scholarly journals Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Andreas Liampas ◽  
Sofia Markoula ◽  
Panagiotis Zis ◽  
Markus Reuber
Keyword(s):  
Muscle Tone ◽  
Body Movement ◽  
Epileptic Seizures ◽  
Psychological Trauma ◽  
Aetiological Factor ◽  
Diagnostic Challenge ◽  
Seizure Disorders ◽  
Antiepileptic Drug Treatment ◽  
The Right ◽  
Patients With Epilepsy

AbstractEpilepsy is a risk factor for the development of psychogenic non-epileptic seizures (PNES) and comorbid epilepsy is recognized as a comorbidity in about 10–30% of patients with PNES. The combination of epileptic and nonepileptic seizures poses a particular diagnostic challenge. In patients with epilepsy, additional PNES may be suspected on the basis of their typical semiology. The possibility of additional PNES should also be considered if seizures fail to respond to antiepileptic drug treatment, in patients with frequent emergency admissions with seizures and in those who develop new types of seizures. The description of semiological details by patients and witnesses can suggest additional PNES. Home video recordings can support an initial diagnosis, however, especially in patients with mixed seizure disorders it is advisable to seek further diagnostic confirmation by capturing all habitual seizure types with video-EEG. The clinical features of PNES associated with epilepsy are similar to those in isolated PNES disorders and include longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes and mouth, ictal crying, recall of ictal experiences and absence of postictal confusion. PNES can also present as syncope-like episodes with unresponsiveness and reduced muscle tone. There is no unique epileptological or brain pathology profile putting patients with epilepsy at risk of additional PNES. However, patients with epilepsy and PNES typically have lower educational achievements and higher levels of psychiatric comorbidities than patients with epilepsy alone. Psychological trauma, including sexual abuse, appears to be a less relevant aetiological factor in patients with mixed seizure disorders than those with isolated PNES, and the gender imbalance (i.e. the greater prevalence in women) is less marked in patients with PNES and additional epilepsy than those with PNES alone. PNES sometimes develop after epilepsy surgery. A diagnosis of ‘known epilepsy’ should never be accepted without (at least brief) critical review. This narrative review summarises clinical, electrophysiological and historical features that can help identify patients with epilepsy and additional PNES.

Neurologist, 25 years’ experience, UK

2020 ◽  
pp. 3-7
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Drug Treatment ◽  
Epileptic Seizure ◽  
Recovery Room ◽  
Epileptic Seizures ◽  
Functional Changes ◽  
Seizure Disorders ◽  
Key Skills ◽  
Antiepileptic Drug Treatment ◽  
Sedative Drugs ◽  
New Diagnosis

This chapter examines two stories of psychogenic non-epileptic seizures (PNES). These dramatic narratives demonstrate how physical and real the effects of PNES are on people’s lives. Both cases also show the impossibility of separating body from mind. Miss A.’s non-epileptic seizure in the recovery room may have been triggered by the sensations associated with waking from her anesthetic, but it is likely to have been prolonged by the sedative drugs she was given in the attempt to stop it. Meanwhile, Mister B.’s dissociative seizure disorder may well have been precipitated by the challenges associated with adjusting to the new diagnosis of epilepsy, but it may have been facilitated by the physical or functional changes in his brain associated with the epileptic seizures. The depression, which may have been physically or psychologically related to the development of his epilepsy or the antiepileptic drug treatment, probably made an etiological contribution to the non-epileptic seizures as well. What these cases also illustrate is how, in the treatment of patients with seizure disorders, listening and observing continue to be the key skills clinicians need as they try to manage conflicts between the need for action and uncertainties, which characterize so much of epileptological practice.

scholarly journals The effectiveness of antiepileptic drug treatment in glioma patients: lamotrigine versus lacosamide

2021 ◽  
Author(s):  
Mark P. van Opijnen ◽  
Pim B. van der Meer ◽  
Linda Dirven ◽  
Marta Fiocco ◽  
Mathilde C. M. Kouwenhoven ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cumulative Incidence ◽  
Primary Outcome ◽  
Risk Model ◽  
Epileptic Seizures ◽  
Diffuse Glioma ◽  
Tumor Patients ◽  
Significant Difference ◽  
Antiepileptic Drug Treatment ◽  
Patients With Epilepsy

