Nonepileptic Seizures Research Articles

Impacto asistencial de la electroencefalografía realizada durante la guardia de Neurofisiología Clínica en un hospital de tercer nivel

IntroductionThe electroencephalogram (EEG) is a useful tool in the diagnosis of pathologies such as non-convulsive status epilepticus (NCSE) or brain death (BD), cardiac arrest (CA), and status epilepticus (SE) treatment monitoring. In addition, it provides irreplaceable information depending on the time it is performed, as is the case with the diagnosis of epilepsy after a first epileptic seizure (ES) or to differentiate these from non-epileptic paroxysmal events (NEPE). Its usefulness is maintained outside the usual working day, but it is not available in many centers. Subjects and methodsRetrospective observational study based on the clinical history of 86 patients who underwent an on-call EEG (ocEEG) at our hospital during 2020. ResultsOne hundred two records requested by Intensive Care (41.1%), Neurology (37.3%), Pediatrics (17.6%) or other services (4%) were made. Suspected NCSE represented 56.7%, followed by treatment monitoring in EE (21.6%). The ME accounted for only 6.9% of the total. The ocEEG avoided potential iatrogenesis in a 56.3% of cases with therapeutic implications, allowed to treat 27.58% of patients who would have remained without treatment until the conventional EEG. An increase in the level of care was required in only 22.2% of all cases. The ocEEG was anticipated a mean of 31.6h to the next conventional EEG that would have been available. ConclusionsThe availability of ocEEG is beneficial in terms of diagnosis, therapy, and hospital management, advancing decision-making and avoiding iatrogenesis. Its availability should become widespread.

Results of a National Delphi consensus on the outpatient management of pediatric psychogenic nonepileptic seizures in the United States

Background and objectivesThe purpose of this study was to develop national consensus based on expert opinion on the optimal outpatient care model of pediatric psychogenic nonepileptic seizures (PNES). MethodsA core working group (CWG) within the PNES special interest group of the Pediatric Epilepsy Research Consortium was established. The CWG developed a rigorous scoring rubric to select experts in pediatric PNES within the United States of America and a three-round Delphi study was conducted to assess consensus on key components of the management of pediatric PNES in the outpatient setting. ResultsEighteen experts representing neurology, psychology, psychiatry, social work and nursing participated in the study. Strong consensus was reached that the multidisciplinary clinic (MDC) model is the gold standard for the outpatient management of pediatric PNES. Consensus was obtained that a neurologist, psychologist and social worker are essential members of the MDC and in the setting of unlimited resources, psychiatry and nursing are also recommended. Further consensus was established on the roles of specific personnel, structure of the clinic, billing practices, trainee inclusion, patient inclusion and exclusion, and end of visit management. While consensus was reached that a new term should be developed for this diagnosis, consensus was not reached on the ideal term. DiscussionExpert consensus was established for the multidisciplinary management of pediatric PNES in the outpatient setting. Specific recommendations were provided that can facilitate the development and implementation of MDCs in other institutions. Further prospective studies are warranted to validate this practice model.

Cognitive deficits’ profiles of attention and executive functions in epilepsy versus psychogenic non-epileptic seizure patients: A preliminary cross-sectional study

Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures (ES) but lack the associated brain electrical disruptions. Their underlying mechanism remains elusive, even though cognitive deficits are commonly reported in both ES and PNES patients. This preliminary cross-sectional study compared attention and executive functions in 20 patients with ES (ES group) and 18 with PNES or comorbid PNES and ES (PNES group) using the Stroop task and attentional network task (ANT). Both groups exhibited a significant Stroop effect, with no significant differences between them. In the ANT assessment, the ES group had significantly slower reaction times (RTs) in non-tone conditions compared to in-tone conditions (P < 0.05). Meanwhile, the PNES group displayed no significant difference in RTs between these conditions, indicating a more pronounced alerting effect in the ES compared to PNES group. No significant disparities emerged in executive control and orientation between the groups. The findings underscore differences in attentional processing between these groups, emphasizing the clinical significance of understanding these cognitive deficits for accurate diagnosis and tailored neuropsychological rehabilitation.

Sexual Abuse, Post-Traumatic Stress Disorder and Psychopathological Characteristics in Women with Functional/Dissociative Seizures.

Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population.

