Psychogenic Seizures Research Articles

Psychotherapeutic treatment of people with disorders of intellectual development and dissociative seizures. English version

Psychotherapeutic treatment of people with disorders of intellectual development and dissociative seizures. English version

Extended diagnostic for dissociative seizures

Extended diagnostic for dissociative seizures

A Retrospective Study Reviewing Timing to Onset of Habitual Psychogenic Non-Epileptic Seizures in a Home Video Telemetry Cohort

Objectives: This study aimed to investigate the onset time to habitual psychogenic non-epileptic seizures (PNES) in adults referred to Guy’s and St Thomas’ Neurophysiology Department for home video telemetry (HVT) with a clinical question of PNES. The primary objective was to determine the optimal time window for HVT recording for patients with suspected PNES to try to improve the allocation of clinical resources. The secondary objective was to explore any potential association between time to habitual PN ES onset and demographic indexes and other clinical, neuro-radiological and semiological findings. Methods: We performed a retrospective analysis of our XLTEK database between 2019 and 2020. A multifactorial analysis of PNES semiologic subtypes, patient demographics, psychiatric comorbidities and neuroimaging was conducted to explore their impact on time to PNES within an HVT study. People who had at least one typical PNES during their recording were included. The exclusion criteria included people who had the test performed without video recording. The total number of participants was 37. The data were extracted from our local XLTEK database. Statistical analyses using Mann–Whitney U and Fischer exact tests were carried out. Results: The mean time to first habitual PNES onset was seven hours, with a mean recording duration of 46 h. The most commonly occurring event type was blank spells (12, 32%), with the least common presentation being déjà vu (1, 3%). There was a significant association between time to PNES onset and male sex (p = 0.04). There was a significant association between time to PNES onset and abnormal MRI findings (p = 0.02). Particular PNES semiologic subtypes were not significantly linked with PNES onset time. Conclusions: Our study highlights that on average, patients with PNES will rapidly have their first habitual event within an HVT study (mean time to event onset of seven hours), consistent with the current literature. This raises the question of whether HVT study duration could be reduced to release study resources and aid departmental efficiencies. We also observe the novel finding that men presented significantly earlier with their habitual PNES event than women, and that abnormal imaging findings were also significantly associated with an earlier time to event onset, although the reason for this association is yet to be determined.

Personality and Attachment Patterns in Patients with Psychogenic Non-Epileptic Seizures in Saudi Arabia

Background and Objectives: The purpose of this study was to investigate personality and relationship patterns in patients with psychogenic non-epileptic seizures (PNES) and compare them to patients with epilepsy and healthy controls. Materials and Methods: A total of 68 participants were recruited (mean age = 29.8 ± 9.4 years), including 25 (36.2%) with PNES. The assessment was conducted using the Relationship Questionnaire (RQ), Big Five Inventory (BFI), Relationship Assessment Scale (RAS), Satisfaction with Life Scale (SWLS), and Conflict Behavior Scale (CBS). Results: The IQ of patients with PNES (88.8 ± 13.6) was lower compared to healthy controls (103.5 ± 28.0) but higher than epilepsy patients (84.6 ± 12.9). There were no significant differences between PNES patients and either patients with epilepsy or healthy controls in terms of security, fearfulness, preoccupation, or dismissiveness based on RQ subscale scores. PNES patients tended to be less satisfied (RAS total score, p = 0.10), but did not differ on overall life quality (on SWLS) compared to epilepsy patients and healthy individuals. There were no significant differences in the scores for different attachment styles (secure, fearful, preoccupied, dismissive) among the groups (p > 0.05). Significant differences were found in agreeableness (p = 0.017) and openness (p = 0.009) among the groups. The PNES group exhibits higher scores in Negative—Own (p = 0.009), Positive—Own (p = 0.011), Negative—Partner (p = 0.011), and Positive—Partner (p = 0.028) compared to epilepsy and healthy individuals. No significant differences observed in the Abusive—Own and Abusive—Partner scores (p > 0.05). Conclusions: In conclusion, this study highlights distinct personality traits and relationship patterns in patients with psychogenic non-epileptic seizures (PNES) compared to epilepsy patients and healthy controls, emphasizing the need for targeted interventions to address these psychological nuances effectively.

