hamer HM. Psychosocial long-term outcome in patients with psychogenic non-epileptic seizures. Seizure 2020; 83:187-192. [PMID: 33181426 DOI: 10.1016/j.seizure.2020.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate psychosocial long-term outcome in patients diagnosed with psychogenic nonepileptic seizures (PNES) and to predict outcome of PNES, economic status, and quality of life (QoL) at follow-up. METHODS Patients diagnosed with PNES in the video-EEG-monitoring unit at our Epilepsy center between 2002-2016 were contacted by phone 1-16 years after communicating the diagnosis. Patients underwent a structured interview asking for current PNES status, psychosocial situation (economic status, marital status, setting of living, driving), depression, and QoL. RESULTS Of 70 PNES patients without comorbid epilepsy (age: 41.1 ± 13.5 years; 74 % female, follow-up: 5.2 ± 4.2 years), 23 patients (33 %) reported to be free of PNES during the last 12 months. Patients with cessation of PNES were younger at PNES onset (p < .01) and diagnosis (p < .01) and had a higher education (p < .05). At follow-up, the proportion of economically active patients only increased in individuals with cessation of PNES (p < .001) while an increased number of patients with persisting PNES relied on governmental support (p < .001). Cessation of PNES was associated with better mood (p < .01) and QoL (p < .001). In multiple regression models, cessation of PNES was only predicted by younger age at onset, while good economic outcome was determined by younger age and good economic status at diagnosis and cessation of PNES at follow-up. Good QoL at follow-up was predicted by low depressive symptoms, freedom of PNES, and economic activity at follow-up. CONCLUSION Long-term outcome in patients with PNES remains to be poor and the majority of patients continue to have PNES. Cessation of PNES was associated with good economic outcome, mood, and QoL.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Bastian Volbers
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Laura Erdmann
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Johannes D Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Tamara M Mueller
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Caroline Reindl
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Nicholson C, Edwards MJ, Carson AJ, Gardiner P, Golder D, Hayward K, Humblestone S, Jinadu H, Lumsden C, MacLean J, Main L, Macgregor L, Nielsen G, Oakley L, Price J, Ranford J, Ranu J, Sum E, Stone J. Occupational therapy consensus recommendations for functional neurological disorder. J Neurol Neurosurg Psychiatry 2020; 91:1037-1045. [PMID: 32732388 DOI: 10.1136/jnnp-2019-322281] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND People with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention. METHODS The recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved. RESULTS We recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document. CONCLUSIONS Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.
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Affiliation(s)
- Clare Nicholson
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Mark J Edwards
- Neurosciences Research Centre, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Paula Gardiner
- Centre for Clinical Brain Services, University of Edinburgh, NHS Lothian, Edinburgh, UK
| | | | - Kate Hayward
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Susan Humblestone
- Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - Helen Jinadu
- The Lishman Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Carrie Lumsden
- Community Rehabilitation and Brain Injury Service, West Lothian Community Health and Care Partnership, Livingston, West Lothian, United Kingdom
| | - Julie MacLean
- Occupational Therapy Department, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Lynne Main
- Neurological rehabilitation out-patient services, Astley Ainslie Hospital, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Lindsey Macgregor
- Falkirk Community Mental Health Service for Adults, NHS Forth Valley, Falkirk, Scotland, United Kingdom
| | - Glenn Nielsen
- Neurosciences Research Centre, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Louise Oakley
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | - Jason Price
- Department of Neuropsychology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Jessica Ranford
- Occupational Therapy Department, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Jasbir Ranu
- Department of Therapy Services, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Ed Sum
- Integrated Community Neurology Team, East Coast Community Healthcare CIC, Lowestoft, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
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Welfare consequences for people diagnosed with nonepileptic seizures: A matched nationwide study in Denmark. Epilepsy Behav 2019; 98:59-65. [PMID: 31299534 DOI: 10.1016/j.yebeh.2019.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the excess direct and indirect costs associated with nonepileptic seizures. METHODS From the Danish National Patient Registry (2011-2016), we identified 1057 people of any age with a diagnosis of psychogenic nonepileptic seizures (PNESs) and matched them with 2113 control individuals. Additionally, 239 partners of patients with PNES aged ≥18 years were identified and compared with 471 control partners. Direct costs included frequencies and costs of hospitalizations and outpatient use weighted by diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations and costs of general practice were derived from National Health Security data. Indirect costs included labor supply-based income data, and all social transfer payments were obtained from Coherent Social Statistics. RESULTS A higher percentage of people with PNES and their partners compared with respective control subjects received welfare benefits (sick pay, disability pension, home care). Those with PNES had a lower employment rate than did controls for equivalent periods up to three years before the diagnosis was made. The additional direct and indirect annual costs for those aged ≥18 years, including transfers to patients with PNES, compared with controls, were €33,697 for people with PNES and €15,121 for their partners. SIGNIFICANCE Psychogenic nonepileptic seizures have substantial socioeconomic consequences for individual patients, their partners, and society.
