Development Of Psychogenic Nonepileptic Seizures Research Articles

Comorbidity of psychogenic non-epileptic seizures with mental disorders

The present review discusses the comorbidity of psychogenic non-epileptic seizures (PNES) with other mental disorders. Data on the prevalence of mood, anxiety, psychotic and personality disorders are presented. The role of traumatic experience in the development of PNES is described. Special attention is given to PNES as an independent nosological entity and its place in the modern classifications of mental disorders.В обзоре рассмотрены вопросы коморбидности психогенных неэпилептических приступов (ПНЭП) с другими психическими расстройствами. Представлены данные о распространенности аффективных, тревожных, психотических и личностных расстройств среди пациентов с ПНЭП. Описана роль травматического опыта в формировании ПНЭП. Отдельно рассмотрен вопрос о нозологической самостоятельности ПНЭП и их месте в современных классификациях психических расстройств.

Comparing epilepsy to psychogenic non-epileptic seizures, identification of risk factors: A retrospective case-control study

Psychogenic Non-epileptic seizures (PNES) are commonly misdiagnosed as epilepsy. Approximately 20% of patients sent to epilepsy centers for intractable seizures were later confirmed with PNES, resulting in incorrect treatment and medical cost. The objective of this case-controlled study is to identify factors associated with the development of PNES.

Characteristics of men with conversion disorder

ObjectiveWomen comprise the majority of subjects with conversion disorders in nearly all studies. The authors previously identified 96 subjects with psychogenic non-epileptic seizures (PNES) and found that female sex, alexithymia and childhood trauma were strongly correlated with the development of PNES. In order to characterize men with PNES, the authors collected questionnaire data on a series of male subjects recruited from an epilepsy monitoring unit (EMU). MethodsOnly male patients admitted to the EMU were asked to complete the Toronto Alexithymia Scale-20 (TAS-20) and the Childhood Trauma Questionnaire (CTQ). Results were correlated with diagnosis at discharge, either epileptic seizures (ES) or PNES. ResultsNinety-two subjects submitted complete questionnaire data. Sixty-nine subjects (74%) were diagnosed with ES, 13 subjects (14%) were diagnosed with PNES and 10 subjects (11%) had an undetermined diagnosis. There were no significant differences on the TAS-20 or the CTQ by diagnosis. ConclusionIn this sample of men admitted to an EMU there was no difference in the extent of alexithymia or childhood trauma between men with ES and PNES. There was a small number of men with a PNES diagnosis, which may have limited our ability to identify differences in the groups. The clear correlation of childhood trauma and alexithymia with development of conversion disorder in women could not be demonstrated in men.

Psychogenic nonepileptic (functional) seizures: Significance of family history and model learning

PurposeIf a positive family history of seizures plays a significant role that contributes to the risk for developing psychogenic nonepileptic seizures (PNES) by means of model learning, one would expect that patients with PNES with a family history of seizures show a different semiology than those without such a history. We investigated whether the above hypothesis is valid. MethodsIn this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, Iran, from 2008 until 2019, were investigated. Demographic and clinical characteristics were compared between patients with a positive family history of seizures and those without such a history ResultsDuring the study period, 274 patients with PNES-only had the inclusion criteria. Seventy-seven (28%) patients had a positive family history of seizures and 197 (72%) patients did not have such a history. There were no significant demographic or clinical differences between the two groups. ConclusionIt seems that a positive family history of seizures and model learning does not play a significant role in the development of PNES. Investigators should explore other potentially significant contributors and risk factors for developing PNES in future studies.

Structural brain abnormalities in patients with psychogenic nonepileptic seizures.

We assessed the relationship between the clinical features of patients with psychogenic nonepileptic seizures (PNES) and referrals for brain imaging tests. We also hypothesized that some clinical factors might be associated with structural brain imaging abnormalities in these patients. In this retrospective study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were studied. One hundred thirty-two patients had a brain magnetic resonance imaging (MRI) study available. Forty-seven patients (36%) had abnormal finding(s) in their MRI. Age (odds ratio = 1.040, p = 0.02), and comorbid epilepsy (odds ratio = 3.006, p = 0.005) were significantly associated with having an abnormal brain MRI. In a subanalysis, we excluded the patients with comorbid epilepsy (46 patients). From the remaining 86 patients (with PNES only), 23 patients (26.7%) had abnormal findings on their MRIs. Common epileptogenic structural brain abnormalities (e.g., tumors, mesial temporal sclerosis, encephalomalacia, and developmental anomalies) were common in patients with comorbid PNES and epilepsy (in 19 out of 46 patients; 41%), but not in those with PNES only (in 4 out of 86 patients; 5%) (p = 0.00001). While the evidence is convergent on the relatively high prevalence of structural brain abnormalities in patients with PNES, the data so far is suboptimal. In order to investigate the significance of structural brain abnormalities in the development of PNES, future well-designed multicenter studies, which include a large number of patients with a unified methodology of imaging, are desirable.