Psychogenic non-epileptic (functional) seizures in adults with intellectual disability and epilepsy: A matched case-control study.

To describe the characteristics of psychogenic non-epileptic (functional) seizures (PNES) in adults with epilepsy and intellectual disability (ID) and to establish differences and risk factors regarding psychosocial functioning between individuals with and without PNES. Adults with ID and epilepsy living in epilepsy care facilities in The Netherlands were screened for PNES by a neurologist. A control group consisting of people with epilepsy and ID, without PNES, was matched according to age, sex, and level of ID. Objective data were retrieved retrospectively from clinical notes of the resident. Standardized questionnaires and tests, adjusted for people with ID, were obtained from participants and their nursing staff. Differences were analyzed using paired t tests, Wilcoxon signed-rank tests, or McNemar's tests, appropriate for matched case-control studies. Conditional logistic regression identified PNES risk factors. Five hundred forty individuals were screened, of which 42 had PNES (point prevalence 7.8%). In total, 35 cases and 35 controls gave consent. Proxy reports indicated that PNES impacted daily life in 79% by adjusting the individual's schedule, and caused minor injuries in one-third. Those with PNES were mainly female (69%); had a mild (46%) or moderate (37%) level of ID; showed more symptoms of depression (p = .024), anxiety (p = .030), self-injurious behavior (p = .015); and experienced more negative life events (p < .001). Clinically relevant predictors of PNES were the number of negative life events (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.12-2.53) and self-injurious behaviors (OR 5.27, 95% CI .97-28.81). Previously, PNES in individuals with ID and epilepsy were described mainly as a reinforced behavioral pattern, due to limited associations with psychiatric disorders. Our results demonstrate that this population does show individual psychosocial vulnerabilities when measured with instruments adjusted for this population, as indicated by proxy reports from daily caregivers. Viewing PNES as an involuntary response, especially for stress-prone individuals with ID, could reduce stigma and improve treatment.

Functional seizure semiology and classification in a public and private hospital

PurposeOur understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. MethodsThe study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital. ResultsA total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (N = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients. ConclusionWhile the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation.

A - 27 Case Study Approach to Initial Exploration of Adaptations of Cognitive Behavioral Therapy (CBT) for Non-Epileptic Seizures (NES) in the Context of Cognitive Impairment

Abstract Objective The following case study seeks to review implementation of CBT for NES, discuss psychotherapeutic adaptations and outcomes while balancing treatment fidelity, and offer preliminary recommendations for expansion of psychotherapeutic modalities for individuals with cognitive impairment. Methods 49-year-old Hispanic male with a history of mixed epileptic (non-lesional frontal lobe medically refractory) and non-epileptic events. Neurological workup included video EEG, which captured seven events without EEG correlate and an unremarkable brain MRI. Neuropsychological evaluation indicated mild cognitive impairment due to epilepsy with deficits in processing speed, executive functioning, and confrontation naming with borderline to low average core visual and verbal abilities. The patient participated in manualized CBT for PNES. Results Treatment adaptations included extending treatment sessions from 12–19 sessions and including the patient’s sister. They read the chapters together and practiced strategies outside of session. She participated in helping him notice patterns of manifestations of fear and anger and their influence on somatic symptoms. Omission of treatment elements with higher cognitive demand (i.e., thought chart). Outcomes included increased awareness of emotions, triggers, and warnings but not episode reduction in the context of increased epileptic seizures. Conclusions Feasibility of treatment may be limited for individuals with mixed epileptic and NES episodes, particularly if there is cognitive impairment and difficulty differentiating between the two. Psychotherapeutic techniques that are concrete and behaviorally based will = be beneficial for individuals with cognitive impairment. Episode reduction in isolation is likely reductionistic when considering treatment effectiveness. Ability to self-manage episodes, quality of life, functional status, and self-efficacy are valuable markers of improvement.

