Psychogenic Nonepileptic Seizures Patients Research Articles

A comparative study of psychiatric comorbidities and quality of life in patients with epilepsy and psychogenic non-epileptic seizures

Background: Epilepsy and psychogenic non-epileptic seizures (PNES) are both common disease entities and psychiatric comorbidities are also high among the sufferers. Studies on the comparison of the levels of comorbidities between the two groups are few in number. Aims and Objectives: The aims of this study were to investigate different psychiatric disorders like depression, anxiety, social functioning, and quality of life (QoL) in epilepsy and PNES patients and compare them statistically. Materials and Methods: 38 epilepsy and 22 PNES patients were evaluated with clinical history and different tools like the mini international neuropsychiatric interview - 5, Beck’s Depression Inventory - 2,state and trait anxiety inventory, Social and Occupational functioning scale for epilepsy and QoL in epilepsy - 31 questionnaire. Comparisons were made between the groups regarding sociodemographic data, scores on different aspects of psychiatric disorders, social functioning, and QoL. Results: The majority in the epilepsy group were males, and in the PNES group were females, while younger age group predominates in both groups. There was a high prevalence of depression and anxiety in both groups, while PNES subjects had significantly higher depression and trait anxiety scores. Social and occupational functions were comparable in the two groups, but QoL indexes were significantly worse in the PNES group. Conclusion: Findings in this study indicate that psychiatric comorbidities like depression and anxiety disorders are much more common among patients with epilepsy and PNES. Occurrence of depression is even higher among patients with PNES. Both epilepsy/PNES and these psychiatric comorbidities affect Socio-occupational functions and their QoL. Thus, it is very important to look for these psychiatric comorbidities and QoL in these patients and implement proper management protocols to improve their mental health as well as their QoL.

Factors affecting long-term prognosis in adult patients with psychogenic non-epileptic seizures.

<p>Among epileptic patients who are monitored using the video-electroencephalography monitoring (VEM) technique, in some patients a psychogenic non-epileptic seizure (PNES) can be identified as a definitive diagnosis. The long-term prognosis of these patients is not well known. In this study, we aimed to determine the factors that affect the prognosis of PNES.</p>. <p>Forty-one PNES patients diagnosed using VEM between 2012 and 2022 were questioned about their PNES frequencies in the last 12 months. According to their semiological characteristics, PNES types were divided into motor and non-motor seizures. The effects of clinical characteristics (e.g. age, gender, marital status, education level and PNES type) on the prognoses were identified.&nbsp;</p>. <p>Twenty-one PNES patients (51.2%) had long-term seizure freedom after VEM. Thirteen of them (31.7%) entered the seizure-free period immediately after VEM, and the other eight (19.5%) continued suffering from PNES for several years and became seizure free in the last 12 months. In the poor-prognosis group, female cases showed worse prognoses than male cases. The prognoses of motor and non-motor PNES types did not show significant differences.&nbsp;</p>. <p>This study showed that 51.2% of the PNES patients examined had long-term seizure freedom and that female patients had worse prognoses than male patients.</p>.

Latency of epileptic and psychogenic nonepileptic seizures.

Due to their semiological similarities, psychogenic nonepileptic seizures (PNESs) can occasionally hardly be differentiated from epileptic seizures (ESs), and long-term video-electroencephalographic monitoring (VEM) is needed for the differential diagnosis. To investigate the time of the first clinical event and its distribution on the days of VEM in ES and PNES patients. In total, a consecutive series of 48 PNES and 51 ES patients matched for gender and age were retrospectively and consecutively evaluated. The time distribution of the seizures during the day was noted. Seizure latency was determined as the time in hours from the start of the video-electroencephalographic recording to the first clinical event. The seizure latency was significantly shorter in PNES patients compared to ES patients (p < 0.001). Seventy-two percent of PNES patients and 49.1% of ES patients had their first seizure in the 24 hours of video-EEG recording (p = 0.023). Recording longer than 48 hours was required for 12.5% of PNES patients and 37.3% of ES patients (p = 0.006). While ESs were almost evenly distributed throughout the day, most PNESs occurred during the evening hours (p = 0.011). We observed that the PNESs appeared earlier than the ESs in the VEM and were concentrated during daylight hours. Although not strictly reliable, seizure latency can contribute to the differential diagnosis of ES and PNES.