Abstract Purpose Optimal treatment with antiepileptic drugs (AEDs) is an important part of care for brain tumor patients with epileptic seizures. Lamotrigine and lacosamide are both examples of frequently used non-enzyme inducing AEDs with limited to no drug-drug interactions, reducing the risk of unfavorable side effects. This study aimed to compare the effectiveness of lamotrigine versus lacosamide. Methods In this multicenter study we retrospectively analyzed data of patients with diffuse grade 2–4 glioma with epileptic seizures. All patients received either lamotrigine or lacosamide during the course of their disease after treatment failure of first-line monotherapy with levetiracetam or valproic acid. Primary outcome was the cumulative incidence of treatment failure, from initiation of lamotrigine or lacosamide, with death as competing event, for which a competing risk model was used. Secondary outcomes were uncontrolled seizures after AED initiation and level of toxicity. Results We included a total of 139 patients of whom 61 (44%) used lamotrigine and 78 (56%) used lacosamide. At 12 months, there was no statistically significant difference in the cumulative incidence of treatment failure for any reason between lamotrigine and lacosamide: 38% (95%CI 26–51%) versus 30% (95%CI 20–41%), respectively. The adjusted hazard ratio for treatment failure of lacosamide compared to lamotrigine was 0.84 (95%CI 0.46–1.56). The cumulative incidences of treatment failure due to uncontrolled seizures (18% versus 11%) and due to adverse events (17% versus 19%) did not differ significantly between lamotrigine and lacosamide. Conclusion Lamotrigine and lacosamide show similar effectiveness in diffuse glioma patients with epilepsy.

P12.01 The effectiveness of antiepileptic drug treatment in glioma patients: lamotrigine versus lacosamide

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii30-ii30
Author(s):  
M P van Opijnen ◽  
P B van der Meer ◽  
L Dirven ◽  
M Fiocco ◽  
M C M Kouwenhoven ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cumulative Incidence ◽  
Primary Outcome ◽  
Risk Model ◽  
Epileptic Seizures ◽  
Diffuse Glioma ◽  
Tumor Patients ◽  
Significant Difference ◽  
Antiepileptic Drug Treatment ◽  
Patients With Epilepsy

Abstract BACKGROUND Optimal treatment with antiepileptic drugs (AEDs) is an important part of care for brain tumor patients with epileptic seizures. Lamotrigine and lacosamide are both examples of frequently used non-enzyme inducing AEDs with limited to no drug-drug interactions, reducing the risk of unfavorable side effects. This study aimed to compare the effectiveness of lamotrigine versus lacosamide. MATERIAL AND METHODS In this multicenter study we retrospectively analyzed data of patients with diffuse grade 2–4 glioma with epileptic seizures. All patients received either lamotrigine or lacosamide during the course of their disease after treatment failure of first-line monotherapy with levetiracetam or valproic acid. Primary outcome was the cumulative incidence of treatment failure, from initiation of lamotrigine or lacosamide, with death as competing event, for which a competing risk model was used. Secondary outcomes were uncontrolled seizures after AED initiation and level of toxicity. RESULTS We included a total of 139 patients of whom 61 (44%) used lamotrigine and 78 (56%) used lacosamide. At 12 months, there was no statistically significant difference in the cumulative incidence of treatment failure for any reason between lamotrigine and lacosamide: 38% (95%CI: 26–51%) versus 30% (95%CI: 20–41%), respectively. The adjusted hazard ratio for treatment failure of lacosamide compared to lamotrigine was 0.84 (95%CI: 0.46–1.56). The cumulative incidences of treatment failure due to uncontrolled seizures (18% versus 11%) and due to adverse events (17% versus 19%) did not differ significantly between lamotrigine and lacosamide. CONCLUSION Lamotrigine and lacosamide show similar effectiveness in diffuse glioma patients with epilepsy.