B - 50 Traumatic Brain Injury in Patients with Psychogenic Non-epileptic Seizures and Functioning

Abstract Objective Past studies reveal that many patients with psychogenic non-epileptic seizures (PNES) also have a traumatic brain injury (TBI) history, but the specific influence of prior TBI on patients is presently under examination. This study aims to investigate the relationship between patients with PNES with a TBI history and symptoms/functioning, compared to those without a TBI history. Method Data collected from patients seen for comprehensive neuropsychiatric evaluation was analyzed, including TBI history, TBI severity, and Global Assessment of Functioning (GAF) scores. The GAF scale allows assignment of a numerical rating to patients based on their psychological and social functioning. Results Patients with PNES without TBI (n = 120; mean age 51) had higher average GAF scores (52.4) compared to those with TBI (n = 164, mean age 54, mean GAF 50) (p = 0.0059). Across PNES patients with a history of TBI, those with mild TBI exhibited notably lower GAF scores (43.2) than those with moderate (48.87) or severe (50) history of TBI. Conclusion Patients with PNES and a history of TBI had lower (worse) GAF scores than those without TBI, and worse in cases of mild TBI. Further exploration of demographic variables, education, and employment status will address potential confounds. Understanding the complex interplay between PNES and TBI may improve diagnosis and management strategies, with further research in advancing clinical practice.

Benzodiazepine receipt in adults with psychogenic non-epileptic seizures in the USA

BackgroundCharacterising benzodiazepine (BZD) prescribing to individuals with psychogenic non-epileptic seizures (PNES) is important for optimising PNES outcomes, but existing data is lacking.MethodsUsing a nationwide administrative claims database (2016–2022), incident PNES...

An essay on the Charcot and Richer hysteria: from charcoal drawings to cell phones.

Hysteria, previously also known as the disease of the womb, has moved from being a woman's illness through the medieval times' stigma of demonic possession, to the modern concept of a functional neurological disorder. Interestingly to the present assay, Charcot (1825-1893) and Richer (1849-1933) described, in their 1887 work Les Démoniaques dans l'art, by means of iconography, semiological aspects of the so-called Grande Attaque Hystérique, which resembles features of psychogenic nonepileptic seizures emulating grand mal epileptic seizures. The aim of the present assay is to describe how those charcoal iconographic representations evolved through history and are nowadays portrayed in videos recorded at epilepsy monitoring units and patients' cell phones.

White matter brain-age in diverse forms of epilepsy and interictal psychosis

Abnormal brain aging is suggested in epilepsy. Given the brain network dysfunction in epilepsy, the white matter tracts, which primarily interconnect brain regions, could be of special importance. We focused on white matter brain aging in diverse forms of epilepsy and comorbid psychosis. We obtained brain diffusion tensor imaging (DTI) data at 3 T-MRI in 257 patients with epilepsy and 429 healthy subjects. The tract-based fractional anisotropy values of the healthy subjects were used to build a brain-age prediction model, and we calculated the brain-predicted age difference (brain-PAD: predicted age—chronological age) of all subjects. As a result, almost all epilepsy categories showed significantly increased brain-PAD (p < 0.001), including temporal lobe epilepsy (TLE) with no MRI-lesion (+ 4.2 yr), TLE with hippocampal sclerosis (+ 9.1 yr), extratemporal focal epilepsy (+ 5.1 yr), epileptic encephalopathy or progressive myoclonus epilepsy (+ 18.4 yr), except for idiopathic generalized epilepsy (IGE). Patients with psychogenic non-epileptic seizures also presented increased brain-PAD. In TLE, interictal psychosis significantly raised brain-PAD by 8.7 years. In conclusion, we observed increased brain aging in most types of epilepsy, which was generally consistent with brain morphological aging results in previous studies. Psychosis may accelerate brain aging in TLE. These findings may suggest abnormal aging mechanisms in epilepsy and comorbid psychotic symptoms.

Seizure detection in EEG signal using Gaussian-stockwell transform and Hermite polynomial features

Electroencephalography (EEG) is a non-intrusive and powerful tool for understanding the complex nature of the brain. Epileptic seizures, a neurological disorder, are characterized by excessively synchronized neuronal activity within the brain. This abnormal synchronization disrupts the normal functioning of neural networks, leading to seizures. This work proposes to use the Gaussian-based Stockwell Transform (GST) to segment EEG signals into various frequency bands such as delta, theta, alpha, beta, and gamma band for analysis. The feature extraction process on these sub-band signals generates a feature set, encompassing the fluctuation index, relative amplitude, holoentropy, logarithmic band power, and the newly introduced Hermite polynomial-based delta amplitude modulation spectrogram. To differentiate between epileptic and non-epileptic events in EEG signals, the previous features have been applied to the Random Forest Classifier (RFC) algorithm. The effectiveness of our proposed method is validated using a benchmark EEG dataset, with GST and RFC demonstrating accurate results in distinguishing seizure activity. Experimental results show an optimal classification accuracy of 96.4 %, a sensitivity of 97 %, and a specificity of 96.4 %.

