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https://www.readbyqxmd.com/read/28092837/differential-diagnosis-of-a-paroxysmal-neurological-event-do-neurologists-know-how-to-clinically-recognize-it
#1
Aleksandar J Ristić, Ksenija Mijović, Zoran Bukumirić, Nikola Vojvodić, Slavko Janković, Vladimir Baščarević, Tijana Đukić, Dragoslav Sokić
PURPOSE: To investigate ability to recognize paroxysmal neurological events (PNE) based on video-recorded events alone in a group of physicians treating prevalent neurological conditions. METHODS: Total of 12 patients' videos (6 epileptic seizures (ES), 4 psychogenic nonepileptic seizures (PNES), 2 other nonepileptic seizures (oNES)) were selected. Videos were displayed once to physicians blind to clinical data and final diagnosis. Physicians determined their clinical choice: ES, PNES, oNES, and I don't know (IDK)...
January 13, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28090678/the-epileptic-and-nonepileptic-spectrum-of-paroxysmal-dyskinesias-channelopathies-synaptopathies-and-transportopathies
#2
REVIEW
Roberto Erro, Kailash P Bhatia, Alberto J Espay, Pasquale Striano
Historically, the syndrome of primary paroxysmal dyskinesias was considered a group of disorders as a result of ion channel dysfunction. This proposition was primarily based on the discovery of mutations in ion channels, which caused other episodic neurological disorders such as epilepsy and migraine and also supported by the frequent association between paroxysmal dyskinesias and epilepsy. However, the discovery of the genes responsible for the 3 classic forms of paroxysmal dyskinesias disproved this ion channel theory...
January 16, 2017: Movement Disorders: Official Journal of the Movement Disorder Society
https://www.readbyqxmd.com/read/28087824/neuropathology-of-sudep-role-of-inflammation-blood-brain-barrier-impairment-and-hypoxia
#3
Zuzanna Michalak, Dima Obari, Matthew Ellis, Maria Thom, Sanjay M Sisodiya
OBJECTIVE: To seek a neuropathologic signature of sudden unexpected death in epilepsy (SUDEP) in a postmortem cohort by use of immunohistochemistry for specific markers of inflammation, gliosis, acute neuronal injury due to hypoxia, and blood-brain barrier (BBB) disruption, enabling the generation of hypotheses about potential mechanisms of death in SUDEP. METHODS: Using immunohistochemistry, we investigated the expression of 6 markers (CD163, human leukocyte antigen-antigen D related, glial fibrillary acid protein, hypoxia-inducible factor-1α [HIF-1α], immunoglobulin G, and albumin) in the hippocampus, amygdala, and medulla in 58 postmortem cases: 28 SUDEP (definite and probable), 12 epilepsy controls, and 18 nonepileptic sudden death controls...
January 13, 2017: Neurology
https://www.readbyqxmd.com/read/28042592/paroxysmal-nonepileptic-events-in-glut1-deficiency
#4
Joerg Klepper, Baerbel Leiendecker, Christin Eltze, Nicole Heussinger
View Supplementary Video Movement disorders are a major feature of Glut1 deficiency. As recently identified in adults with paroxysmal exercise-induced dystonia, similar events were reported in pediatric Glut1 deficiency. In a case series, parent videos of regular motor state and paroxysmal events were requested from children with Glut1 deficiency on clinical follow-up. A questionnaire was sent out to 60 families. Videos of nonparoxysmal/paroxysmal states in 3 children illustrated the ataxic-dystonic, choreatiform, and dyskinetic-dystonic nature of paroxysmal events...
November 2016: Movement Disorders Clinical Practice
https://www.readbyqxmd.com/read/28039841/how-reliable-is-ictal-duration-to-differentiate-psychogenic-nonepileptic-seizures-from-epileptic-seizures
#5
Udaya Seneviratne, Erica Minato, Eldho Paul
We sought to investigate (1) differences in ictal duration between psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES), (2) the odds of being PNES when seizures last ≥5min, and (3) the value of ictal duration as a diagnostic test to differentiate PNES from ES. We retrospectively reviewed video-EEG recordings and tabulated ictal durations of all PNES and ES. We estimated the mean ictal durations of PNES and ES using linear mixed models. The odds of being PNES when seizures last ≥5min were estimated using logistic regression...
December 28, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28027373/new-onset-seizure-in-adults-and-adolescents-a-review
#6
Jay R Gavvala, Stephan U Schuele
Importance: Approximately 8% to 10% of the population will experience a seizure during their lifetime. Only about 2% to 3% of patients go on to develop epilepsy. Understanding the underlying etiology leading to an accurate diagnosis is necessary to ensure appropriate treatment and that patients with low risk for recurrence are not treated unnecessarily. Observations: Patients can present with new-onset seizure for a variety of reasons such as acute symptomatic seizures due to acute brain injury or metabolic derangements, or unprovoked seizures that are the initial manifestation of epilepsy...