Diagnostic and treatment services for patients with Psychogenic Nonepileptic Seizures (PNES): A survey of health professionals in urban China

PurposeThis study is intended to provide an overview of diagnostic and treatment services for patients with psychogenic nonepileptic seizures (PNES) across China. MethodsUsing a questionnaire devised by the PNES Task Force of Neuropsychiatry Commission of the International League Against Epilepsy (ILAE), we conducted a survey among Chinese health professionals at the Sixth Advanced International Course: Clinical Epileptology. Descriptive analyses were performed. ResultsResponses from 102 eligible clinicians were analysed. Responses were received from urban areas in 20 provinces/municipalities around China. Most respondents were neurologists. The results showed that hospitals in urban China were mostly well-equipped, and that health professionals’ understanding of PNES largely reflected current international expert opinion. However, many of the participants would not actually make the diagnosis, and most provided neither follow-up nor treatment (especially psychotherapy) for patients with PNES. Only about one third of the patients diagnosed with PNES were estimated to receive at least one appointment for psychological treatment. In the opinion of the respondents, tacit trauma (neglect and stress) play an important role in the development of PNES. The main obstacles to patients with PNES accessing health services for their condition were thought to be lack of knowledge or awareness among health professionals, patients and society. ConclusionDespite good access to equipment, diagnostic and treatment services for patients with PNES in China are currently deficient. Education programs about PNES with different target groups, and more effective referral and social security systems emerge as particular development needs from this survey.

Expanding the theory of symptom modeling in patents with psychogenic nonepileptic seizures

Symptom modeling has been used to explain the development of psychogenic nonepileptic seizures (PNES) in predisposed patients, but has been understood only in the context of individuals who have both PNES and epileptic seizures. Our aim in the study described here was to learn whether this concept applies to patients with PNES who do not have epileptic seizures, that is, to determine whether the prevalence of having personally witnessed a seizure prior to the occurrence of their event differs in patients with PNES and those with epileptic seizures. We interviewed 27 patients with PNES and 35 patients with epileptic seizures. A significantly larger number of patients with PNES (66%) admitted to having witnessed a seizure prior to their event compared with patients with epileptic seizures (11%) ( P < 0.001). This suggests that symptom modeling plays a key role in the development of PNES, even among individuals without a coexisting history of epilepsy.

Development of psychogenic non-epileptic seizures in response to auditory hallucinations

Psychogenic non-epileptic seizures can co-exist with epileptic seizures. Differentiating between the two is central to appropriate management. We report the case of a patient with established focal epilepsy who developed psychogenic non-epileptic seizures in direct response to second-person auditory hallucinations. To our knowledge, this is the first description of such an occurrence. These non-epileptic seizures improved with treatment of the underlying psychosis. The relationship between epilepsy and psychosis is outlined, and the possible causes and nosology of these psychogenic non-epileptic seizures are discussed.

Evidence of brain abnormality in patients with psychogenic nonepileptic seizures

Markers of brain abnormalities in patients with psychogenic nonepileptic seizures (PNES) were studied to explore whether physical brain disorder is associated with an increased risk of PNES. Evidence of epileptiform EEG changes, MRI abnormalities, and neuropsychological (NPS) deficits was obtained from the records of 329 consecutive patients in whom the diagnosis of PNES was established at our center between 1991 and 2001. Two hundred six patients had PNES alone, and 123 PNES and epilepsy (PNES + E). In the PNES-only group, at least one marker of brain disorder was detected in 22.3% of patients (epileptiform potentials in 8.7%, MRI changes in 9.7%, NPS deficits in 9.7%). The actual prevalence of abnormalities is likely to be higher because 54.9% of the patients with only psychogenic seizures did not undergo MRI or neuropsychological testing. Evidence of brain abnormality was found more frequently in the PNES + E group (epileptiform potentials in 70.7%, MRI changes in 60.2%, NPS deficits in 52.8%). Although markers of brain abnormality were detected much less commonly in the PNES than in the PNES + E group, they were still found in a substantial proportion of patients with PNES alone. This suggests that physical brain disease plays a role in the development of PNES. Markers of physical abnormality were not more common in the right hemisphere.