The Effectiveness of Antiepileptic Drug Treatment in Glioma Patients: Lamotrigine Versus Lacosamide

2021 ◽  
Author(s):  
Mark van Opijnen ◽  
Pim van der Meer ◽  
Linda Dirven ◽  
Marta Fiocco ◽  
Mathilde Kouwenhoven ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cumulative Incidence ◽  
Primary Outcome ◽  
Risk Model ◽  
Epileptic Seizures ◽  
Diffuse Glioma ◽  
Tumor Patients ◽  
Significant Difference ◽  
Antiepileptic Drug Treatment ◽  
Patients With Epilepsy

Abstract Purpose: Optimal treatment with antiepileptic drugs (AEDs) is an important part of care for brain tumor patients with epileptic seizures. Lamotrigine and lacosamide are both examples of frequently used non-enzyme inducing AEDs with limited to no drug-drug interactions, reducing the risk of unfavorable side effects. This study aimed to compare the effectiveness of lamotrigine versus lacosamide.Methods: In this multicenter study we retrospectively analyzed data of patients with diffuse grade 2-4 glioma with epileptic seizures. All patients received either lamotrigine or lacosamide during the course of their disease after treatment failure of first-line monotherapy with levetiracetam or valproic acid. Primary outcome was the cumulative incidence of treatment failure, from initiation of lamotrigine or lacosamide, with death as competing event, for which a competing risk model was used. Secondary outcomes were uncontrolled seizures after AED initiation and level of toxicity.Results: We included a total of 139 patients of whom 61 (44%) used lamotrigine and 78 (56%) used lacosamide. At 12 months, there was no statistically significant difference in the cumulative incidence of treatment failure for any reason between lamotrigine and lacosamide: 38% (95%CI: 26-51%) versus 30% (95%CI: 20-41%), respectively. The adjusted hazard ratio for treatment failure of lacosamide compared to lamotrigine was 0.84 (95%CI: 0.46-1.56). The cumulative incidences of treatment failure due to uncontrolled seizures (18% versus 11%) and due to adverse events (17% versus 19%) did not differ significantly between lamotrigine and lacosamide. Conclusion: Lamotrigine and lacosamide show similar effectiveness in diffuse glioma patients with epilepsy.

The use of progesterone during pregnancy in women with epilepsy as an alternative to the correction of doses of anticonvulsants

GYNECOLOGY ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 12-15
Author(s):  
Elena V. Tsallagova ◽  
Vasily O. Generalov ◽  
Timur R. Sadykov
Keyword(s):  
Clinical Remission ◽  
Epileptic Seizures ◽  
Progesterone Concentration ◽  
Teratogenic Effects ◽  
Safe Alternative ◽  
Patients With Epilepsy

Pregnancy is the most dangerous period in terms of interruption of even persistent and long-term remission. At the same time increasing the dose of anticonvulsant increases the risk of teratogenic effects. Aim. to assess the possibility of using progesterone to prevent relapse of epileptic seizures during pregnancy. Materials and methods. 38 pregnant patients with epilepsy with clinical remission before pregnancy, with relapse of epileptic seizures in I trimester of pregnancy, age 31.81.4 years. Dydrogesterone in a dose of 10 to 60 mg/day was prescribed after the relapse of remission. Anticonvulsant dosage was not changed. The blood progesterone concentration and EEG control was carried out. Results. During pregnancy, the level of progesterone in the blood gradually increased from 77.8 nmol/l at 78 weeks of pregnancy to 521.1 nmol/l at 3637 weeks of pregnancy, without exceeding the limits. EEG results did not deteriorate. None of the patients had seizures during pregnancy. Conclusion. Progesterone therapy is an adequate and safe alternative to increasing the dose of anticonvulsants in case of recurrent seizures during pregnancy.

scholarly journals Perception about Etiology of Epilepsy and Help-Seeking Behavior in Patients with Epilepsy

2021 ◽  
Author(s):  
Gautam Das ◽  
Samar Biswas ◽  
Souvik Dubey ◽  
Durjoy Lahiri ◽  
Biman Kanti Ray ◽  
...  
Keyword(s):  
Help Seeking ◽  
Tertiary Care ◽  
Epileptic Seizures ◽  
Treatment Seeking ◽  
Professional Help ◽  
Epileptic Patients ◽  
Seeking Behavior ◽  
Tertiary Care Centers ◽  
Patients With Epilepsy