27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28007363/an-emergency-medicine-focused-review-of-seizure-mimics
#7
James Webb, Brit Long, Alex Koyfman
BACKGROUND: Seizures result in a change in motor, sensory, and behavioral symptoms caused by abnormal neurologic electrical activity. The symptoms share similar presentations of several other conditions, leading to difficulties in diagnosis and frequent improper management. OBJECTIVE: This review evaluates adult patients with suspected seizure, signs and symptoms of seizure, mimics of seizure, and an approach to management of seizure mimics. DISCUSSION: A seizure is caused by abnormal neurologic electrical activity resulting in altered motor, sensory, and behavioral symptoms...
December 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27988107/understanding-psychogenic-nonepileptic-seizures-phenomenology-semiology-and-the-integrative-cognitive-model
#8
Markus Reuber, Richard J Brown
Psychogenic Nonepileptic Seizures (PNES) are one of the commonest differential diagnoses of epilepsy. This paper provides a narrative review of what has been learnt in the last 25 years regarding the visible manifestations, physiological features, subjective experiences and interactional aspects of PNES. We then explore how current insights into PNES semiology and phenomenology map onto the Integrative Cognitive Model (ICM), a new account of these phenomena that unifies previous approaches within a single explanatory framework...
November 15, 2016: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/27955838/risk-factors-for-diagnostic-delay-in-psychogenic-nonepileptic-seizures-among-children-and-adolescents
#9
Kette D Valente, Ruda Alessi, Silvia Vincentiis, Bernardo Dos Santos, Patricia Rzezak
BACKGROUND: This study aims to analyze a series of pediatric patients with psychogenic nonepileptic seizures (PNES) to establish the diagnostic gap and possible risk factors for the delayed diagnosis in this age group. METHODS: We evaluated all children with PNES documented by video electroencephalography. None had a previous diagnosis of PNES. In total, we included 53 children (interquartile range: 7 to 17 years; mean age 12.81 years [S.D. 3.15]; 60.4% girls) who underwent a protocol consisting of neurological and psychiatric interviews...
November 9, 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/27888513/decreased-allopregnanolone-levels-in-cerebrospinal-fluid-obtained-during-status-epilepticus
#10
Stefano Meletti, Chiara Lucchi, Giulia Monti, Giada Giovannini, Roberta Bedin, Tommaso Trenti, Cecilia Rustichelli, Giuseppe Biagini
Neuroactive steroids are increasingly considered as relevant modulators of neuronal activity. Especially allopregnanolone (AP) and pregnenolone sulfate (PS) have been shown to possess, respectively, anticonvulsant or proconvulsant properties. In view of the potential role of these steroids, we aimed at evaluating AP and PS levels in cerebrospinal fluid (CSF) and blood samples obtained from patients with status epilepticus (SE). To this purpose, we enrolled 41 patients affected by SE and 41 subjects investigated for nonepileptic neurologic disorders...
November 26, 2016: Epilepsia
https://www.readbyqxmd.com/read/27776298/neurologists-can-identify-diagnostic-linguistic-features-during-routine-seizure-clinic-interactions-results-of-a-one-day-teaching-intervention
#11
Laura Jenkins, Jeremy Cosgrove, Paul Chappell, Ammar Kheder, Dilraj Sokhi, Markus Reuber
The diagnostic distinction between epilepsy and psychogenic nonepileptic seizures (PNES) can be challenging. Previous studies have demonstrated that experts in conversation analysis can identify linguistic and interactional features in transcripts and recordings of interviews with patients that reliably distinguish between epilepsy and PNES. In this study, ten senior neurology trainees took part in a one-day intervention workshop about linguistic and interactional differences in the conversation behavior of patients with epilepsy and those with PNES...
October 21, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27743551/early-childhood-trauma-and-hippocampal-volumes-in-patients-with-epileptic-and-psychogenic-seizures
#12
Benjamin Johnstone, Dennis Velakoulis, Cheng Yi Yuan, Anthony Ang, Chris Steward, Patricia Desmond, Terence J O'Brien
OBJECTIVE: Exposure to early life childhood trauma has been implicated as resulting in a vulnerability to epileptic and psychogenic nonepileptic seizures (PNES), hippocampal atrophy, and psychiatric disorders. This study aimed to explore the relationships between childhood trauma, epilepsy, PNES, and hippocampal volume in patients admitted to a video-electroencephalogram monitoring (VEM) unit. METHODS: One hundred thirty-one patients were recruited from the Royal Melbourne Hospital VEM unit...