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O'Connell N, Nicholson T, Blackman G, Tavener J, David AS. Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study. Gen Hosp Psychiatry 2019; 58:94-102. [PMID: 31031213 DOI: 10.1016/j.genhosppsych.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study describes medication prescribing patterns in patients with motor functional neurological disorder (mFND) treated in South London and Maudsley NHS Foundation Trust (SLaM), comparing outcomes to a control group of psychiatric patients from the same hospital trust. METHOD This is a retrospective case-control study using a psychiatric case register. Cross-sectional data were obtained from 322 mFND patients and 644 psychiatry controls who had had contact with SLaM between 1st January 2006 and 31st December 2016. RESULTS A slightly lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, OR: 0.59, CI: 0.39-0.89, p < 0.05). Of medication recipients, mFND patients were prescribed a higher number of agents (mean: 4.7 v 2.9, p = 0.001) and had higher prescription rates of antidepressants, anti-epileptics, analgesics, and certain non-psychotropic medications. Higher numbers of prescriptions were associated with co-morbid physical conditions, and previous psychiatric admissions. CONCLUSIONS This is the first study to describe medication prescriptions in a large cohort of mFND patients. Patients were prescribed a wide range of psychiatric and physical health medications, with higher rates of polypharmacy than controls. Psychotropic medication prescription is not necessarily the first line treatment for mFND, where physiotherapy and psychotherapy may be offered initially. There is limited, early-phase evidence for pharmacological therapies for mFND, and as such, the benefit-to-risk ratio of prescribing in this complex and poorly understood disorder should be carefully assessed.
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Affiliation(s)
- Nicola O'Connell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 DeCrespigny Park, London SE5 8AF, United Kingdom. nicola.k.o'
| | - Timothy Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 DeCrespigny Park, London SE5 8AF, United Kingdom.
| | - Graham Blackman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 DeCrespigny Park, London SE5 8AF, United Kingdom.
| | - Jennifer Tavener
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 DeCrespigny Park, London SE5 8AF, United Kingdom.
| | - Anthony S David
- Institute of Mental Health, UCL Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom.
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Korman GP, Sarudiansky M, Lanzillotti AI, Areco Pico MM, Tenreyro C, Valdez Paolasini G, D'Alessio L, Scevola L, Kochen S, Myers L. Long-term outcome in a sample of underprivileged patients with psychogenic nonepileptic seizures (PNES) living in Argentina. Epilepsy Behav 2019; 94:183-188. [PMID: 30965202 DOI: 10.1016/j.yebeh.2019.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the present study was to perform a long-term follow-up of economically disadvantaged Latin American patients diagnosed as having psychogenic nonepileptic seizures (PNES) and contribute to the field's understanding of outcome in this population. BACKGROUND A handful of studies have examined outcome of patients once the diagnosis of PNES has been communicated. However, the vast majority of these have been conducted in the first world countries with samples that were predominantly Caucasian. There is limited knowledge about outcome in economically disadvantaged Latin American patients diagnosed as having PNES. METHODS This is a study of 23 patients (20 women, 3 men) with PNES in which demographic data (age, education, nationality, presence of psychological trauma, age of onset) were retrospectively retrieved from medical files. Follow-up was done through a telephonic questionnaire in which investigators collected clinical information (seizure characteristics at follow-up, and treatments employed) and changes in demographic data. RESULTS Patients from this Argentinian PNES sample demonstrated having many similar demographic and clinical characteristics to samples from US and European studies. Long-term follow-up revealed, however, decreased seizure frequency and intensity as well as a substantial improvement in occupational status. A majority had engaged in psychotherapy as well as alternative and complementary approaches. A majority had also developed what are suspected to be other functional symptoms. CONCLUSIONS Argentinian patients from economically disadvantaged backgrounds, diagnosed as having PNES reported improvements in seizure frequency and occupational status during long-term follow-up. Future studies will need to focus on what (e.g., communication of diagnosis, psychotherapy, alternative treatments) may have contributed to these changes.
