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Asadi-Pooya AA, Brigo F, Trinka E, Lattanzi S, Adel Kishk N, Karakis I, Ristic AJ, Alsaadi T, Alkhaldi M, Turuspekova ST, Aljandeel G, Al-Asmi A, Contreras G, Daza-Restrepo A, Kutlubaev MA, Guekht A, Calle-López Y, Jusupova A, San-Juan D, Khachatryan SG, Gigineishvili D, Mesraoua B, Dubenko A, Mirzaei Damabi N. A global survey on the attitudes of neurologists and psychiatrists about functional/psychogenic/dissociative/nonepileptic-seizures/attacks, in the search of its name. Epilepsy Behav 2023; 145:109292. [PMID: 37321160 DOI: 10.1016/j.yebeh.2023.109292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE We conducted an observational study to investigate the opinions of neurologists and psychiatrists all around the world who are taking care of patients with seizures [epilepsy and functional seizures (FS)]. METHODS Practicing neurologists and psychiatrists from around the world were invited to participate in an online survey. On 29th September 2022, an e-mail including a questionnaire was sent to the members of the International Research in Epilepsy (IR-Epil) Consortium. The study was closed on 1st March 2023. The survey, conducted in English, included questions about physicians' opinions about FS and anonymously collected data. RESULTS In total, 1003 physicians from different regions of the world participated in the study. Both neurologists and psychiatrists identified "seizures" as their preferred term. Overall, the most preferred modifiers for "seizures" were "psychogenic" followed by "functional" by both groups. Most participants (57.9%) considered FS more difficult to treat compared to epilepsy. Both psychological and biological problems were considered as the underlying cause of FS by 61% of the respondents. Psychotherapy was considered the first treatment option for patients with FS (79.9%). CONCLUSION Our study represents the first large-scale attempt of investigating physicianś attitudes and opinions about a condition that is both frequent and clinically important. It shows that there is a broad spectrum of terms used by physicians to refer to FS. It also suggests that the biopsychosocial model has gained its status as a widely used framework to interpret and inform clinical practice on the management of patients.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute Neuroscience Christian-Doppler Medical Centre, Paracelsus Medical University, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria; Member of the European Referencenetwork EpiCARE, European; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology,Hall in Tirol, Austria.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
| | - Nirmeen Adel Kishk
- Department of Neurology, Cairo University Epilepsy Unit (CUEU), School of Medicine, Cairo University, Cairo, Egypt.
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Aleksandar J Ristic
- Clinic for Neurology, Clinical Center of Serbia, Medical Faculty University of Belgrade, Serbia.
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, and Khalifa University, Abu Dhabi, UAE.
| | - Modhi Alkhaldi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 34212, Dammam, Saudi Arabia.
| | - Saule T Turuspekova
- Department of Nervous Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq.
| | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Oman.
| | | | - Anilu Daza-Restrepo
- Neurosciences and Complex Systems Unit (ENyS), Epilepsy Unit, CONICET, Hosp. El Cruce "N. Kirchner", Univ. Nat. A. Jauretche (UNAJ), F. Varela, Prov. Buenos Aires, Argentina.
| | - Mansur A Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa., Russia.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Yamile Calle-López
- Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Hospital Universitario San Vicente Fundación, Medellín, Colombia.
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan.
| | - Daniel San-Juan
- Epilepsy Clínic. National Institute of Neurology and Neurosurgery, México City, Mexico.
| | - Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia.
| | - David Gigineishvili
- Institute of Neurology, Javakhishvili Tbilisi State University, Department of Neurology & Neurosurgery, Tbilisi, Georgia.
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar.
| | - Andriy Dubenko
- Institute of Neurology, Psychiatry and Narcology of NAMS, Ukraine.
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Ladino LD, Benjumea-Cuartas V, Calle-López Y, Orozco-Hernández JP, Castrillón-Velilla DM, López-González R, Daza-Restrepo A, Genel Castillo MA, Reuber M, Denton A, Tellez-Zenteno JF. Psychogenic nonepileptic seizures in Latin America: A survey describing current practices. Epilepsy Behav 2021; 114:107150. [PMID: 32507294 DOI: 10.1016/j.yebeh.2020.107150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. This study provides an overview of diagnostic and treatment services for patients with PNES across Latin America. METHODS In 2017-2018, clinicians practicing in Latin America with responsibilities for patients with PNES were contacted to respond to a survey regarding the management of this disorder developed by the International League Against Epilepsy (ILAE) PNES Task Force. RESULTS Three hundred and sixty responses from 17 Latin American countries were analyzed. Most respondents were neurologists (81%) under 40 years of age (61%). Fifty-seven percent of professionals stated that they personally diagnose PNES, but only 33% stated that they provide follow-up, and only 20% that they recommend treatment. Many participants (54%) characterized themselves as either unfamiliar with the diagnosis or inexperienced in arranging treatment. Most respondents reported having access to brain magnetic resonance imaging (MRI; 88%) and routine electroencephalogram (EEG; 71%), 64% have the access to video-EEG longer than 8 h, and 54% of professionals performed video-EEG to confirm PNES diagnoses. Although cognitive-behavioral therapy was recognized as the treatment of choice (by 82% of respondents), there was little access to it (60%). In contrast, a high proportion of respondents reported using antidepressant (67%), antiseizure (57%), and antipsychotic medications (54%) as treatments for PNES. SIGNIFICANCE This study reveals several deficiencies in the diagnosis and treatment of patients with PNES in Latin America. The barriers are reinforced by lack of knowledge among the specialists and poor healthcare system support. There is inadequate access to prolonged video-EEG and psychotherapy. An inappropriate use of antiseizure medicines seems commonplace, and there are low follow-up rates by neurologists after the diagnosis. Multidisciplinary guidelines are required to improve the approach of patients with PNES.