Abstract Objectives Patients with epilepsy and their family have diverse beliefs about the cause of their illness that generally determine their treatment-seeking behavior. In this study, our aim was to find out different beliefs about epilepsy that lead to different help-seeking patterns, which act as barrier to the intended modern medical management of epilepsy. Materials and Methods One hundred and fifty consecutive consenting patients accompanied by a reliable informant/family member fulfilling the International Classification of Epileptic Seizures (ICES), simplified version, were included. Demographic and clinical data of all the eligible subjects was collected. Perceived cause of illness and help-seeking pattern were explored from patient/informant by administering proper instruments. Results Respondents identified varied causes of epilepsy and explored multiple help-seeking options before reaching tertiary care centers. We observed that, generally, epileptic patients/relatives who had belief in causes like supernatural causes sought help from nonprofessional personnel and those attributed their symptom to bodily pathology had professional help-seeking. Conclusions The belief in supernatural causes not being conformed to the biomedical models of the epileptic disorders increases the treatment gap.

Comparison of Personality Characteristics on the Bear-Fedio Inventory Between Patients With Epilepsy and Those With Non-Epileptic Seizures

2012 ◽  
Vol 24 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Geoffrey Tremont ◽  
Megan M. Smith ◽  
Lyndsey Bauer ◽  
Michael L. Alosco ◽  
Jennifer D. Davis ◽  
...  
Keyword(s):  
Epileptic Seizures ◽  
Personality Characteristics ◽  
Patients With Epilepsy

scholarly journals Nasal Sinus Tract of Odontogenic Origin: Report of a Case

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Sagar Sareen ◽  
Anjani Kumar Pathak ◽  
Parth Purwar ◽  
Jaya Dixit ◽  
Divya Singhal ◽  
...  
Keyword(s):  
Holistic Approach ◽  
Health Care Research ◽  
Sinus Tract ◽  
Treatment Modalities ◽  
Diagnostic Challenge ◽  
Nasal Sinus ◽  
Comprehensive Management ◽  
Odontogenic Origin ◽  
The Right

Extraoral sinus tract often poses a diagnostic challenge to the clinician owing to its rare occurrence and absence of symptoms. The accurate diagnosis and comprehensive management are inevitable as the aetiology of such lesions is often masked and requires holistic approach. The present case report encompasses the management of an extraoral discharging sinus tract at the base of the right nostril in a chronic smoker. The lesion which was earlier diagnosed to be of nonodontogenic origin persisted even after erratic treatment modalities. Our investigations showed the aetiology of sinus tract to be odontogenic. Initially, a five-step program as recommended by the Agency for Health Care Research and Quality was used for smoking cessation followed by root canal therapy (RCT) and surgical management of the sinus tract. The patient has been under stringent follow-up and no reoccurrence has been noted.

Non-central serous chorioretinopathy in a patient with systemic lupus erythematosus and hydroxychloroquine retinopathy

2021 ◽  
Vol 14 (1) ◽  
pp. e237243
Author(s):  
Diogo Hipolito-Fernandes ◽  
Maria Elisa Luís ◽  
Rita Flores ◽  
Rita Anjos
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Systemic Lupus ◽  
Diagnostic Challenge ◽  
Hydroxychloroquine Retinopathy ◽  
The Right

Subretinal fluid accumulation in a patient with systemic lupus erythematosus (SLE) may represent a diagnostic challenge. We present a case of a 43-year-old man with baseline diagnosis of SLE and hydroxychloroquine-associated maculopathy who reported progressive vision loss on the right eye, associated with corticosteroids use for an arthritic crisis. Ophthalmological examination did not reveal any acute finding. On optical coherence tomography, subretinal fluid in the perifoveal area was visible on the right eye, with corresponding enlargement of the visual field defect. An increased choroidal thickness was also visible. Fluorescein angiography revealed, on the right eye, two pinpoint areas of leakage and indocyanine green angiography signs of choroidal vascular hyperpermeability. Considering a diagnosis of a non-central central serous chorioretinopathy, corticosteroids use was interrupted, with resolution of the subretinal fluid. This case illustrates the relevance of a multimodal imaging approach to guide the diagnosis of patient with an SLE with subretinal fluid.

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