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Affiliation(s)
- Guido Pablo Korman
- CAEA, CONICET, Facultad de Psicología, Universidad de Buenos Aires, Argentina.
| | | | | | | | | | | | | | - Laura Scevola
- Mental Health Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | | | - Lorna Myers
- Northeast Regional Epilepsy Group, United States of America
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Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes. Epilepsy Behav 2018; 89:70-78. [PMID: 30384103 DOI: 10.1016/j.yebeh.2018.10.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 11/21/2022]
Abstract
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of individuals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.
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Hyperventilation-Induced Non-epileptic Seizures in an Adolescent Boy with Pediatric Medical Traumatic Stress. Harv Rev Psychiatry 2018; 25:180-190. [PMID: 28471819 DOI: 10.1097/hrp.0000000000000131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Graham CD, O'Hara DJ, Kemp S. A case series of Acceptance and Commitment Therapy (ACT) for reducing symptom interference in functional neurological disorders. Clin Psychol Psychother 2018; 25:489-496. [DOI: 10.1002/cpp.2174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/16/2017] [Accepted: 12/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Christopher D. Graham
- Leeds Institute of Health Sciences; University of Leeds; Leeds UK
- Department of Clinical Neuropsychology; Leeds Teaching Hospitals NHS Trust, St James University Hospital; Leeds UK
| | - Daniel J. O'Hara
- Department of Clinical Neuropsychology; Leeds Teaching Hospitals NHS Trust, St James University Hospital; Leeds UK
| | - Steven Kemp
- Department of Clinical Neuropsychology; Leeds Teaching Hospitals NHS Trust, St James University Hospital; Leeds UK
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An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management. Can J Neurol Sci 2018; 45:130-136. [DOI: 10.1017/cjn.2017.283] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractThe purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity.
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Graham CD, Kyle SD. Further discussion of a preliminary study of sleep quality in functional neurological disorders: A reply to Professor Kawada. J Neurol Sci 2017; 381:346. [DOI: 10.1016/j.jns.2017.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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Kanemoto K, LaFrance WC, Duncan R, Gigineishvili D, Park S, Tadokoro Y, Ikeda H, Paul R, Zhou D, Taniguchi G, Kerr M, Oshima T, Jin K, Reuber M. PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report. Epilepsia Open 2017; 2:307-316. [PMID: 29588959 PMCID: PMC5862115 DOI: 10.1002/epi4.12060] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/05/2023] Open
Abstract
An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.
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Affiliation(s)
- Kousuke Kanemoto
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - W. Curt LaFrance
- Rhode Island HospitalBrown UniversityProvidenceRhode IslandU.S.A.
| | | | - David Gigineishvili
- Department of Neurology & NeurosurgerySarajishvili Institute of NeurologyTbilisi State UniversityTbilisiGeorgia
| | - Sung‐Pa Park
- Department of NeurologyKyungpook National University School of MedicineDaeguKorea
| | - Yukari Tadokoro
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Hiroko Ikeda
- Department of PediatricsEpilepsy CenterNHO Shizuoka Institute of Epilepsy and Neurological DisordersShizuokaJapan
| | - Ravi Paul
- Department of PsychiatrySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Dong Zhou
- Department of NeurologyWest China HospitalSichuan UniversityChengduChina
| | - Go Taniguchi
- Department of Neuropsychiatrythe University of TokyoTokyoJapan
| | - Mike Kerr
- Learning Disability PsychiatryCardiff UniversityCardiffUnited Kingdom
| | - Tomohiro Oshima
- Department of NeuropsychiatryAichi Medical UniversityNagakuteJapan
| | - Kazutaka Jin
- Tohoku Daigaku Daigakuin Igakukei Kenkyuka IgakubuSendaiMiyagiJapan
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The Impact of PNES is About More than Counting Events. Epilepsy Curr 2016; 16:314-315. [PMID: 27799859 DOI: 10.5698/1535-7511-16.5.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Salinsky M, Storzbach D, Goy E, Kellogg M, Boudreau E. Health care utilization following diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2016; 60:107-111. [PMID: 27206227 DOI: 10.1016/j.yebeh.2016.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/21/2016] [Accepted: 04/02/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The long-term outcome of patients with psychogenic nonepileptic seizures (PNES) is of importance given the disabling symptoms and tendency to affect patients early in their productive years. Health care utilization (HCU) is an important outcome measure reflecting overall health status and costs. There is little information regarding long-term HCU following diagnosis of PNES. METHODS We retrospectively reviewed records of Veterans diagnosed with PNES during epilepsy monitoring unit (EMU) evaluation. For the three-year period following diagnosis of PNES, we reviewed emergency department (ED) visits, hospitalizations, outpatient clinic visits, and radiology procedures. We compared the three years following PNES diagnosis with the three years preceding diagnosis. We also compared patients with PNES and patients with epileptic seizures (ES). RESULTS Emergency department visits and hospitalizations