Furthering the Evidence of Comorbid Psychiatric Disorders in Pediatric Patients With Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) are defined by episodes of abnormal movement, sensations, or cognitive experiences similar to epileptic seizures. These events, however, are not related to abnormal electrical brain discharges and are thought to be cause by a psychological process. Children appear to carry a lower risk for PNES compared to adults and yet this diagnosis maybe present in up to 10% of the pediatric patients. The main features of PNES in such age group is discussed.

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

Clinical Child Psychology and Psychiatry ◽

10.1177/13591045211037276 ◽

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.

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

Scientific Reports ◽

10.1038/s41598-020-72101-8 ◽

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.

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Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures

Neurology ◽

10.1212/wnl.0000000000012270 ◽

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.

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The Roles of the Patient and Family

10.1093/med/9780190265045.003.0016 ◽

2017 ◽

Author(s):

Julia L. Doss ◽

Jeffrey Mark Robbins

Keyword(s):

Outpatient Treatment ◽

Pediatric Patients ◽

Physical Symptoms ◽

Adult Patients ◽

Psychogenic Nonepileptic Seizures ◽

Ongoing Process ◽

The Family ◽

Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) is a complicated disorder to both diagnose and treat. While challenging to manage, the physical symptoms represent only a part of the treatment of PNES. This chapter addresses how to approach the family and the patient from the first diagnostic encounter to the evolving process of outpatient treatment. In addition, working with pediatric and adult patients differs significantly. Pediatric patients with PNES must develop tools for improved management of their symptoms first and then proceed to working on underlying stressors. For adult patients, making the connection between symptoms and underlying stressors is an ongoing process that is woven throughout the course of treatment. Both an adult and a child case are presented to further illustrate these dynamics.

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