Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: A study of an Argentine population

2013 ◽  
Vol 29 (1) ◽  
pp. 155-160 ◽  
Author(s):  
Laura Scévola ◽  
Julia Teitelbaum ◽  
Silvia Oddo ◽  
Estela Centurión ◽  
César Fabián Loidl ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Drug Resistant ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Drug Resistant Epilepsy

Nonepileptic Events

2017 ◽  
Author(s):  
David K. Chen ◽  
W. Curt LaFrance
Keyword(s):  
Conversion Disorder ◽  
Evidence Based ◽  
Drug Resistant ◽  
Significant Morbidity ◽  
Psychogenic Nonepileptic Seizures ◽  
Clinical Evaluations ◽  
Evidence Based Treatments ◽  
Nonepileptic Seizures ◽  
Drug Resistant Epilepsy ◽  
Underlying Pathology

Nonepileptic events (NEE) represent important differential diagnoses in patients with neurobehavioral paroxysms, especially those with apparent drug-resistant epilepsy. Errant recognition of NEE may not only subject the patient to potential complications of unnecessary epilepsy treatment, but delay the delivery of treatment that properly addresses the underlying pathology. For many patients with NEE, such as those with the conversion disorder psychogenic nonepileptic seizures (PNES) or with physiologic NEE (e.g., cardiac-induced syncope), delays in the provision of proper treatment have been shown to be associated with significant morbidity. This review focuses on clinical evaluations aiming to enhance the recognition of the different etiologies of NEE and distinguish between NEE and epilepsy, as well as between NEE of varying pathologies. Evidence-based treatments and management of NEE, particularly those pertaining to PNES, will also be discussed.

scholarly journals Rational Approach to Children with Drug-Resistant Epilepsy

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Elaine Wirrell
Keyword(s):  
Quality Of Life ◽  
Psychiatric Disorders ◽  
Neurological Disorders ◽  
Poor Quality ◽  
Rational Approach ◽  
Drug Resistant ◽  
Unexpected Death ◽  
Increased Risk ◽  
Drug Resistant Epilepsy

Epilepsy is one of the most common neurological disorders to affect children, and has its highest incidence in infancy. Approximately one-quarter of children have seizures which are drug-resistant, and place the child at increased risk of cognitive delays, attention, behavior and psychiatric disorders, injury, sudden unexpected death and poor quality of life. This article presents a rational approach to the investigation and management of children with drug-resistant epilepsy.    

Eye movement desensitization and reprocessing treatment in functional neurological symptom disorder with psychogenic nonepileptic seizures: A study of two cases

2021 ◽  
pp. 135910452110372
Author(s):  
Onur O Demirci ◽  
Eser Sagaltici
Keyword(s):  
Psychiatric Disorders ◽  
Eye Movement ◽  
Neurological Symptom ◽  
Term Treatment ◽  
Post Traumatic Stress ◽  
Psychogenic Nonepileptic Seizures ◽  
Long Term Treatment ◽  
Scale Scores ◽  
Nonepileptic Seizures ◽  
Functional Neurological Symptom Disorder

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients’ cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.

scholarly journals Neurological disorder-associated genetic variants in individuals with psychogenic nonepileptic seizures

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Costin Leu ◽  
Jocelyn F. Bautista ◽  
Monica Sudarsanam ◽  
Lisa-Marie Niestroj ◽  
Arthur Stefanski ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Genetic Variants ◽  
Large Scale ◽  
Genetic Factors ◽  
Tertiary Care ◽  
Genetic Research ◽  
Genetic Investigation ◽  
Psychogenic Nonepileptic Seizures ◽  
Whole Exome ◽  
Nonepileptic Seizures