were more frequent in patients with PNES compared with those in patients with ES (p=0.01). There was no overall improvement in HCU during the three-year interval following diagnosis of PNES. A transient decrease during the year following diagnosis was not sustained over three-year follow-up. Pain complaints rather than seizures were the most common reason for presentation, whereas the opposite was true for patients with ES (p<0.01). There was a sharp decrease in neurology outpatient visits (p<0.001) and a decrease in primary care visits (p<0.05) after PNES was diagnosed. Total outpatient visits were unchanged. CONCLUSIONS Overall HCU did not improve during the three years following diagnosis of PNES, compared with three years preceding diagnosis. The results add to studies documenting poor seizure outcomes following diagnosis of PNES and underscore the need for more effective and comprehensive treatments, addressing comorbid symptoms.
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Affiliation(s)
- Martin Salinsky
- Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States.
| | - Daniel Storzbach
- Oregon Health & Sciences University, Portland, OR, United States
| | - Elizabeth Goy
- Oregon Health & Sciences University, Portland, OR, United States
| | - Marissa Kellogg
- Oregon Health & Sciences University, Portland, OR, United States
| | - Eilis Boudreau
- Portland Veterans Affairs Medical Center, Portland, OR, United States; Oregon Health & Sciences University, Portland, OR, United States
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De Toffol B, Biberon J, Hingray C, El-Hage W. Crisi non epilettiche psicogene (CNEP). Neurologia 2016. [DOI: 10.1016/s1634-7072(16)77533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hingray C, Biberon J, El-Hage W, de Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris) 2016; 172:263-9. [DOI: 10.1016/j.neurol.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 10/21/2022]
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Abstract
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients' and carers' questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. We reviewed data on prognosis of functional neurologic disorders from two systematic reviews on functional motor disorders and dissociative (nonepileptic) seizures as well as additional studies on functional visual and sensory symptoms. Methodologic problems include heterogeneity in studied samples and outcome measures, diagnostic suspicion and referral bias, small size and retrospective design of available studies, possible treatments during follow-up, and literature review bias. With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. Measures of quality of life and working status were often poor at follow-up. Frequency of misdiagnosis at follow-up was as low as other neurologic and psychiatric disorders. Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. Emotional disorders and personality disorders were inconsistent predictors. Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
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Affiliation(s)
- J Gelauff
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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Wiseman H, Reuber M. New insights into psychogenic nonepileptic seizures 2011-2014. Seizure 2015; 29:69-80. [PMID: 26076846 DOI: 10.1016/j.seizure.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/24/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE There has been a rapid increase in the rate of publications about psychogenic nonepileptic seizures (PNES). This review summarises insights from the 50 most important original articles about PNES published since 2011 and describes the advances made in the understanding of PNES over the last 3 years. METHOD We carried out a systematic literature search of all English language publications about PNES published between October 2011 and October 2014 on Scopus, Ovid Medline and Web of Knowledge, and inspected all abstracts. Having excluded all review articles, case reports, conference abstracts, articles exploring PNES in children, and articles not actually focussing on PNES, we considered 150 papers for inclusion in this review. We assessed the quality of the identified studies and used expert judgement to identify the 50 most important publications from the review period and composed a narrative review based on these original papers. RESULTS Almost one half of the studies initially identified only provided Class 4 evidence. Recent work has provided more support for a biopsychosocial account of PNES. It has illustrated the heterogeneity of PNES, identifying varying and distinct psychological profiles of individuals with this disorder. These findings suggest that intervention needs to be flexible or adaptive if it is appropriately to target the different mechanisms which may give rise to PNES. Several educational and psychotherapeutic interventions for PNES have been described, but sufficiently powered randomised controlled trials are yet to be undertaken. Recent research using social, economic and quality of life indicators has provided further evidence of the societal and individual burden of PNES. CONCLUSION The research into PNES published over the last 3 years has deepened our understanding of the condition as a biopsychosocial disorder which is neither a "physical" nor a "psychological" condition. A number of small studies have demonstrated the potential of educational and psychotherapeutic treatments, but rigorous and sufficiently large trials still need to be conducted to determine the effectiveness of these interventions.