Psychiatric Comorbidities in Functional Neurological Disorders and Psychogenic Non-Epileptic Seizures: A Systematic Review and Policy Recommendations for Improving Assessment and Treatment.

Psychogenic Non-Epileptic Seizures (PNES) and Functional Neurological Disorders (FND) are progressively attracting the attention of healthcare professionals both in the medical or surgical specialties and in psychiatric ones. Due to FND and PNES complex presentation, often comorbid with other neurological, medical, and psychiatric conditions, starting from our experience with patients presenting with both conditions, we conducted a systematic review of articles that address the comorbidity of PNES and FND with other psychiatric conditions. Our review supports the point that PNES and FND are not autonomous conditions but develop on the grounds of other psychiatric comorbidities including autism, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and alexithymia. Persons with PNES and FND have often a history of child abuse, neglect, and trauma, and these conditions can also trigger the two conditions if appearing later in life. We also propose policies to endorse the comorbidity theory and improve assessment and treatment. The scrutinized studies confirm that PNES and FND might be comorbid or represent manifestations of what we hypothesize as an integrated biopsychosocial model where early trauma, abuse, and neglect lead to a progressive neuro sensitivity that can present in the same person, usually young female patients, as a combination of dysthymia, alexithymia, autism, PTSD, BPD, FND, and PNES.

Stress-Induced Syncope: A Case Study

Four adolescent female athletes across four grades were diagnosed with either psychogenic nonepileptic seizures or conversion disorder. The females underwent thorough evaluations with their primary care providers and episode and symptom tracking by their athletic trainer. Through different applications of cognitive behavioral therapy and one-on-one counseling, the disorders resolved. Teaching athletes the importance of choosing healthy coping mechanisms to stress is vital to quality mental health. It is recommended that more research be done on psychogenic nonepileptic seizures and provide an understanding to those working with the adolescent population on triggers and treatments for psychogenic nonepileptic seizures.

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.

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.

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.

Functional neurological disorder in pregnancy, labour and the postpartum period: systematic review.

Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up. We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions. Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.

One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: A nonrandomized controlled trial.

Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy. In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life. Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44-24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37-12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12-5.04) to 12-month postenrollment (mean = .98, 95% CI = .40-2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-onlycomparisons improved on only one of 19 (5.3%). NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.

Locus coeruleus co-activation patterns at rest show higher state persistence in patients with dissociative seizures: A Pilot Study.

Dissociative seizures are paroxysmal disruptions of awareness and behavioral control in the context of affective arousal. Alterations in stress-related endocrine function have been demonstrated, but the timescale of dissociation suggests that the central locus coeruleus (LC) noradrenergic system is likely pivotal. Here, we investigate whether LC activation at rest is associated with altered brain network dynamics. A preliminary co-activation pattern (CAP) analysis of resting-state functional magnetic resonance imaging (fMRI) in 14 patients with dissociative seizures and 14 healthy controls was performed by using the LC as a seeding region. The red nucleus served as a control condition. Entry rates, durations, and state transition probabilities of identified CAPs were calculated. Analyses were corrected for demographic, technical, and clinical confounders including depression and anxiety. Three LC-related CAPs were identified, with the dominant two showing inverse activations and deactivations of the default mode network and the attention networks, respectively. Analysis of transition probabilities between and within the three CAPs revealed higher state persistence in patients compared to healthy controls for both CAP2LC (Cohen's d = -0.55; p = 0.01) and CAP3LC (Cohen's d = -0.57; p = 0.01). The control analysis using the red nucleus as a seed yielded similar CAPs, but no significant between-group differences in transition probabilities. Higher state persistence of LC-CAPs in patients with dissociative seizures generates the novel hypothesis that arousal-related impairments of network switching might be a candidate neural mechanism of dissociation. Dissociative seizures often arise during high affective arousal. The locus coeruleus is a brain structure involved in managing such acute arousal states. We investigated whether the activity of the locus coeruleus correlates with activity in other regions of the brain (which we refer to as "brain states"), and whether those brain states were different between patients with dissociative seizures and healthy controls. We found that patients tended to stay in certain locus coeruleus-dependent brain states instead of switching between them. This might be related to the loss of awareness and disruptions of brain functions ("dissociation") that patients experience during seizures.