Development and Validation of Machine-Learning Models to Support Clinical Diagnosis for Non-Epileptic Psychogenic Seizures

Electroencephalographic (EEG) signal processing and machine learning can support neurologists’ work in discriminating Psychogenic Non-Epileptic Seizure (PNES) from epilepsy. PNES represents a neurological disease often misdiagnosed. Although the symptoms of PNES patients can be similar to those exhibited by epileptic patients, EEG signals during a psychogenic seizure do not show ictal patterns such as in epilepsy. Therefore, PNES diagnosis requires long-term EEG video. Applying signal processing and machine-learning methodologies could help clinicians find helpful information in the clinical diagnosis of PNES by analyzing EEG signals registered in resting conditions and in a short time. These methodologies should prevent long EEG recording sessions and avoid inducing seizures in the subjects. The aim of our study is to develop and validate several machine-learning models on a larger dataset, consisting of 225 EEGs (75 healthy, 75 PNES, and 75 subjects with epilepsy). A deep analysis of our results shows that changes in the evaluation strategy led to changes in accuracy from 45% to 83.98% for a standard Light Gradient Boosting Machine (LGBM) classifier. Our findings suggest that it is necessary to operate a very rigorous control in terms of experimental data collection (patient selection, signal acquisition) and terms of validation strategies to obtain and reproducible results.

EEG abnormalities in patients with PNES (P1-1.003)

<h3>Objective:</h3> Our goal is to characterize EEG abnormalities in patients with psychogenic non epileptic seizures (PNES) with and without epilepsy as well as examine the relationship between EEG and imaging in this cohort at a Level-4 Epilepsy center. <h3>Background:</h3> Prior studies have shown that <i>PNES patients have higher rates of EEG abnormalities; both epileptiform and non-epileptiform as compared to the general population. Studies have noted EEG changes in patients with PNES. For most of these studies, studying EEG abnormalities were not a primary goal. These studies were older, had smaller sample sizes, some were in specific groups (children, neurological conditions, developmentally delayed people ) or did not distinguish between underlying cerebral disorders vs or epilepsy. In one recent larger study, which did find higher rate of interictal EEG abnormalities in patients with PNES (1.8 times more likely, this did not reach significance) but used routine EEGs to study interictal data.</i> <h3>Design/Methods:</h3> Retrospective chart review of all patients discharged from the Epilepsy Monitoring Unit between 1/2016 and 12/2018. <h3>Results:</h3> 287 patients with PNES and 17 with PNES and epilepsy (PNES+E) were included. Age was mean of 41 years (PNES) and 39 years (PNES+E). 78.4% of PNES patients had normal interictal EEG, 21.6% had abnormal interictal EEG. 17.6% of PNES+E patients had normal interictal EEG and 82.4% had abnormal interictal EEG. Overall, 15.1 % of patients had an interictal epileptiform abnormality. 10.8% of pts with PNES had epileptiform discharges as compared to 88.2% of patients with PNES+E. Overall, 17.4% of the total pts had a non-epileptiform abnormality on their EEG. In the PNES group, this was 16% and in the PNES+E group, it was 41.2% <h3>Conclusions:</h3> Patients with PNES have a much higher rate of epileptiform discharges at 11% compared to the general population (~2%) <b>Disclosure:</b> Dr. Mirza has nothing to disclose. Dr. Agostini has nothing to disclose. The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS. Dr. Doyle has nothing to disclose. Dr. Alick-Lindstrom has nothing to disclose. irina podkorytova has nothing to disclose. Dr. Hays has nothing to disclose. Dr. Zepeda Garcia has nothing to disclose. Dr. Perven has nothing to disclose. Dr. Dieppa has nothing to disclose. Dr. Das has received personal compensation for serving as an employee of Concentra. Dr. Das has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for janicek. The institution of an immediate family member of Dr. Das has received research support from NIH.

