Psychogenic non-epileptic seizures: aetiology, diagnosis and management

2014 ◽  
Vol 20 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Maria Oto ◽  
Markus Reuber
Keyword(s):  
Psychological Treatment ◽  
Epileptic Seizures ◽  
Initial Step ◽  
Diagnosis And Management ◽  
Model Combining ◽  
Underlying Causes ◽  
Iatrogenic Harm ◽  
Patient’S History

SummaryPsychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient's history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

Clinical-Psychological Treatment of Epileptic Seizures: A Controlled Study

1991 ◽  
pp. 81-96 ◽  
Author(s):  
Niels Birbaumer ◽  
Thomas Elbert ◽  
Brigitte Rockstroh ◽  
Irene Daum ◽  
Peter Wolf ◽  
...  
Keyword(s):  
Psychological Treatment ◽  
Epileptic Seizures ◽  
Controlled Study

scholarly journals An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management

2018 ◽  
Vol 45 (2) ◽  
pp. 130-136 ◽  
Author(s):  
Ángela Milán-Tomás ◽  
Michelle Persyko ◽  
Martin del Campo ◽  
Colin M. Shapiro ◽  
Karl Farcnik
Keyword(s):  
Poor Prognosis ◽  
Multidisciplinary Approach ◽  
Treatment Algorithm ◽  
Family Physicians ◽  
Epileptic Seizures ◽  
National Registry ◽  
Diagnosis And Management ◽  
Ovid Medline ◽  
The Family ◽  
Embase Database

AbstractThe purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity.

scholarly journals Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1270-1279 ◽  
Author(s):  
Vassil Traykov ◽  
Maria Grazia Bongiorni ◽  
Giuseppe Boriani ◽  
Haran Burri ◽  
Roberto Costa ◽  
...  
Keyword(s):  
Preventive Measures ◽  
Electronic Device ◽  
Heart Rhythm ◽  
Initial Step ◽  
Needle Aspiration ◽  
Further Education ◽  
Cardiac Implantable Electronic Device ◽  
Infection Rates ◽  
Clinical Practices ◽  
Diagnosis And Management

Abstract Aims Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide. Methods and results A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively. Conclusion Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory.

Neuropsychologist, 14 years’ experience, France; Neuropsychology Intern, France

2020 ◽  
pp. 139-140
Author(s):  
Markus Reuber ◽  
Gregg H. Rawlings ◽  
Steven C. Schachter
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Medical Care ◽  
Medical History ◽  
Posttraumatic Stress ◽  
Traumatic Event ◽  
Epileptic Seizures ◽  
Semistructured Interview ◽  
Car Crash ◽  
Tragic Event ◽  
Patient’S History

This chapter discusses how a patient’s history failed to inform a Neuropsychologist about the patient’s Non-Epileptic Seizures (NES). A comprehensive exploration of the patient’s medical history revealed no specific seizure triggers. At the same time, tests looking for biomedical abnormalities failed to identify any indication of epilepsy. He was then diagnosed with NES and was sent to the Neuropsychologist for a full psychological evaluation. After two interviews, the Neuropsychologist decided to see the patient with his wife, with the aim of exploring the couple’s relationship and sexuality. In this meeting, the Neuropsychologist found out that the patient had been involved in a car crash in which a number of his friends had been instantly killed. During his recovery in the few weeks after this tragic event, the patient exhibited his first non-epileptic seizures. It is very interesting to underline that during the course of his medical care, the patient was unable to discuss this traumatic event, even when interacting with a trained psychologist and during the course of a semistructured interview that involves an assessment of traumatic reactions. Only his body revealed an actual and authentic posttraumatic stress disorder with selective amnesia limited to the triggering event.

An integrated neuropsychiatric approach to diagnosis and management of patients with epileptic seizures

2005 ◽  
Vol 7 (5) ◽  
pp. 389-402 ◽  
Author(s):  
Donald M. Hilty ◽  
James A. Bourgeois ◽  
Steven G. Sugden ◽  
Celia H. Chang ◽  
Mark E. Servis ◽  
...  
Keyword(s):  
Epileptic Seizures ◽  
Diagnosis And Management

Psychological treatments for functional non-epileptic attacks: a systematic review

2009 ◽  
Vol 21 (4) ◽  
pp. 158-168 ◽  
Author(s):  
Danielle Gaynor ◽  
Hannah Cock ◽  
Niruj Agrawal
Keyword(s):  
Systematic Review ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Epileptic Seizures ◽  
Future Research ◽  
Psychological Treatments ◽  
Psychogenic Seizures ◽  
Epileptic Attack ◽  
Behavioural Therapies ◽  
Randomised Controlled

Objective:There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA.Methods:A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded.Results:17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective.Conclusion:While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment.

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