Abstract Psychogenic nonepileptic seizures (PNES) are diagnosed in approximately 30% of patients referred to tertiary care epilepsy centers. Little is known about the molecular pathology of PNES, much less about possible underlying genetic factors. We generated whole-exome sequencing and whole-genome genotyping data to identify rare, pathogenic (P) or likely pathogenic (LP) variants in 102 individuals with PNES and 448 individuals with focal (FE) or generalized (GE) epilepsy. Variants were classified for all individuals based on the ACMG-AMP 2015 guidelines. For research purposes only, we considered genes associated with neurological or psychiatric disorders as candidate genes for PNES. We observe in this first genetic investigation of PNES that six (5.88%) individuals with PNES without coexistent epilepsy carry P/LP variants (deletions at 10q11.22-q11.23, 10q23.1-q23.2, distal 16p11.2, and 17p13.3, and nonsynonymous variants in NSD1 and GABRA5). Notably, the burden of P/LP variants among the individuals with PNES was similar and not significantly different to the burden observed in the individuals with FE (3.05%) or GE (1.82%) (PNES vs. FE vs. GE (3 × 2 χ2), P = 0.30; PNES vs. epilepsy (2 × 2 χ2), P = 0.14). The presence of variants in genes associated with monogenic forms of neurological and psychiatric disorders in individuals with PNES shows that genetic factors are likely to play a role in PNES or its comorbidities in a subset of individuals. Future large-scale genetic research studies are needed to further corroborate these interesting findings in PNES.

Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012270
Author(s):  
Anne Sofie Hansen ◽  
Charlotte Ulrikka Rask ◽  
Ann-Eva Christensen ◽  
Maria Rodrigo-Domingo ◽  
Jakob Christensen ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Psychiatric Disorders ◽  
Wide Spectrum ◽  
Psychiatric Evaluation ◽  
Healthy Controls ◽  
Psychogenic Nonepileptic Seizures ◽  
Relative Risks ◽  
Wide Range ◽  
Comparison Groups ◽  
Nonepileptic Seizures

Objective:Knowledge regarding psychiatric disorders in children and adolescents with psychogenic nonepileptic seizures (PNES) is limited. This study outlines the spectrum and risk of psychiatric disorders in childhood-onset PNES.Methods:A nationwide matched cohort study of children and adolescents with PNES aged 5-17 years at time of diagnosis between January 1, 1996 and December 31, 2014. Two matched comparison groups were included: children and adolescents with epilepsy (ES), and children and adolescents without PNES or epilepsy, termed healthy controls (HC). Outcomes were prevalent psychiatric disorders prior to index (i.e. date of diagnosis or corresponding date for HCs), and incident psychiatric disorders two years after index. Relative risks (RRs) were calculated and adjusted for potential confounders.Results:We included 384 children and adolescents with validated PNES, 1,152 with epilepsy, and 1,920 healthy controls. Among the PNES cases, 153 (39.8%) had prevalent psychiatric disorders and 150 (39.1%) incident psychiatric disorders. As compared to the epilepsy and healthy controls, children and adolescents with PNES had elevated risks of both prevalent psychiatric disorders (adjusted RRPNES/ES: 1.87, 95% CI: 1.59–2.21, adjusted RRPNES/HC: 5.54, 95% CI: 4.50–6.81), and incident psychiatric disorders (adjusted RRPNES/ES: 2.33, 95% CI: 1.92–2.83, adjusted RRPNES/HC: 8.37, 95% CI: 6.31–11.11). A wide spectrum of specific psychiatric disorders displayed elevated RRs.Conclusions:Children and adolescents with PNES are at higher risk of a wide range of psychiatric disorders as compared to children and adolescents with epilepsy and healthy controls. A careful psychiatric evaluation is warranted to optimize and individualize treatment.

scholarly journals Mortality in patients with psychogenic nonepileptic seizures

Neurology ◽  
2020 ◽  
Vol 95 (6) ◽  
pp. e643-e652 ◽  
Author(s):  
Russell Nightscales ◽  
Lara McCartney ◽  
Clarissa Auvrez ◽  
Gerard Tao ◽  
Sarah Barnard ◽  
...  
Keyword(s):  
General Population ◽  
Standardized Mortality Ratio ◽  
Psychogenic Nonepileptic Seizures ◽  
Risk Of Death ◽  
Significant Difference ◽  
Tertiary Hospitals ◽  
Mortality Ratio ◽  
Nonepileptic Seizures ◽  
External Causes ◽  
Drug Resistant Epilepsy

ObjectiveTo investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population.MethodsThis retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports.ResultsA total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0–3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4–19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and “epilepsy” was recorded as the cause of death in 24%.ConclusionsPatients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.

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