Child Neurology Residency Survey of Psychogenic Nonepileptic Seizure Education (P2-2.004)

<h3>Objective:</h3> To assess the learning needs of pediatric neurology resident trainees and program directors (PD) on the education of psychogenic nonepileptic seizures (PNES) during training. <h3>Background:</h3> PNES proves difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently, given overlapping semiologic findings between the two diagnoses. Previous studies have shown trainees, including neurology trainees, are not very accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have a formal curriculum for teaching PNES and there are no ABPN standards for residency curricula in this topic. <h3>Design/Methods:</h3> Two unique surveys were designed, one for child neurology trainees and one for PDs. Questions were designed to assess trainees’ abilities, current education received, and desired teaching. Similarly, PDs’ level of confidence in trainee management of PNES was assessed, as well as specific preferences for a standardized curriculum. <h3>Results:</h3> Sixty-five trainees out of approximately 202 and 21 PDs and associate PDs have responded to the survey. About one-third of trainees report neutral to low levels of confidence and 36.9% report neutral to low levels of knowledge in caring for PNES patients. Trainees reported that directing PNES patients to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60.0% and 46.1% reporting difficulty, respectively. Trainees report preferring to learn about this topic through reading material and simulation. One-fifth of PDs feel their current PNES education is not sufficient and 52.4% of PDs would incorporate a standardized curriculum, with remaining PDs reporting willingness depending on the required time. <h3>Conclusions:</h3> Areas of needed training and desired teaching format were identified based on trainee responses. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study will be utilized to create a national curriculum. <b>Disclosure:</b> The institution of Dr. Albert has received research support from Nationwide Children’s Hospital, Division of Neurology, Internal Research Grant. Dr. Freedman has nothing to disclose. Dr. Talai has nothing to disclose.

Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people’s illness representations? An experimental vignette study

Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public’s representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18–25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants’ illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study’s first insights into the dynamics of lay responses to PNES.

Impact of comorbid psychogenic non-epileptic seizures on migraine: An observational study.

There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine. This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively. Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease. Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger.

Structural Changes in Brain Magnetic Resonance Imaging Associated With Psychogenic Non-epileptic Seizures: An Analytical Cross-Sectional Study.

Background Psychogenic non-epileptic seizures (PNES) are often seen as indicators of poor motor and sensory function caused by psychological responses to stressful experiences. A seizure might trigger these reactions. The aim of our study was to assess the structural changes in brain MRI associated with psychogenic non-epileptic seizures. Methodology A retrospective analytical cross-sectional study at the Department of Medicine and Neurology, Ayub Teaching Hospital, Abbottabad, was conducted from October 2020 to September 2021. The medical records of patients with confirmed PNES were collected and retrospectively evaluated. Results Medical records and MRI scans were accessible for 52 patients with PNES; 10 patients were excluded from the study. The average age of the patients (standard deviation) was 34 (±9) years, and the average age at onset was 31.6 (±5.8) years. Based on the video-EEG recordings, 57.1% of patients (n=24) were classified as having broadly generalized motor seizures, 40% of patients (n=17) were classified as having predominantly akinetic seizures defined primarily by blank spells, and only one patient was classified as having focal motor seizures. Only three patients (7%) had a positive epilepsy family history. Twenty-four (47.6%) patients with brain MRI scans reported abnormal findings, while 22 (52.4%) had normal MRI findings. The majority of patients with abnormal MRIs had nonspecific white matter changes (50%), mesial temporal sclerosis (15%), and cysts (15%). In a statistical analysis, age at the beginning of PNES (p = 0.04), duration of PNES (p=0.01), concomitant epilepsy (p = 0.05), generalized motor seizures (p= 0.03), and focal motor seizures (p= 0.02) were strongly associated with abnormal brain MRI findings. Conclusion Research reveals that persons with PNES have a higher-than-average prevalence of anatomical brain abnormalities. The main takeaway is that these findings lend credence to the growing body of data suggesting that PNES may not be a medical mystery but rather a disorder with physical foundations in the brain. Important implications for diagnosing and treating PNES patients are discussed, as are the outcomes of earlier neuroimaging investigations of PNES. Studying the involvement of structural brain anomalies in the etiology of psychogenic non-epileptic seizures requires further well-designed multicenter studies with larger sample sizes and a consistent imaging approach (PNES). It is crucial to consider any confounding variables, such as co-occurring mental diseases, while designing this study.

