Incidence Of Psychogenic Nonepileptic Seizures Research Articles

THE PHENOMENON OF SIMULATING SEIZURES IN EPILEPSY: CASE REPORT

Psychogenic non-epileptic seizures may resemble epileptic ones, but bioelectric activity is not recorded on the electroencephalogram. In some cases, psychogenic non-epileptic seizures and epilepsy are diagnosed simultaneously. The frequency of epilepsy in patients with diagnosed psychogenic non–epileptic seizures is 22%, and the incidence of psychogenic non-epileptic seizures among patients with epilepsy is 12%. The article describes a clinical case of a patient with diagnosed epilepsy, in whom psychogenic non-epileptic seizures were detected simultaneously with epileptic seizures. Polymorphic non-convulsive and convulsive seizures were observed in the clinical presentation. The patient received anti-epileptic therapy in high doses for a long time without significant effect. Convulsive seizures in most cases occurred during the day in crowded places in the presence of people. Most often, the patient managed to attract the attention of others and ask for help. A pathopsychological examination revealed a pronounced sharpening of hysteroid and epileptoid traits with excessive fixation on the state of the patient's health. For the first time in years of being treated by different doctors, the patient admitted during psychotherapy that convulsive seizures that occur with her are "useful". It was advantageous for her to take on the role of a person out of health in order to protect herself from her husband's aggression and get sympathy, feel special, get rid of extra burden at work. The article provides a differential diagnosis between factitious disorder, conversion disorder, simulation and aggravation. It is concluded that convulsive seizures in the patient occurred by the mechanism of a factitious disorder. The following facts speak in favor of this: motivation for this behavior is not clear to others and is of an internal nature, the desire to accept the role of a person out of health, awareness of seizures "usefulness", lack of attention in the family, hysteroid character traits. It is concluded that for the successful treatment of comorbidity conditions of psychogenic non-epileptic seizures and epilepsy, close interaction of a neurologist, a psychiatrist, a psychotherapist and a psychologist is extremely important.

Incidence and prevalence of psychogenic nonepileptic seizures (functional seizures): a systematic review and an analytical study

Aim Psychogenic nonepileptic seizures (PNES) or functional seizures are universal phenomena. However, data on their epidemiology is limited. The aim of the current study was to review the literature on the epidemiology of PNES and to provide analytical estimates of its incidence and prevalence based on the direct data that are available from previous studies on PNES. Methods The methods of this work had two parts: (1) MEDLINE, PsycINFO, and Scopus from inception to 19 October 2019 were systematically searched. (2) The analytical study of the incidence and prevalence of PNES was performed, based on the following data from previous studies: incidence of PNES, duration of PNES before making a diagnosis, outcome and mortality of PNES. Results The search strategy yielded five articles; three were on the incidence and two on the prevalence. In the analytical part of the study, the incidence of PNES was calculated to be 3.1 (95% Confidence Interval: 1.1–5.1) per 100,000 population per year. The calculated prevalence rate of PNES in 2019 was 108.5 (95% Confidence Interval: 39.2–177.8) per 100,000 population, in the USA. Conclusion While, the generalizability of these calculated incidence and prevalence rates to other places in the world is limited, they give us a reasonable hint that PNES is a common condition and the prevalence is much more than that it was thought before. Supplemental data for this article is available online at https://doi.org/10.1080/00207454.2021.1942870.

Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge.

Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4–4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to “dual diagnosis,” is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.

Pins and PNES: Systematic content analysis of Pinterest for information on psychogenic nonepileptic seizures (PNES)

Pinterest is a visual search based, the fourth largest social networking site in the U.S. with 81% of its users being women. Because of Pinterest's popularity and the high incidence of psychogenic nonepileptic seizures (PNES) among women, the aim of our current study was to perform a thorough content analysis of information available about PNES on Pinterest. The systematic search of Pinterest using various PNES related keywords revealed 57 unique pins. This was followed by content analysis by two independent reviewers. Most (87.7%) pins included in the final analysis reported at least one factor indicative of PNES. Most common were the consistent association of PNES with emotional triggers (61.4%), history of current or remote abuse (57.9%), and seizure's unresponsiveness to antiepileptic drugs (38.6%). Semiology of PNES was reported in 77.2% pins and two-thirds (66.6%) mentioned diagnostic procedures. Psychogenic nonepileptic seizure treatment and prognosis were reported in 68.4% and 56.1% pins, respectively. Around one-third of pins were from academic resources. More than 80% of pins targeted lay people with the primary aim of education and awareness and used a neutral or positive tone. To our knowledge, even though most pins have scientifically sound information, this widely popular web-based resource seems to be underutilized by academia, healthcare workers, and stakeholders for the dissemination of awareness about PNES.

