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Psychogenic Nonepileptic Spells

Chloe E Hill, Hannah Schwartz, Nabila Dahodwala, Brian Litt, Kathryn A Davis
OBJECTIVE: This study investigated continuity of neurological care for patients discharged from the epilepsy monitoring unit (EMU) with a diagnosis of psychogenic nonepileptic spells (PNES). Because PNES are seizure-like episodes that cannot be explained by abnormal electrical brain activity, they are challenging for patients to understand and accept. Consequently, after diagnosis, patients commonly fail to start recommended psychotherapy and instead pursue redundant medical care. As consistent relationships with healthcare providers may help, we instituted standard follow-up for patients diagnosed with PNES...
September 2017: Epilepsy & Behavior: E&B
C Gasca-Salas, A E Lang
The diagnosis of functional neurologic disorders can be challenging. In this chapter we review the diagnostic criteria and rating scales reported for functional/psychogenic sensorimotor disturbances, psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD). A recently published scale for sensorimotor signs has some limitations, but may help in the diagnosis, and four motor and two sensory signs have been reported as highly reliable. There is good evidence using eight specific signs for the differentiation of PNES from seizures...
2016: Handbook of Clinical Neurology
Stephanie Chen-Block, Bassel W Abou-Khalil, Amir Arain, Kevin F Haas, Andre H Lagrange, Martin J Gallagher, Nabil J Azar, Pradumna Singh, Hasan H Sonmezturk
RATIONALE: Epilepsy and psychogenic nonepileptic spells (PNES) can coexist, often posing diagnostic and therapeutic challenges. We sought to identify clinical and historical characteristics of two groups of patients, those with coexisting epilepsy and PNES and those with PNES alone, and determine the prevalence of coexisting epilepsy/PNES with strict diagnostic criteria in a large group of epilepsy monitoring unit (EMU) patients. METHODS: We reviewed the medical records of all consecutive patients admitted to the Vanderbilt University Medical Center Adult EMU between July 1, 2007 and June 30, 2012...
September 2016: Epilepsy & Behavior: E&B
Erik K St Louis, Gregory D Cascino
PURPOSE OF REVIEW: This review identifies the diverse and variable clinical presentations associated with epilepsy that may create challenges in diagnosis and treatment. RECENT FINDINGS: Epilepsy has recently been redefined as a disease characterized by one or more seizures with a relatively high recurrence risk (ie, 60% or greater likelihood). The implication of this definition for therapy is that antiepileptic drug therapy may be initiated following a first seizure in certain situations...
February 2016: Continuum: Lifelong Learning in Neurology
Rick Hendrickson, Alexandra Popescu, Gena Ghearing, Anto Bagic
Psychogenic nonepileptic spells (PNESs) are often very difficult to treat, which may be, in part, related to the limited information known about what a person experiences while having PNESs. For this retrospective study, thoughts, emotions, and dissociative features during a spell were evaluated in 351 patients diagnosed with PNESs (N=223) or epilepsy (N=128). We found that a statistically higher number of thoughts, emotions, and dissociative symptoms were endorsed by patients with PNESs versus patients with epilepsy...
October 2015: Epilepsy & Behavior: E&B
Diana Mungall Robinson, Batool F Kirmani
The objective of our study was to emphasize the importance of intensive video EEG monitoring in patients with a well-established diagnosis of epilepsy with moderate cognitive impairment. The idea was to diagnose new onset frequent atypical events prompting the need for frequent emergency room and clinic visits and hospital admissions. Retrospective chart reviews were conducted on patients with chronic epilepsy with moderate cognitive impairment who had an increased incidence of new onset episodes different from the baseline seizures...
2014: Case Reports in Psychiatry
Evan R Gedzelman, Suzette M LaRoche
Psychogenic nonepileptic seizures have long been known by many names. A short list includes hysteroepilepsy, hysterical seizures, pseudoseizures, nonepileptic events, nonepileptic spells, nonepileptic seizures, and psychogenic nonepileptic attacks. These events are typically misdiagnosed for years and are frequently treated as electrographic seizures and epilepsy. These patients experience all the side effects of antiepileptic drugs and none of the benefits. Video electroencephalogram (EEG) monitoring is the gold standard diagnostic test that can make a clear distinction between psychogenic nonepileptic seizures and epilepsy...