Attachment style of patients diagnosed with psychogenic non-epileptic seizures at a tertiary Epilepsy Center in the Czech Republic.

Quality and type of early relationships with primary caregivers is considered one of the key factors in the etiopathogenesis of many mental disorders including depression, anxiety, and conversion disorders. This study focused on the type and quality of attachment style in adult patients with psychogenic non-epileptic seizures (PNES). We evaluated the demographic data and profiles of PNES patients (n = 262) and group of healthy volunteers (n = 51) measured by the Parental Bonding Inventory (PBI) and Experiences in Close Relationships (ECR) and Experiences in Close Relationships-Relationship Structure (ECR-RS). Significant differences in measured values between the two groups were identified; specifically, differences in the caregiver style-father and mother overprotection (PBI) was higher in the PNES group. The most frequent type of attachment in PNES was type 2 (preoccupied). Correlations between the PBI and ECR results were also found. This study highlighted certain attachment styles in patients with PNES and statistically significant differences between patients with PNES and a healthy sample. Some correlations between the results of the questionnaires with socio-demographic factors were found. The identification of specific patterns in attachment may be useful for further use in reaching a differential diagnosis and administering tailored psychotherapy of patients with PNES.

Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures (PNESs) are paroxysmal events that resemble epileptic seizures without concomitant changes in electroencephalograms (EEGs) or any other physiological cause. These seizures are one of the most common and dramatic conversion disorders. First responders treat many PNES patients with unnecessary emergency abortive medication and sometimes even intubate them. Several of our PNES patients have complained they have experienced harsh attitudes from health care practitioners (HCPs), especially during their stay in the emergency room (ER). To assess the emotional attitude of HCPs toward PNES patients. We handed a questionnaire containing 23 questions regarding PNES patients to HCPs from emergency medicine, internal medicine, and neurology disciplines. The questions dealt with three categories: diagnosis, management, and emotional attitudes. Overall, 47 HCPs participated in this study: 11 ER, 18 internal medicine, and 18 neurology practitioners. The HCP from those disciplines showed high knowledge and good management practice of PNES patients. On the other hand, the HCPs agreed with most emotional attitude statements regarding PNES patients, reflecting a high percentage of negative emotional attitudes toward this group of patients. We did not find any correlation between negative emotional attitude and HCP department, profession, or seniority. Although HCPs in our center perform good management practice regarding PNES patients, most reported a negative emotional attitude. This finding implies that what PNES patients feel regarding the harsh attitudes is also reflected by HCP views. Emotional attitudes towards PNES patients may not depend solely on the level of knowledge of the HCPs.

Frequency and economic burden of psychogenic non-epileptic seizures in patients applying for disability benefits due to epilepsy.

Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures and are often misdiagnosed as epilepsy. To investigate the frequency of PNES and to calculate the economic burden of the patients who admitted to video-electroencephalographicmonitoring (VEM) to obtain a diagnosis of epilepsy in order to apply for disability retirement. The present retrospective study included 134 patients who required disability reports between 2013 and 2019 and had their definite diagnoses after VEM. Following VEM, the patients were divided into three groups: epilepsy, PNES, and epilepsy + PNES. In total, 22.4% (n = 30) of the patients were diagnosed with PNES, 21.6% (n = 29) with PNES and epilepsy, and 56% (n = 75), with epilepsy. The frequency of PNES among all patients was of 44% (n = 59). In patients with PNES alone, the annual cost of using anti-seizure medication was of 160.67 ± 94.04 dollars; for psychostimulant drugs, it was of 148.3 ± 72.48 dollars a year; and the mean direct cost for diagnostic procedures was of 582.9 ± 330.0 (range: 103.52-1601.3) dollars. Although it is challenging to determine the qualitative and quantitative total cost in these patient groups, early diagnosis and sociopsychological support will reduce the additional financial burden on the health system and increase the quality of life of the patients.