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Affiliation(s)
- Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia.
| | | | - Yamile Calle-López
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia
| | | | | | - Reydmar López-González
- Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia
| | | | - Mario Alberto Genel Castillo
- Unidad de Monitoreo de Epilepsia del Instituto de Ciencias Cardiovasculares del Hospital del Prado en Tijuana, Mexico
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Alyssa Denton
- Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - José F Tellez-Zenteno
- Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Stefanski A, Calle-López Y, Leu C, Pérez-Palma E, Pestana-Knight E, Lal D. Clinical sequencing yield in epilepsy, autism spectrum disorder, and intellectual disability: A systematic review and meta-analysis. Epilepsia 2020; 62:143-151. [PMID: 33200402 PMCID: PMC7839709 DOI: 10.1111/epi.16755] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
Objective Clinical genetic sequencing is frequently utilized to diagnose individuals with neurodevelopmental disorders (NDDs). Here we perform a meta‐analysis and systematic review of the success rate (diagnostic yield) of clinical sequencing through next‐generation sequencing (NGS) across NDDs. We compare the genetic testing yield across NDD subtypes and sequencing technology. Methods We performed a systematic review of the PubMed literature until May 2020. We included clinical sequencing studies that utilized NGS in individuals with epilepsy, autism spectrum disorder (ASD), or intellectual disability (ID). Data were extracted, reviewed, and categorized according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Two investigators performed clinical evaluation and grouping following the International League Against Epilepsy (ILAE) guidelines. Pooled rates of the diagnostic yield and 95% confidence intervals were estimated with a random‐effects model. Results We identified 103 studies (epilepsy, N = 72; ASD, N = 14; ID, N = 21) across 32,331 individuals. Targeted gene panel sequencing was used in 73, and exome sequencing in 36 cohorts. Given highly selected patient cohorts, the diagnostic yield was 17.1% for ASD, 24% for epilepsy, and 28.2% for ID (23.7% overall). The highest diagnostic yield for epilepsy subtypes was observed in individuals with ID (27.9%) and early onset seizures (36.8%). The diagnostic yield for exome sequencing was higher than for panel sequencing, even though not statistically significant (27.2% vs 22.6%, P = .071). We observed that clinical sequencing studies are performed predominantly in countries with a high Inequality‐adjusted Human Development Index (IHDI) (countries with sequencing studies: IHDI median = 0.84, interquartile range [IQR] = 0.09 vs countries without sequencing studies: IHDI median = 0.56, IQR = 0.3). No studies from Africa, India, or Latin America were identified, indicating potential barriers to genetic testing. Significance This meta‐analysis and systematic review provides a comprehensive overview of clinical sequencing studies of NDDs and will help guide policymaking and steer decision‐making in patient management.
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Affiliation(s)
- Arthur Stefanski
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yamile Calle-López
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Program, Neuroclinica, University of Antioquia, Medellín, CO, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Eduardo Pérez-Palma
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elia Pestana-Knight
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA.,Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
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Abstract
Psychogenic nonepileptic seizures (PNES) are episodes of seizure-like symptoms that are not associated with epileptiform discharges on electroencephalogram (EEG). They can be remarkably difficult to distinguish from epileptic seizures: both may involve alterations in mental status and behavior, sensory or perceptual disturbances, as well as simple or complex motor patterns. Pictorial expressions of PNES have always attracted attention from the lay public and medical practitioners alike, by showing the rich variety of semiologies seen in the condition and its differences with epileptic seizures. In this article, we present two new contemporary artistic descriptions by the Canadian artist Iris Hauser about PNES. The depictions highlight key signs seen in PNES such as "eyes closed during events", "the hyperextension of the back and limbs", and the "claw-like finger posturing". We believe that the drawings can provide a valuable educational component in the initial assessment of patients suspected of having PNES as a training tool to identify and refer patients for more advanced testing.
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Affiliation(s)
- Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, Medellin, Colombia; Neurology Section, University of Antioquia, NeuroClínica, Medellin, Colombia.
| | - Yamile Calle-López
- Neurology Section, University of Antioquia, NeuroClínica, Medellin, Colombia
| | - Alexandra Carter
- Saskatchewan Epilepsy Program, Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - José Francisco Tellez-Zenteno
- Saskatchewan Epilepsy Program, Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada.
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