Clinical Semiology and Comparative Analysis of Different Classification Systems of Psychogenic Nonepileptic Seizures

Abstract Objective Only a few studies have compared the different classification systems of psychogenic nonepileptic seizures (PNESs). A universally acceptable classification system for PNES will aid in the early diagnosis and may lead to better standardization for future studies. This study aimed to describe the clinical semiology and provide comparative analysis of PNES classification systems described by Hubsch et al, Wadwekar et al, Dhiman et al, and Asadi-Pooya. Materials and Methods Prospectively, patients provisionally diagnosed clinically as PNES were confirmed on video electroencephalography and their semiology was classified according to the classification systems mentioned earlier. Patients were additionally evaluated for coexisting anxiety or depression using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and its severity assessed using Hamilton's depression/anxiety rating scales. Results A total of 104 PNES patients were included in the study. Mean age at presentation was 24.5 ± 10.4 years with females as the predominant proportion (76.9%). Whole body flaccidity was the commonest clinical presentation of PNES seen in 60.58% cases. All PNES cases could be classified using the Asadi-Pooya's classification, while 8.7, 47.1, and 53.8% PNES events remained unclassified, respectively, using the classification system as described by Dhiman et al, Wadwekar et al, and Hubsch et al; 33(31.73%) PNES patients had depression and 8 (7.7%) had generalized anxiety disorder in our study. Conclusion Nonmotor manifestations were the most frequent semiology in our cohort. Of the PNES classification systems studied, Asadi-Pooya's classification was easier to apply and could classify all the patients in the study.

Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross-sectional study.

To describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020. Cross-sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out. Overall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26-44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non-epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow-up. The clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy. Inmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.

Elevated plasma neurofilament light and glial fibrillary acidic protein in epilepsy versus nonepileptic seizures and nonepileptic disorders.

Research suggests that recurrent seizures may lead to neuronal injury. Neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP) levels increase in cerebrospinal fluid and blood in response to neuroaxonal damage, and they have been hypothesized as potential biomarkers for epilepsy. We examined plasma NfL and GFAP levels and their diagnostic utility in differentiating patients with epilepsy from those with psychogenic nonepileptic seizures (PNES) and other nonepileptic disorders. We recruited consecutive adults admitted for video-electroencephalographic monitoring and formal neuropsychiatric assessment. NfL and GFAP levels were quantified and compared between different patient groups and an age-matched reference cohort (n = 1926) and correlated with clinical variables in patients with epilepsy. A total of 138 patients were included, of whom 104 were diagnosed with epilepsy, 22 with PNES, and 12 with other conditions. Plasma NfL and GFAP levels were elevated in patients with epilepsy compared to PNES, adjusted for age and sex (NfL p = .04, GFAP p = .04). A high proportion of patients with epilepsy (20%) had NfL levels above the 95th age-matched percentile compared to the reference cohort (5%). NfL levels above the 95th percentile of the reference cohort had a 95% positive predictive value for epilepsy. Patients with epilepsy who had NfL levels above the 95th percentile were younger than those with lower levels (37.5 vs. 43.8 years, p = .03). An elevated NfL or GFAP level in an individual patient may support an underlying epilepsy diagnosis, particularly in younger adults, and cautions against a diagnosis of PNES alone. Further examination of the association between NfL and GFAP levels and specific epilepsy subtypes or seizure characteristics may provide valuable insights into disease heterogeneity and contribute to the refinement of diagnosis, understanding pathophysiological mechanisms, and formulating treatment approaches.