Effect of Emotional Valence on Working Memory of Psychogenic Non-Epileptic Seizures (PNES) Patients

Background The present study investigated how emotional valence influenced the working memory of patients with psychogenic non-epileptic seizures (PNES) as compared to healthy individuals. Methods Emotional-N-Back task (E-N-back task) was administered to 15 PNES patients and equal number of healthy individuals. A 2 × 3 one-way analysis of variance (ANOVA) was used. Correct detection (accuracy) and reaction (RT) time were recorded as behavioral performance measures. Results The ANOVA result of correct detection (accuracy) measure revealed significant difference in the performance of patients with PNES as compared with healthy individual, F (2, 48) = 17.08, p = 0.001. However, on the measure of reaction time (RT), both groups performed equally and there was no significant difference, F (2, 48) = 1.13, p = 0.33. Also the results of present study showed that patients with PNES are quicker in identifying unpleasant picture stimuli, which is evident from their mean comparison: unpleasant ( M = 65.55, SD = 15.66), pleasant ( M = 58.22, SD = 20.03), and neutral ( M = 45.11, SD = 23.13). Conclusion Conclusively, the finding of the present study shows a significant effect of emotional valence on working memory of patients with PNES on the measure of correct detection (accuracy), but not for second measure, i.e., reaction time this clearly reveals that patients with PNES are poor at emotional–cognitive integration, specifically at working memory level.

Family Functioning in Psychogenic Nonepileptic Seizures: Qualitative Study

Abstract Background: Psychogenic nonepileptic seizures (PNES) are understood as epileptic presentations without a neurological basis. PNES has underlying psychological stressors that manifest physiologically. However, family functioning has been poorly studied despite its potential to be one of the major stressors. Few studies on family functioning have focused on differences between PNES and epileptic seizures than an in-depth inquiry into family functioning in PNES. Methods: Patients diagnosed with PNES by a psychiatrist or neurologist through home videos were chosen to participate in the study. Participants had at least one seizure in the previous week before the interview, and those who had physical disabilities or comorbid epilepsy were excluded from the study. In-depth interviews were developed and conducted. Determined data was analyzed through latent thematic analysis. Results: Based on the determined data, nine themes were identified. They included interaction and attachment, communication, structure and system, distressful family factors, expressed emotions, cultural aspects, maladaptive coping, adaptive coping, and negative emotional experience. Approach avoidance and hints of ending relationships were the types of communication among PNES patients, attachment has been inconclusive, transgenerational trauma, disengaged boundaries, coalition, and maladaptive triangles are prevalent among families of PNES patients. Over-involvement and hostility are the expressed emotions that were found. Both maladaptive and adaptive coping strategies are found among PNES patients. Finally, superstitions and beliefs in possession exist among families of PNES patients. Conclusion: Family dysfunction is prevalent among families of PNES patients, and hence, family-based interventions are necessary.

Automated temporal lobe epilepsy and psychogenic nonepileptic seizure patient discrimination from multichannel EEG recordings using DWT based analysis

Psychogenic nonepileptic seizure (PNES) and epileptic seizure resemble each other, behaviorally. This similarity causes misdiagnosis of PNES and epilepsy patients, thus patients suffering from PNES may be treated with antiepileptic drugs which can have various side effects. Furthermore, seizure is diagnosed after time consuming examination of electroencephalography (EEG) recordings realized by the expert. In this study, automated temporal lobe epilepsy (TLE) patient, PNES patient and healthy subject discrimination method from EEG signals is proposed in order to eliminate the misdiagnosis and long inspection time of EEG recordings. Also, this study provides automated approach for TLE interictal and ictal epoch classification, and TLE, PNES and healthy epoch classification. For this purpose, subbands of EEG signals are determined from discrete wavelet transform (DWT), then classification is performed using ensemble classifiers fed with energy feature extracted from the subbands. Experiments are conducted by trying two approaches for TLE, PNES and healthy epoch classification and patient discrimination. Results show that in the TLE, PNES and healthy epoch classification the highest accuracy of 97.2%, sensitivity of 97.9% and specificity of 98.1% were achieved by applying adaptive boosting method, and the highest accuracy of 87.1%, sensitivity of 86.0% and specificity of 93.6% were attained using random under sampling (RUS) boosting method in the TLE patient, PNES patients and the healthy subject discrimination.

