Psychogenic Nonepileptic Seizures in Women

AbstractPsychogenic nonepileptic seizures (PNES) are the most common type of functional neurological symptom disorders and are frequently diagnosed in tertiary care epilepsy monitoring units. These are associated with significant decline in social functioning and quality of life. The majority of patients with PNES are women, outnumbering men by a ratio of 3:1. Female sex preponderance occurs after puberty and usually before the age of 55 years. Many of the psychiatric risk factors in PNES (depression, anxiety, history of traumatic experiences, other somatic symptom disorders) are more common in women and may partially account for the difference in sex prevalence. Neurobiological and neurohumoral mechanisms may also play a role, but our understanding is limited at this point. In this review, we present information on epidemiology and risk factors, neurobiological and psychological mechanisms, clinical approach to diagnosis, evidence-based treatment, and long-term outcomes. We highlight findings related to differences between women and men in PNES. Most of these data are not decisive and require further corroboration. While the disorder may be more frequently suspected in women, all patients with suspected PNES deserve an objective and thorough investigation of their symptoms. Early and accurate identification of this disorder should be a priority, especially as evidence-based treatments, which may lead to improved outcomes, are increasingly available.

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Nonepileptic Events

10.1093/med/9780190228484.003.0024 ◽

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.

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Psychogenic nonepileptic seizures in children—Prospective validation of a clinical care pathway & risk factors for treatment outcome

Epilepsy & Behavior ◽

10.1016/j.yebeh.2020.106971 ◽

2020 ◽

Vol 105 ◽

pp. 106971 ◽

Cited By ~ 3

Author(s):

Tyson Sawchuk ◽

Jeffrey Buchhalter ◽

Birgit Senft

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Care Pathway ◽

Clinical Care ◽

Psychogenic Nonepileptic Seizures ◽

Nonepileptic Seizures ◽

Clinical Care Pathway

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Risk Factors and Outcomes for Vancomycin-ResistantEnterococcusBloodstream Infection in Children

Infection Control and Hospital Epidemiology ◽

10.1086/655464 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1038-1042 ◽

Cited By ~ 14

Author(s):

Eric J. Haas ◽

Theoklis E. Zaoutis ◽

Priya Prasad ◽

Mingyao Li ◽

Susan E. Coffin

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Tertiary Care ◽

Bloodstream Infections ◽

Older Age ◽

The Difference ◽

Nested Case Control ◽

Epidemiological Characteristics

Background and Objective.Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistantEnterococcus(VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptibleEnterococcus(VSE) BSI in this population.Methods.A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.Results.We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).Conclusion.Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

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Anorexia nervosa: diagnosis, risk factors and evidence-based treatments

Progress in Neurology and Psychiatry ◽

10.1002/pnp.452 ◽

2016 ◽

Vol 20 (6) ◽

pp. 24-29c ◽

Cited By ~ 1

Author(s):

Sara Kakhi ◽

Jacinta McCann

Keyword(s):

Risk Factors ◽

Anorexia Nervosa ◽

Evidence Based ◽

Evidence Based Treatments

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Evidence-Based Treatments

10.1093/med/9780190265045.003.0014 ◽

2017 ◽

Author(s):

W. Curt LaFrance ◽

Laura H. Goldstein

Keyword(s):

Treatment Options ◽

Controlled Trials ◽

Limited Sample ◽

Future Studies ◽

Psychogenic Nonepileptic Seizures ◽

The Past ◽

Evidence Based Treatments ◽

Nonepileptic Seizures ◽

New Treatment ◽

Functional Neurological Disorders

Psychogenic nonepileptic seizures (PNES) have been in the medical literature for centuries. However, treatments were limited, being based on uncontrolled data, until the past decade. Treatment advances published since 2010 have included pilot controlled trials using psychotherapies, psychoeducational approaches, medications, and combined pharmacological and psychotherapeutic approaches that provide new treatment options for patients with PNES. This chapter describes these controlled trials in detail. It also covers studies of treatments for other functional neurological disorders including PNES. One conclusion from this review is that future studies still need to improve on as-yet limited sample sizes and provide insights into predictors of treatment outcome so that rational decisions can be made about which treatments offer the best outcome and who is likely to best respond to which treatment.

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Role of Biomarkers in Differentiating New-onset Seizures from Psychogenic Nonepileptic Seizures

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_139_17 ◽

2017 ◽

Vol 08 (04) ◽

pp. 581-584 ◽

Cited By ~ 5

Author(s):

Mahendra Javali ◽

Purushottam Acharya ◽

Shripal Shah ◽

Rohan Mahale ◽

Pushparaja Shetty ◽

...

Keyword(s):

Tertiary Care ◽

Serum Prolactin ◽

Review Of Literature ◽

Partial Seizures ◽

Psychogenic Nonepileptic Seizures ◽

Nonepileptic Seizures ◽

Clonic Seizures ◽

The Mean ◽

New Onset

ABSTRACT Introduction: Review of literature revealed very limited studies considering a combination of serum prolactin (PRL) and serum creatine kinase (CK) as markers for differentiating epileptic and psychogenic nonepileptic seizures (PNES). Therefore, in the present study, we analyzed the role of serum PRL and serum CK, individually and in combination. Methodology: This prospective study was conducted in a tertiary care medical teaching hospital over a period of 18 months. Patients aged over 15 years suspected to have new-onset seizures presenting within 5 h of ictus were included in this study. CK, serum PRL was measured at 0–1, 1–3, and 3–5 h after seizures. Results: Hundred subjects were studied for the role of serum PRL and serum CK in differentiating epileptic and PNES. The mean age was 42.24 years with a male:female ratio of 1.27:1. All patients of generalized tonic–clonic seizures (GTCS), who presented within 1 h, had elevated PRL, whereas 75% of patients with partial seizures had elevated PRL within 1 h of presentation. Nearly 91.66% of patients with GTCS who presented within 1 h had elevated CPK, whereas 70% of patients with partial seizures had elevated CPK. None of the patients diagnosed with PNES showed rise in either of the markers. Conclusion: In the present study, none of the patients with PNES showed raise in either serum PRL or CK. However, there was no correlation between the types of seizure and PRL or serum CK levels.

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