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.

Diagnostic Value of Bereitschaftspotential in People With Functional Seizures.

Bereitschaftspotential (BP) or readiness potential in people with functional movement disorders can aid diagnostic workup. We evaluated the diagnostic value of BP as an interictal EEG marker in people with functional seizures (FS). We recorded and analyzed BP interictal before intended movements in 17 adults with FS and 17 controls with alternative diagnoses. We evaluated the signals for the presence of BP, latency, amplitude, and early versus late BP. Bereitschaftspotential was present in all except one person with FS. We found no significant differences in the latency and amplitude of BP between participants with FS and controls. The early BP showed the most significant variance in amplitude, latency, and presence. We found interictal typical BP values in participants with FS and variable semiology, while earlier research found interictal no BP in functional movement disorders. These findings do not support the use of BP as an interictal diagnostic tool for FS. Differences in early BP and focus on FS with pure motor semiology are starting points for further research evaluating potential interictal markers in people with FS.

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.

ILLNESS PERCEPTION AND TREATMENT EXPECTATION IN PATIENTS WITH FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER AT LAHORE, PAKISTAN

OBJECTIVE To explore the perceived illness and treatment expectations of patients with Functional Neurological Symptom Disorder. DESIGN OF STUDY It is a Descriptive Research Design PLACE AND DURATION The study was executed at Department of Psychiatry of government and private teaching hospitals of Lahore, Pakistan over a period of 12 months, from Jan 2023 to Dec 2023. METHOD A total of 100 adult participants were recruited as per criteria. Demographic Information Questionnaire and Short Explanatory Model Interview (SEMI) were employed and the qualitative data generated from SEMI was converted to numerical codes and discrete categories by the method of stepwise reduction. The descriptive frequencies were then presented in the tabular format. RESULTS Majority of the participants were female, educated, students and housewives, with 1 – 6 months duration of the illness, mixed symptoms presentation, pseudo seizures and motor symptoms. The main reasons of onset of illness was mentioned as marriage related factors and familial and social factors and majority participants believe that magic can affect others. The intensity of the symptoms were perceived as ‘extreme intense’ associated with the fear about the worsening of symptoms and serious discomfort. The main difficulties due to illness was reported to be lack of interest in daily activities, and increase in problem in relationships. The patients expect proper treatment and prescription of medicines which was followed by responses that they will learn the diagnosis and will receive advice from doctors regarding their illness. CONCLUSION The patient’s perception towards their illness was serious and concerned and their expectations was receiving proper treatment, medications and learning the disorder and doctor’s advice.

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.

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.

Nonictal electroencephalographic measures for the diagnosis of functional seizures.

Functional seizures (FS) look like epileptic seizures but are characterized by a lack of epileptic activity in the brain. Approximately one in five referrals to epilepsy clinics are diagnosed with this condition. FS are diagnosed by recording a seizure using video-electroencephalography (EEG), from which an expert inspects the semiology and the EEG. However, this method can be expensive and inaccessible and can present significant patient burden. No single biomarker has been found to diagnose FS. However, the current limitations in FS diagnosis could be improved with machine learning to classify signal features extracted from EEG, thus providing a potentially very useful aid to clinicians. The current study has investigated the use of seizure-free EEG signals with machine learning to identify subjects with FS from those with epilepsy. The dataset included interictal and preictal EEG recordings from 48 subjects with FS (mean age = 34.76 ± 10.55 years, 14 males) and 29 subjects with epilepsy (mean age = 38.95 ± 13.93 years, 18 males) from which various statistical, temporal, and spectral features from the five EEG frequency bands were extracted then analyzed with threshold accuracy, five machine learning classifiers, and two feature importance approaches. The highest classification accuracy reported from thresholding was 60.67%. However, the temporal features were the best performing, with the highest balanced accuracy reported by the machine learning models: 95.71% with all frequency bands combined and a support vector machine classifier. Machine learning was much more effective than using individual features and could be a powerful aid in FS diagnosis. Furthermore, combining the frequency bands improved the accuracy of the classifiers in most cases, and the lowest performing EEG bands were consistently delta and gamma.

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...