From Request To Result: The Clinical Significance of EEG in a Tertiary Hospital in Turkey

Objective: This study aimed to assess the clinical and demographic profiles of patients undergoing electroencephalography (EEG) over one year, evaluate EEG's impact on patient management, and ascertain the appropriateness of EEG requests. Methods: A retrospective analysis was conducted in the neurophysiology department at XXX University Faculty of Medicine over 12 months from October 2022 to October 2023. The study included the EEG request to the neurophysiology department; pediatrics and the cases that had artifacts or technical issues were excluded. Age, gender, imaging characteristics, EEG findings, and the reasons for EEG requests were recorded. The contribution of EEG to patient management was analyzed. Results: The study included 1217 patients with a mean age of 34.4±16.5 years, ranging from 18 to 90 years. Of these, 656 were female and 561 male. A history of epilepsy was reported in 821 patients. Neurology outpatient clinics, inpatient wards, and intensive care units requested the majority of EEGs. Epilepsy, presyncope/syncope, and psychogenic non-epileptic seizures (PNES) were the top reasons for EEG requests. Among the newly diagnosed epilepsy patients, 13 showed abnormal EEG results. The study identified MRI abnormalities in 202 patients, with a 27% concordance between EEG and MRI findings. EEG significantly influenced patient management in 577 cases (46.5%), demonstrating its crucial role in clinical decision-making. Conclusion: EEG's diagnostic value, particularly in epilepsy and complex neurological conditions, remains unique. Advocating suiting EEG requests and increasing physician knowledge of seizures can optimize patient care and resource use.

Dissimilar Changes in Serum Cortisol after Epileptic and Psychogenic Non-Epileptic Seizures: A Promising Biomarker in the Differential Diagnosis of Paroxysmal Events?

The hypothalamic-pituitary-adrenal axis is known to be involved in the pathogenesis of epilepsy and psychiatric disorders. Epileptic seizures (ESs) and psychogenic non-epileptic seizures (PNESs) are frequently differentially misdiagnosed. This study aimed to evaluate changes in serum cortisol and prolactin levels after ESs and PNESs as possible differential diagnostic biomarkers. Patients over 18 years with ESs (n = 29) and PNESs with motor manifestations (n = 45), captured on video-EEG monitoring, were included. Serum cortisol and prolactin levels as well as hemograms were assessed in blood samples taken at admission, during the first hour after the seizure, and after 6, 12, and 24 h. Cortisol and prolactine response were evident in the ES group (but not the PNES group) as an acute significant increase within the first hour after seizure. The occurrence of seizures in patients with ESs and PNESs demonstrated different circadian patterns. ROC analysis confirmed the accuracy of discrimination between paroxysmal events based on cortisol response: the AUC equals 0.865, with a prediction accuracy at the cutoff point of 376.5 nmol/L 0.811 (sensitivity 86.7%, specificity 72.4%). Thus, assessments of acute serum cortisol response to a paroxysmal event may be regarded as a simple, fast, and minimally invasive laboratory test contributing to differential diagnosis of ESs and PNESs.

Psychogenic non-epileptic seizures in individuals with intellectual disability/borderline cognitive function: Characterization through a comparison study

PurposeWe set out to characterize psychogenic non-epileptic seizures (PNES) in individuals with either intellectual disability (ID) or borderline intellectual function (BIF) in comparison to those with normal cognitive function. We aimed to identify differences between the two groups to improve clinical management protocols. MethodsWe conducted a retrospective, observational, single-center study. The medical records of individuals (aged ≥ 14 years) diagnosed with PNES, confirmed through video-electroencephalography (vEEG) at a specialized epilepsy center between January 2008 and December 2021, were reviewed. We restricted our study to individuals who underwent comprehensive neuropsychological evaluations. Furthermore, demographic, clinical, and neuropsychological data with potential prognostic indicators, alongside the reevaluation of vEEG recordings were studied. We compared two study groups based on intelligence quotient (IQ): individuals without ID (IQ≥85; n = 25) and those with either mild ID or BIF (n = 25). ResultsNo statistically significant clinical differences were observed between the two groups. Individuals with mild ID/BIF didn't show a longer diagnostic delay, and the prescription of inappropriate antiseizure medications (ASMs) was comparable in both cohorts. Most individuals with mild ID/BIF were treated with behavioral psychotherapeutic approaches with similar outcomes in both subgroups. ConclusionsIndividuals with mild ID/BIF and PNES don't differ in clinical management. Demographic and clinical data, as well as semiology, were comparable to those of individuals with normal cognitive function. Cognitive behavioral therapy (CBT) appears to be an effective treatment approach for individuals with and without mild ID/BIF. Further studies are needed to validate and ascertain their possible applicability in individuals with moderate/severe ID.