Psychogenic Nonepileptic Seizures in a Mother and Her Son–Fate or Chance?

Psychogenic Nonepileptic Seizures (PNES) are defined as typical seizure-like activities or behaviors without cortical epileptiform discharges. The diagnosis of PNES remains a challenge and continuous video electroencephalography (cEEG) remains the gold standard to differentiate between epileptic seizures and PNES. Despite advances made in our understanding of PNES, diagnosing and treating this well-known entity remains a challenge. 25% of patients with seizures will be misdiagnosed as having PNES or epileptic seizures even by certified Neurologists. Do patient characteristics and demographics increase our accuracy to diagnose PNES? We present a case of a mother and her son, both diagnosed with PNES by cEEG monitoring in our epilepsy monitoring unit. While familial prevalence of conversion disorders is reported in the literature, this will be the first case report describing the incidence of PNES in two members of the same family. Do psychogenic epilepsies run in families? Will the diagnosis of PNES in one family member increase the probability of PNES in their relatives with seizures? Larger patient pools need to be studied to draw a definite conclusion regarding our observation.

Psychogenic non-epileptic seizures in a second-trimester pregnant woman with a previous child loss.

To the Editor: Psychogenic non-epileptic seizures (PNES), also known as non-epileptic attack disorder,1 are events that apparently simulate an epileptic seizure and are triggered essentially by emotion and psychological events of which a patient does not have control. These are not due to abnormal electrical discharges in the brain as in epilepsy. We report a case of PNES in a pregnant woman. Case report. Ms A, a 19-year-old woman who was 24 weeks pregnant, was transferred via life flight from a local hospital. She initially presented to the local hospital for complaints of headache, syncopal episodes with visual changes, and loss of consciousness for 1 day. Shortly after she arrived at the local hospital, she developed reduced sensation on the right side and decreased movement on left side of her body. During her evaluation, she developed tonic-clonic seizures for which a loading dose of phenytoin was given and she was intubated for airway protection and transferred to our facility. Electroencephalography (EEG) revealed no epileptiform activity. Magnetic resonance imaging and magnetic resonance venography of brain showed no abnormalities. Complete blood cell count, comprehensive metabolic panel results, lactic acid test findings, and results of blood gas analysis were within normal limits. Video EEG showed no epileptogenic activity. Ms A had past history of drop attacks since age 13 with a frequency of 1 or 2 attacks per year. During those attacks she would lose consciousness for less than a minute with no residual deficits. She discovered that these attacks or spells occurred in conjunction with an increase in stressors in her life. At the time of this presentation, she found herself threatened by her roommate and felt stress about her pregnancy because she had lost a child in the past. The true prevalence of PNES is unknown, but the estimated prevalence is 2 to 33 per 100,000.2 The prevalence of epilepsy is 0.5% to 1% in the general population; among the general population, intractable epilepsy accounts for 20% to 30%, of which 10%–20% is accounted for by PNES.3 PNES are more prevalent in females, who constitute up to 80% of cases.4 Although PNES is common in all age groups, patients usually present in their third decade. Several clinical signs help to distinguish these non-epileptic spells from epileptic seizures, including gradual onset, fluctuating course, side-to-side head movements, bilateral asynchronous movements, arching of back, stuttering, and violent thrashing movements.5 The duration of PNES may vary from less than 2 minutes to 150 minutes. Video EEG remains the gold standard for distinguishing PNES from epileptic seizure. PNES is often associated with psychiatric conditions such as major depressive disorders, anxiety or bipolar disorder,posttraumatic stress disorder, and borderline personality traits.6 PNES is more commonly seen in patients with epilepsy and also in patients with a family history of epilepsy.7 It can also be reflected as a manifestation of repressed psychological detriment in response to trauma, such as child and sexual abuse.8 There is no single strategy designed for the management of PNES. Treatment should include multidimensional approaches involving a neurologist, psychiatrist, psychotherapist, and primary care physician. The primary focus should be on addressing the underlying trigger. Psychotherapy, including cognitive-behavioral therapy, insight-oriented therapy, and mindfulness techniques, remains the mainstay of treatment.9 Treatment of comorbid conditions such as anxiety and depression results in a decrease in the incidence of PNES and an improvement in the overall prognosis.9