EEG and MRI Abnormalities in Patients With Psychogenic Nonepileptic Seizures.

To compare the rate of EEG and MRI abnormalities in psychogenic nonepileptic seizures (PNES) patients with and without suspected epilepsy. Patients were also compared in terms of their demographic and clinical profiles. A retrospective analysis of 271 newly diagnosed PNES patients admitted to the epilepsy monitoring unit between May 2000 and April 2008, with follow-up clinical data collected until September 2015. One hundred ninety-four patients were determined to have PNES alone, 16 PNES plus possible epilepsy, 14 PNES plus probable epilepsy, and 47 PNES plus confirmed epilepsy. Fifty-seven of the 77 patients (74.0%) with possible, probable, or definite epilepsy exhibited epileptiform activity on EEG, versus only 16 of the 194 patients (8.2%) in whom epilepsy was excluded. Twenty-four of these 194 patients (12.4%) had MRI abnormalities. Three of 38 patients (7.9%) with both EEG and MRI abnormalities were confirmed not to have epilepsy. In PNES patients with EEG or MRI abnormalities compared with those without, patients with abnormalities were more likely to have epilepsy risk factors, such as central nervous system structural abnormalities, and less likely to report minor head trauma. The presence of EEG abnormalities in PNES-only patients did not influence antiseizure medication reduction, whereas those with MRI abnormalities were less likely to have their antiseizure medications reduced. Psychogenic nonepileptic seizure patients without MRI or EEG abnormalities are less likely to have associated epilepsy, risk factors for epilepsy, and had different demographic profiles. There is a higher-than-expected level of EEG and MRI abnormalities in PNES patients without epilepsy.

Identification of risk factors and distinguishing psychogenic nonepileptic seizures from epilepsy: A retrospective case-control study

IntroductionPatients with psychogenic non-epileptic seizures (PNES) experience significant morbidity and early mortality, secondary to delayed diagnosis. Better characterizing risk factors and exploring how PNES differentially affects sex and racial strata may facilitate earlier diagnosis. MethodsFrom a Hawaiʻi neuroscience institution, 101 PNES patients were investigated in relation to sociodemographic and medical comorbidities. Cases were compared to 202 sex-, age-, and race-matched controls—representing patients with neurological disorders (general controls)—, as well as 404 unmatched epilepsy controls. ResultsRelative to general controls, PNES patients had increased odds (p < 0.05) of being: female, younger age, Native Hawaiian or other Pacific Islander (NHPI), suburban origin, from the lowest income quartile, Medicaid beneficiaries, homeless, current/former smoker, illicit drug users (marijuana, opioids/narcotics, polysubstance abuse), have anxiety, depression, post-traumatic stress disorder, bipolar disorder, traumatic history, World Health Organization obesity class 3, traumatic brain injury, epilepsy, and somatoform disorder. In relation to epilepsy controls, PNES patients exhibited increased odds of being: employed, having attention-deficit/hyperactivity disorder, asthma, migraines, and chronic pain. Relative to females, male PNES patients exhibited increased odds of military insurance, diabetes mellitus type 2, and hypertension. Relative to Whites, the NHPI and Asian PNES patients presented increased odds of asthma, migraines, chronic pain, gastroesophageal reflux disease, and thyroid disease. Per multivariable logistic regression, anxiety was the only consistent predictor of PNES across all sex and race strata. ConclusionPredictors of PNES’s vary amongst the strata of race and sex. Lower socioeconomic status, along with several psychiatric and medical comorbidities, could increase a clinician’s suspicion for earlier medical workup and diagnosis of PNES.