2014: Neuropsychiatric Disease and Treatment
Rick Hendrickson, Alexandra Popescu, Ronak Dixit, Gena Ghearing, Anto Bagic
Psychogenic nonepileptic spells (PNES) are frequently challenging to differentiate from epileptic seizures. The experience of panic attack symptoms during an event may assist in distinguishing PNES from seizures secondary to epilepsy. A retrospective analysis of 354 patients diagnosed with PNES (N=224) or with epilepsy (N=130) investigated the thirteen Diagnostic and Statistical Manual-IV-Text Revision panic attack criteria endorsed by the two groups. We found a statistically higher mean number of symptoms reported by patients with PNES compared with those with epilepsy...
August 2014: Epilepsy & Behavior: E&B
Hajo M Hamer, Seung Bong Hong
Patients with epilepsy caused by mid-grade and high-grade tumors do not usually undergo formal presurgical epilepsy evaluations before tumor resection. However, a minority of these patients may benefit significantly from just such a structured presurgical evaluation especially when seizure freedom or seizure reduction is a surgical aim in addition to total tumor resection. Typical cases comprise patients with multifocal tumors, tumors with bilateral extension, tumors over eloquent cortex, and the need for differentiation of spells of an uncertain nature, for example, epileptic versus psychogenic nonepileptic seizures...
December 2013: Epilepsia
Ronak Dixit, Alexandra Popescu, Anto Bagić, Gena Ghearing, Rick Hendrickson
Differentiating between psychogenic nonepileptic spells (PNES) and epileptic seizures without video-EEG monitoring is difficult. The presence of specific medical comorbidities may discriminate the two, helping physicians suspect PNES over epilepsy earlier. A retrospective analysis comparing the medical comorbidities of patients with PNES with those of patients with epilepsy was performed in 280 patients diagnosed with either PNES (N = 158, 74.7% females) or epilepsy (N = 122, 46.7% females) in the Epilepsy Monitoring Unit (EMU) of the University of Pittsburgh Medical Center over a two-year period...
August 2013: Epilepsy & Behavior: E&B
Batool F Kirmani
Epilepsy is a chronic medical condition which is disabling to both patients and caregivers. The differential diagnosis of epilepsy includes psychogenic nonepileptic spells or "pseudoseizures." Epilepsy is due to abnormal electrical activity in the brain, and pseudoseizure is a form of conversion disorder. The brain waves remain normal in pseudoseizures. The problem arises when a patient with significant psychiatric history presents with seizures. Pseudoseizures become high on the differential diagnosis without extensive work up...
2013: Case Reports in Neurological Medicine
Ünsal Yılmaz, Ayşe Serdaroğlu, Esra Gürkaş, Tuğba Hirfanoğlu, Ali Cansu
We aimed to determine the types and clinical characteristics of paroxysmal nonepileptic events (PNEs) in children. During a 13-year period, 765 patients underwent long-term video-EEG monitoring, and 95 (12.4%) of them were identified to have PNEs. The most common diagnoses were conversion disorder, parasomnias, staring spells, movement disorders, and hypnic jerks. Paroxysmal nonepileptic events originated from physiologic or organic (43.2%) and psychogenic (56.8%) causes. Mean delay in diagnosis was 3.1 years...
April 2013: Epilepsy & Behavior: E&B
Susannah Brock Cornes, Tina Shih
PURPOSE OF REVIEW: : The neurologic consultant is frequently called to evaluate the patient with transient neurologic deficits, or spells. Spells can present with a broad array of clinical features, making a systematic evaluation challenging. Familiarity with a variety of key features for different spell types will help the consultant create an appropriate differential diagnosis to guide the diagnostic evaluation. RECENT FINDINGS: : Recent practice parameters outline the appropriate evaluation for patients presenting with first unprovoked seizure, and an update in the International League Against Epilepsy classification scheme for seizures has shifted the terminology used to describe these spells...