Altered fronto-limbic-motor response to stress differs between functional and epileptic seizures in a TBI model

Background and ObjectivesPsychogenic nonepileptic (functional) seizures (FS) clinically resemble epileptic seizures (ES) with both often preceded by traumatic brain injury (TBI). FS and ES emergence and occurrence after TBI may be linked to aberrant neurobehavioral stress responses. We hypothesized that neural activity signatures in response to a psychosocial stress task would differ between TBI + FS and TBI + ES after controlling for TBI status (TBI-only). MethodsIn the current multicenter study, participants were recruited prospectively from Rhode Island Hospital, Providence Rhode Island Veterans Administration Medical Center, and the University of Alabama at Birmingham Medical Center. Previous diagnoses of TBI, ES, and FS were verified based on data collected from participants, medical chart and record review, and, where indicated, results of EEG and/or video-EEG confirmatory diagnosis. TBI + ES (N = 21) and TBI + FS (N = 21) were matched for age and sex and combined into an initial group (TBI + SZ; N = 42). A TBI-only group (N = 42) was age and sex matched to the TBI with seizures (TBI + SZ) group. All participants completed an fMRI control math task (CMT) and stress math task (SMT) based on the Montreal Imaging Stress Task (MIST). ResultsThe TBI + SZ group (n = 24 female) did not differ in mood or anxiety severity compared to TBI-only group (n = 24 female). However, TBI + FS group (n = 11 female) reported greater severity of these symptoms compared to TBI + ES (n = 13 female). The linear mixed effects analysis identified neural responses that differed between TBI-only and TBI + SZ during math performance within the left premotor cortex and during auditory feedback within bilateral prefrontal cortex and hippocampus/amygdala regions. Additionally, neural responses differed between TBI + ES and TBI + FS during math performance within the right dorsolateral prefrontal cortex and bilateral amygdala during auditory feedback within the supplementary motor area. All tests comparing neural stress responses to psychiatric symptom severity failed to reach significance. DiscussionControlling for TBI and seizure status, these findings implicate specific nodes within frontal, limbic, and sensorimotor networks that may maintain functional neurological symptoms and possibly distinguish FS from ES. This study provides class II evidence of differences in neural responses to psychosocial stress between ES and FS after TBI.

A comparison of patients with epileptic seizures (ES) versus those with psychogenic non-epileptic seizures (PNES) on measures of alexithymia, mood, and anxiety

ObjectiveTo compare persons with epilepsy (PWE) to those with psychogenic non-epileptic seizures (PNES) on measures of depression, anxiety, and alexithymia subscales (i.e., difficulty identifying emotions, difficulty describing emotions, and external-oriented thinking). Material and methodsIn this retrospective study, 235 epilepsy patients and 90 patients with PNES were evaluated between 2012 and 2020 at the Northeast Regional Epilepsy Group. These patients had completed the Toronto Alexithymia Scale (TAS-20), The Center for Epidemiologic Studies - Depression Scale (CES-D) and The State-Trait Anxiety Inventory (STAI). Background information was collected regarding work/student/disability status at the time of the evaluation history of psychiatric diagnosis; psychological trauma; and involvement in psychotherapy either at the time of the evaluation or prior. ResultsSignificant differences between PWEs and those with PNES were found not only in historical data (e.g., Psychiatric History, History of Trauma, and History of Therapy) (p < .001) but also on measures of Depression (p = .002) and Anxiety (p < .001). ANOVA analysis also revealed significant differences in the distribution of the TAS-Total score, TAS-Describing emotions, and TAS-Identifying emotions. Using logistic regression (stepwise model) the optimal set of predictors for a differential diagnosis of epilepsy and PNES was combination of TAS-Identifying emotions score, history of psychological trauma, and history of therapy. The accuracy of the prediction was determined to be 80.2 %. ConclusionsAlthough higher alexithymia rates are present in PNES and PWEs, clinicians may find a combination of TAS-Identifying Emotion score, history of trauma, and history of psychotherapy useful in supporting a differential diagnosis. Also, a subgroup may exist among those with PNES with high levels of alexithymia, depression, and anxiety that may require a different treatment approach focused on addressing difficulties in identifying and describing their emotions and their other symptomatology.