Prof M. Murugappan Poster Award

Background:Patients with psychogenic non epileptic seizures (PNES) tend to have more frequent and disabling seizures than those which true epilepsy and are often misdiagnosed as epilepsy due to lack of clear diagnostic criteria and variations in clinical semiology.Aims & Objectives:To understand the type of clinical manifestations seen in patients of PNES and the cultural beliefs regarding their symptoms.Material & Methods:71 patients who consented were enrolled in the study after institutional ethics committee approval. They were diagnosed by the neurologist to be having psychogenic seizures on the basis of their clinical presentation and a 2 hours VEEG recording which was normal. The details of the psychogenic seizure viz. clinical manifestation, duration of the episode, loss of consciousness, incontinence and injuries were recorded on a proforma. Patient’s history was taken in detail to understand areas of conflicts, interpersonal problems, discord or any other stressors. The cultural attributions of the patients were also recorded in open and closed ended questions.Results:Clinical manifestations included verbal unresponsiveness (74%), whole body rigidity (72%), upper limb (55%) and lower limb movements (39%), vocalisations and head movements in less than 25% and automatisms in only 6 patients. Pelvic thrusting as a manifestation was seen in only 1 patient. 38 patients attributed their symptoms to being possessed by God/ghost/evil spirit; 9 to black magic being done on them; 24 patients did not relate symptoms to religious beliefs. 62 patients had visited faith healers.Conclusions:This study is first of its kind which looks at the various clinical presentations of PNES patients in order to assess if there is any cultural basis for the symptoms.

Abstract- Poster

• Background:Patients with psychogenic non epileptic seizures (PNES) tend to have more frequent and disabling seizures than those which true epilepsy and are often misdiagnosed as epilepsy due to lack of clear diagnostic criteria and variations in clinical semiology.• Aims & Objectives:To understand the type of clinical manifestations seen in patients of PNES and the cultural beliefs regarding their symptoms.• Material & Methods:71 patients who consented were enrolled in the study after institutional ethics committee approval. They were diagnosed by the neurologist to be having psychogenic seizures on the basis of their clinical presentation and a 2 hours VEEG recording which was normal. The details of the psychogenic seizure viz. clinical manifestation, duration of the episode, loss of consciousness, incontinence and injuries were recorded on a proforma. Patient’s history was taken in detail to understand areas of conflicts, interpersonal problems, discord or any other stressors. The cultural attributions of the patients were also recorded in open and closed ended questions.• Results:Clinical manifestations included verbal unresponsiveness (74%), whole body rigidity (72%), upper limb (55%) and lower limb movements (39%), vocalisations and head movements in less than 25% and automatisms in only 6 patients. Pelvic thrusting as a manifestation was seen in only 1 patient. 38 patients attributed their symptoms to being possessed by God/ghost/evil spirit; 9 to black magic being done on them; 24 patients did not relate symptoms to religious beliefs. 62 patients had visited faith healers.Conclusions:• This study is first of its kind which looks at the various clinical presentations of PNES patients in order to assess if there is any cultural basis for the symptoms.

Clinical manifestations and cultural correlates of psychogenic nonepileptic seizure symptoms: An Indian perspective.

Patients with psychogenic nonepileptic seizures (PNES) tend to have more frequent and disabling seizures than those which true epilepsy and are often misdiagnosed as epilepsy due to lack of clear diagnostic criteria and variations in clinical semiology. This study was an attempt to improve the understanding and type of clinical manifestations seen in patients of PNES and the cultural beliefs regarding their symptoms. In this cross-sectional observational study, 71 patients diagnosed with PNES by neurologists on the basis of their clinical presentation and a two hours normal VEEG recording were enrolled in the study after ethics approval. The clinical manifestations of PNES were recorded in detail along with details of various cultural attributions of the patients to the symptoms which were recorded in open- and closed-ended questions. Clinical manifestations included verbal unresponsiveness (74%), whole body rigidity (72%), upper limb (55%) and lower limb movements (39%), vocalizations and head movements in less than 25%, and automatisms in only 6 patients. Pelvic thrusting as a manifestation was seen in only one patient. Thirty-eight patients attributed their symptoms to being possessed by God/ghost/evil spirit; nine to black magic being done on them; twenty-four patients did not relate symptoms to religious beliefs. Sixty-two patients had visited faith healers. This study is the first of its kind which looks at various clinical presentations of PNES patients in order to assess if there is any cultural basis for the symptoms.