November 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27737716/brain-region-and-epilepsy-associated-differences-in-inflammatory-mediator-levels-in-medically-refractory-mesial-temporal-lobe-epilepsy
#13
Kenneth I Strauss, Kost V Elisevich
BACKGROUND: Epilepsy patients have distinct immune/inflammatory cell profiles and inflammatory mediator levels in the blood. Although the neural origin of inflammatory cells and mediators has been implied, few studies have measured these inflammatory components in the human brain itself. This study examines the brain levels of chemokines (8), cytokines (14), and vascular injury mediators (3) suspected of being altered in epilepsy. METHODS: Soluble protein extracts of fresh frozen resected hippocampus, entorhinal cortex, and temporal cortex from 58 medically refractory mesial temporal lobe epilepsy subjects and 4 nonepileptic neurosurgical subjects were assayed for 25 inflammation-related mediators using ultrasensitive low-density arrays...
October 13, 2016: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/27723497/communicating-diagnostic-certainty-of-psychogenic-nonepileptic-seizures-a-national-study-of-provider-documentation
#14
Hamada H Altalib, Khalid Elzamzamy, Mary Jo Pugh, Javier Ballester Gonzalez, Kei-Hoi Cheung, Brenda T Fenton, Robert D Kerns, Cynthia A Brandt, W Curt LaFrance
Management of psychogenic nonepileptic seizures (PNES) requires collaboration among and between health care professionals. Although criteria are established for diagnosis of PNES, miscommunication between neurologists, primary care providers, and mental health professionals may occur if the clinical impression is not clearly articulated. We extracted progress notes from the Department of Veterans Affairs (VA) electronic health record (EHR) nationally to study veterans who were evaluated for PNES. Of the 750 patients being worked up for PNES, the majority of patients did not meet criteria for PNES (64...
October 7, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27723496/ictal-verbal-help-seeking-occurrence-and-the-underlying-etiology
#15
Ali A Asadi-Pooya, Marjan Asadollahi, Krzysztof Bujarski, Amin H Rabiei, Narsis Aminian, Dale Wyeth, Michael R Sperling
PURPOSE: Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology. METHODS: We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "help" in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied...
October 7, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27723495/semiological-classification-of-psychogenic-nonepileptic-seizures
#16
Ali A Asadi-Pooya, Jennifer Tinker, Elizabeth Fletman
PURPOSE: We classified patients with psychogenic nonepileptic seizures (PNESs) according to a newly proposed classification system. Then, we investigated the demographic and clinical differences between various classes of the patients. METHODS: We retrospectively investigated all patients with PNESs admitted to the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We classified the patients into four distinct classes: patients with generalized motor seizures, patients with akinetic seizures, patients with focal motor seizures, and patients with seizures with subjective symptoms...
October 7, 2016: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/27719870/explanation-as-treatment-for-functional-neurologic-disorders
#17
J Stone, A Carson, M Hallett
There is widespread agreement that the way health professionals communicate the diagnosis of functional neurologic disorders (FND) has a central role in treatment, as it does arguably for most conditions. In this chapter we discuss barriers to effective diagnosis, different models of explanation and evidence regarding the importance of effective communication of the diagnosis in FND, especially movement disorders, and dissociative (nonepileptic) seizures. Debates and disagreements about how to go about this task often reflect different theoretic models held by health professionals rather than evidence...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27719869/prognosis-of-functional-neurologic-disorders
#18
J Gelauff, J Stone
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients' and carers' questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. We reviewed data on prognosis of functional neurologic disorders from two systematic reviews on functional motor disorders and dissociative (nonepileptic) seizures as well as additional studies on functional visual and sensory symptoms. Methodologic problems include heterogeneity in studied samples and outcome measures, diagnostic suspicion and referral bias, small size and retrospective design of available studies, possible treatments during follow-up, and literature review bias...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27719868/factitious-disorders-and-malingering-in-relation-to-functional-neurologic-disorders
#19
C Bass, P Halligan
Interest in malingering has grown in recent years, and is reflected in the exponential increase in academic publications since 1990. Although malingering is more commonly detected in medicolegal practice, it is not an all-or-nothing presentation and moreover can vary in the extent of presentation. As a nonmedical disorder, the challenge for clinical practice remains that malingering by definition is intentional and deliberate. As such, clinical skills alone are often insufficient to detect it and we describe psychometric tests such as symptom validity tests and relevant nonmedical investigations...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27719852/functional-coma
#20
L Ludwig, L McWhirter, S Williams, C Derry, J Stone
Functional coma - here defined as a prolonged motionless dissociative attack with absent or reduced response to external stimuli - is a relatively rare presentation. In this chapter we examine a wide range of terms used to describe states of unresponsiveness in which psychologic factors are relevant to etiology, such as depressive stupor, catatonia, nonepileptic "pseudostatus," and factitious disorders, and discuss the place of functional or psychogenic coma among these. Historically, diagnosis of functional coma has sometimes been reached after prolonged investigation and exclusion of other diagnoses...
2017: Handbook of Clinical Neurology
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