October 2011: Continuum: Lifelong Learning in Neurology
Katherine H Noe, Madeline Grade, Cynthia M Stonnington, Erika Driver-Dunckley, Dona E C Locke
The influence of gender on psychogenic nonepileptic seizures (PNES) diagnosis was examined retrospectively in 439 subjects undergoing video-EEG (vEEG) for spell classification, of whom 142 women and 42 men had confirmed PNES. The epileptologist's predicted diagnosis was correct in 72% overall. Confirmed epilepsy was correctly predicted in 94% men and 88% women. In contrast, confirmed PNES was accurately predicted in 86% women versus 61% men (p=0.003). Sex-based differences in likelihood of an indeterminate admission were not observed for predicted epilepsy or physiologic events, but were for predicted PNES (39% men, 12% women, p=0...
March 2012: Epilepsy & Behavior: E&B
Martin Salinsky, David Spencer, Eilis Boudreau, Felicia Ferguson
OBJECTIVES: Psychogenic nonepileptic seizures (PNES) are frequently encountered in epilepsy monitoring units (EMU) and can result in significant long-term disability. We reviewed our experience with veterans undergoing seizure evaluation in the EMU to determine the time delay to diagnosis of PNES, the frequency of PNES, and cumulative antiepileptic drug (AED) treatment. We compared veterans with PNES to civilians with PNES studied in the same EMU. METHODS: We reviewed records of all patients admitted to one Veterans Affairs Medical Center (VAMC) EMU over a 10-year interval...
September 6, 2011: Neurology
Amir M Arain, Yanna Song, Nandakumar Bangalore-Vittal, Shahid Ali, Shagufta Jabeen, Nabil J Azar
OBJECTIVE: Psychogenic nonepileptic seizures (PNES) are common paroxysmal events that mimic and can often be misdiagnosed as epileptic seizures. PNES account for 10 to 40% of patients referred to epilepsy centers. Patients with uncontrolled PNES are at times subjected to vagus nerve stimulator (VNS) implantation. We report a series of such referred patients studied with video/EEG monitoring at our institution. METHODS: We evaluated patients who were implanted with a VNS by their primary neurologist for refractory seizures and who were referred to the Vanderbilt University epilepsy monitoring unit for a second opinion...
August 2011: Epilepsy & Behavior: E&B
William O Tatum, Andrew Spector
The misdiagnosis of epilepsy may occur from the misinterpretation of a routine scalp EEG. Typically, interictal epileptiform discharges are misidentified on EEGs because of the overinterpretation of normal variants or variations in normal electrocerebral activity. Most reports of misinterpretation have arisen from patients diagnosed with psychogenic nonepileptic attacks using in-patient video-EEG monitoring. However, because seizures are rarely captured in the routine performance of EEG in the outpatient setting, ictal overinterpretation is much less likely to occur...
June 2011: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Roderick Duncan, Saif Razvi, Sharon Mulhern
There are few published population-based data for psychogenic nonepileptic seizures (PNES). We prospectively identified first presentations of PNES from a population of 367,566, over 3 years. PNES were diagnosed in 68 patients, in 54 of whom the diagnosis was confirmed by video/EEG recording, indicating an incidence of 4.90/100,000/year. Median diagnostic delay was 0.6 ± 0.2 year. At presentation with PNES, our patients already had high rates of psychological morbidity, medically unexplained symptoms other than PNES, and economic dependence...
February 2011: Epilepsy & Behavior: E&B
Roderick Duncan
Psychogenic nonepileptic seizures (PNES; also known as pseudoseizures, nonepileptic attack disorder) are common. They continue to pose diagnostic difficulties, with mean delays from onset to diagnosis of several years, during which time they are often treated as epilepsy. The literature suggests that clinical diagnosis has limited reliability. However, it may be useful to regard the diagnosis of PNES as having two stages-- that of suspecting the diagnosis and that of confirming it. Clinical features of the history and spells allow the diagnosis of PNES to be suspected in the first place, so that the appropriate expertise and tests can be brought to bear...
December 2010: Expert Review of Neurotherapeutics
Maria Oto, Colin A Espie, Roderick Duncan
PURPOSE: To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome. METHODS: Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months. RESULTS: Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized...
October 2010: Epilepsia
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