Psychogenic nonepileptic seizures in children: A review

One of the considerations when a child presents with paroxysmal events is psychogenic nonepileptic seizures (PNES). PNES are discernible changes in behavior or consciousness that resemble epileptic seizures but are not accompanied by electrophysiologic changes. They are usually understood as the manifestation of a conversion disorder that reflects underlying psychological distress. There is a lack of population-based data on the prevalence or incidence of PNES in pediatric populations. The prevalence of PNES in children would appear to be lower than that in the adult population, but the prevalence of PNES seems to increase with age, and nonepileptic paroxysmal events are more likely to be PNES in adolescence than earlier in childhood. In terms of manifestation, PNES in childhood have been described using various categorizations and terminology, making comparisons across studies difficult. There is some evidence that events are more likely to involve unresponsiveness in younger children and prominent motor symptoms in older children. The most common precipitating factors would appear to be school-related difficulties and interpersonal conflict within the child's family. In terms of psychopathology, children with PNES are at high risk for symptoms of depression and anxiety. Accurate diagnosis of PNES in children is likely to involve taking a comprehensive description of the episodes, garnering the child's medical/developmental history, video-electroencephalography (video-EEG) to rule out epileptic seizures, and an evaluation of family functioning. The importance of effective and sensitive communication of the diagnosis of PNES has been emphasized and management approaches will typically involve multidisciplinary efforts to safely manage the events at home and at school. Interventions to reduce the effect of precipitating psychosocial stressors and the involvement of a mental health professional to treat comorbid psychopathology will also form part of an effective management plan. Outcome at follow-up is reported to be largely positive, although studies have not been able to follow all children, and few studies have focused on predictors of a good outcome. Future controlled intervention studies using a range of outcome measures are needed to identify efficacious approaches and predictors of best outcome.

Patients with epilepsy and patients with psychogenic non-epileptic seizures: Video-EEG, clinical and neuropsychological evaluation

Purpose The incidence of psychogenic non-epileptic seizures (PNES) is 4.9/100,000/year and it is estimated that about 20–30% of patients referred to tertiary care epilepsy centers for refractory seizures have both epilepsy and PNES. The purpose of our study is to evaluate psychiatric disorders and neuropsychological functions among patients with PNES, patients with epilepsy associated with PNES and patients with epilepsy. Methods We evaluated 66 consecutive in-patients with video-EEG recordings: 21 patients with epilepsy, 22 patients with PNES and 10 patients with epilepsy associated with PNES; 13 patients were excluded (8 because of mental retardation and 5 because they did not present seizures or PNES during the recording period). Results All patients with PNES had a psychiatric diagnosis (100%) vs. 52% of patients with epilepsy. Cluster B personality disorders were more common in patients with PNES. We observed fewer mood and anxiety disorders in patients with PNES compared with those with epilepsy. We did not find statistically significant differences in neuropsychological profiles among the 3 patient groups. Conclusion This study can help to contribute to a better understanding of the impact of PNES manifestations, in addition to the occurrence of seizures, in order to provide patients with more appropriate clinical, psychological and social care.

Four-year incidence of psychogenic nonepileptic seizures in adults in hamilton county, OH.

In this retrospective study, the incidence of psychogenic nonepileptic seizures in Hamilton County, OH, between 1995 and 1998 was determined. The mean incidence of psychogenic nonepileptic seizures was 3.03/100,000, with the highest incidence in 1998 (4.6/100,000). Most patients with the diagnosis of psychogenic nonepileptic seizures were aged 25 to 45 years (4.38/100,000).