Epilepsy in patients with psychogenic non-epileptic seizures (original) (raw)
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Article Epilepsy in patients with psychogenic non-epileptic seizures
2016
The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50 % (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolongi...
Psychogenic non-epileptic seizures: aetiology, diagnosis and management
Advances in Psychiatric Treatment, 2014
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.
Epilepsia, 2006
Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video-EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.
The diagnosis of psychogenic non-epileptic seizures: A review
Seizure, 1997
Diagnosing psychogenic non-epileptic seizures (PNES) is a clinical challenge. There is neither a standard in diagnosing PNES nor a comprehensive theoretical framework for this type of seizure. The diagnosis of PNES must be made by excluding epilepsy. However, epilepsy cannot always be determined and PNES and epileptic seizures may coexist. In this study, the characteristics of PNES and patients are discussed. The diagnosis of PNES and epileptic seizures was facilitated by the simultaneous recording of seizures on video tape and EEG. Seizure provoking techniques, hormonal indices, and psychological methods were also used. The benefits and limitations of these techniques are discussed and proposals are made for clinical guidelines.
Epilepsia, 2013
An international consensus group of clinician-researchers in epilepsy, neurology, neuropsychology, and neuropsychiatry collaborated with the aim of developing clear guidance on standards for the diagnosis of psychogenic nonepileptic seizures (PNES). Because the gold standard of video electroencephalography (vEEG) is not available worldwide, or for every patient, the group delineated a staged approach to PNES diagnosis. Using a consensus review of the literature, this group evaluated key diagnostic approaches. These included: history, EEG, ambulatory EEG, vEEG/monitoring, neurophysiologic, neurohumoral, neuroimaging, neuropsychological testing, hypnosis, and conversation analysis. Levels of diagnostic certainty were developed including possible, probable, clinically established, and documented diagnosis, based on the availability of history, witnessed event, and investigations, including vEEG. The aim and hope of this report is to provide greater clarity about the process and certainty of the diagnosis of PNES, with the intent to improve the care for people with epilepsy and nonepileptic seizures.
Psychogenic non-epileptic seizures—Diagnostic issues: A critical review
Clinical Neurology and Neurosurgery, 2009
In this review we systematically assess our current knowledge about psychogenic non-epileptic seizures (PNES), epidemiology, etiology, with an emphasis on the diagnostic issues. Relevant studies were identified by searching the electronic databases. Case reports were not considered. Articles were included when published after 1980 up till 2005 (26 years). A total of 84 papers were identified; 60 of which were actual studies. Most studies have serious methodological limitations. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. The incidence of PNES in the general population is low. However, a relatively high prevalence is seen in patients referred to epilepsy centres (15-30%). Caution is needed in the clinical interpretation of ictal features suggested to be pathognomic for PNES. Video-EEG is widely considered to be the gold standard for diagnosing PNES. Still the differential diagnosis epileptic/non-epileptic seizures can be difficult. Despite the current available technical facilities, the mean latency between onset of PNES and final diagnosis as being nonepileptic and psychogenic is approximately 7 years. One of the reasons for diagnostic delay is that the diagnosis of PNES is often limited to a 'negative' process and consequently PNES is characterized as a 'non-disease' (i.e. 'not epilepsy'). The psychological diagnosis is thus an important, although not a conclusive, 'second phase' aspect of medical decision making. Specific relations between seizure presentation and underlying psychological mechanisms are not conclusive. A classification between major motor manifestations and unresponsiveness is recognized. With respect to psychological etiology, a heterogeneous set of factors have been identified that may be involved in the causation, development and provocation of PNES.
Clinical differentiation of psychogenic non-epileptic seizure: a practical diagnostic approach
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background Psychogenic non-epileptic seizure (PNES) has long been the counterpart of epileptic seizure (ES). Despite ample of evidence differentiating the two, PNES mistakenly diagnosed as ES was still common, resulting in unnecessary exposure to long-term antiepileptic medications and reduced patient’s and caregiver’s quality of life, not to mention the burgeoning financial costs. Objectives In this review, we aimed to elucidate various differences between PNES and epileptic seizure with respect to baseline characteristics, seizure semiology, EEG pattern, and other key hallmark features. Methods An unstructured search was carried out in PubMed, MEDLINE, and EMBASE using keywords pertinent to PNES and ES differentiation. Relevant information was subsequently summarized herein. Results PNES differs significantly with ES in terms of baseline characteristics, prodromal symptoms, seizure semiology, presence of pseudosleep, and other hallmark features (for instance provoking seizure with...
Epilepsy & Behavior, 2009
We followed 103 patients for 6-16 months after discharge from elective long-term video/EEG monitoring to compare clinical outcomes and quality of life between patients diagnosed with epileptic (ES) and those diagnosed with psychogenic nonepileptic (PNES) seizures. Outcome measures determined at telephone or mail follow-up included seizure frequency, antiepileptic drug use, and self-reported quality of life using the Quality of Life in Epilepsy inventory. Of the 62 responders, 41 were diagnosed with ES and 11 with PNES, using strictly applied criteria. Those with ES reported significant improvement in Seizure Worry (P = 0.003), Medication Side Effects (P < 0.001), and Social Function (P < 0.001). In addition, both groups showed a decrease in seizure frequency. Furthermore, both groups showed a significant decrease in antiepileptic drug use at follow-up, with a greater, and sustained, decrease for the PNES group. Approximately half the patients in each group reported an improvement in overall condition.
Treatment and Diagnosis of Psychogenic Nonepileptic Seizures
Seizures, 2018
Psychogenic nonepileptic seizure (PNES) is one of the most common clinical conditions in which the diagnostic complexity is experienced. Misdiagnosis leads to many years of wrong treatment regimens, side effects of drugs, additional financial burdens and adverse effects on social life. Differential diagnosis with epileptic seizures (ES) is one of the most common problems in neurology clinics as well as other health centers. A careful history from the patient and his relatives, detailed neurological and psychiatric examination are very important in reaching the correct diagnosis and treatment. Although imaging advances such as video electroencephalography (vEEG) have improved the ability of physicians to accurately identify these disorders, the diagnosis and treatment of PNES is still a challenging issue. Early diagnosis, young age, less psychiatric comorbidity have a positive effect on prognosis. Psychiatric evaluation of patients with PNES may be particularly helpful in elucidating the etiology and detecting comorbid diseases and may be helpful in the long-term treatment of these patients.