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Affiliation(s)
- Hannah Wiseman
- Academic Neurology Unit, University of Sheffield, United Kingdom.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, United Kingdom
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Dworetzky BA. Issues in PNES Treatment. Epilepsy Curr 2015; 15:68-9. [PMID: 26251642 PMCID: PMC4519018 DOI: 10.5698/1535-7597-15.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
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Baslet G, Dworetzky B, Perez DL, Oser M. Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clin EEG Neurosci 2015; 46:54-64. [PMID: 25465435 PMCID: PMC4552047 DOI: 10.1177/1550059414557025] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) were first described in the medical literature in the 19th century, as seizure-like attacks not related to an identified central nervous system lesion, and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment, and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less well-studied using controlled and uncontrolled trials. Within the discussion of acute interventions, we present a preliminary evaluation for feasibility of a mindfulness-based psychotherapy protocol in a very small sample of PNES patients. We demonstrated in 6 subjects that this intervention is feasible in real-life clinical scenarios and warrants further investigation in larger scale studies. The final treatment phase is long-term follow-up. Long-term outcome studies in PNES show that a significant proportion of patients remains symptomatic and experiences continued impairments in quality of life and functionality. We believe that PNES should be understood as a disease that requires different types of intervention during the various phases of treatment.
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Affiliation(s)
- Gaston Baslet
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Barbara Dworetzky
- Harvard Medical School, Boston, MA, USA Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - David L Perez
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Neurology, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Duncan R, Graham CD, Oto M. Neurologist assessment of reactions to the diagnosis of psychogenic nonepileptic seizures: relationship to short- and long-term outcomes. Epilepsy Behav 2014; 41:79-82. [PMID: 25310503 DOI: 10.1016/j.yebeh.2014.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the relationship between neurologist assessment of reactions to the diagnosis of PNESs and outcomes at 6-12 months and at 5-10 years. METHODS Two hundred thirty-eight patients with psychogenic nonepileptic seizures (PNES) were recruited into a long-term follow-up study. At diagnosis and 6-12 months post diagnosis, doctors recorded their assessments of patient and caregiver reactions to the diagnosis of PNESs. RESULTS At baseline, 92/238 patients (38.7%) and 73/106 caregivers (68.9%) were assessed as having understood and accepted the diagnosis, while 6.7% of patients and 10.4% of caregivers reacted with anger. At 6-12 months, patient acceptance rose to 57.7%, with caregiver acceptance static at 70.8%. Attendance at follow-up was predicted by the presence of a caregiver at baseline: only one patient who came with a caregiver at baseline did not attend at 6-12 months (OR: 123.80, p < 0.001). Outcome at 6-12 months was predicted by patient acceptance at baseline (OR: 2.85, p = 0.006) and at 6-12 months (OR: 13.83, p < 0.001) and by caregiver acceptance at 6-12 months (OR: 10.77, p < 0.001). Presentation to primary or secondary care with attacks at 5-10 years was predicted by caregiver acceptance at 6-12 months (OR: 3.50, p = 0.007). CONCLUSION Patient understanding and acceptance of the diagnosis of PNESs are linked to outcome at 6-12 months. The beliefs of caregivers may be important for outcome in the longer term, particularly with respect to health-care use.
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Affiliation(s)
- Roderick Duncan
- Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand.
| | - Christopher D Graham
- NHS Lothian, Department of Clinical Neuropsychology, Astley Ainslie Hospital, Edinburgh EH9 2HL, Scotland, UK
| | - Maria Oto
- Scottish Epilepsy Centre, Glasgow G51 4QD, Scotland, UK
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