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Psychogenic epilepsy

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...
October 12, 2016: Epilepsy & Behavior: E&B
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
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
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
R Duncan
In the investigation of psychogenic nonepileptic seizures (PNES), the main differential diagnoses are between convulsive PNES and tonic-clonic seizures, between swoon PNES and syncope, and between pseudoabsence PNES and absence seizures. For the best diagnostic certainty, events must be captured, ideally using video-electroencephalogram (EEG), including an electrocardiographic channel. The "video" part of video-EEG allows EEG changes (or lack of them) to be interpreted in the appropriate clinical context. When the diagnosis is based on less good data (e...
2017: Handbook of Clinical Neurology
Brian D Moseley, Sandra Dewar, Zulfi Haneef, Dawn Eliashiv, John M Stern
Epilepsy monitoring unit (EMU) admissions are essential for the classification/localization of epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). However, the duration of admissions is highly variable. Accordingly, we evaluated the duration of 596 EMU admissions and reasons for prolonged (>7 days) lengths of stay (LOS). The average LOS was longer for patients diagnosed with ES (8.0 days, SD 4.1 days) than all others (6.0 days, SD 3.9 days, p<0.001). Of the 596 admissions, 231 (38.8%) had prolonged LOS...
September 1, 2016: Epilepsy Research
Ying Xu, Dennis Nguyen, Armin Mohamed, Cheryl Carcel, Qiang Li, Mansur A Kutlubaev, Craig S Anderson, Maree L Hackett
PURPOSE: To determine the frequency of false positive diagnoses of epilepsy and to explore its imitators and consequences. METHOD: A systematic review of all published observational studies (to November 2015) was conducted to determine the proportion of false positive diagnoses of epilepsy. We included studies of people of all ages receiving a diagnosis of epilepsy. All observational study designs were included with the exception of case-reports and case series with fewer than 3 participants...
October 2016: Seizure: the Journal of the British Epilepsy Association
Marlena Hupalo, Janusz W Smigielski, Dariusz J Jaskolski
PURPOSE: To find the optimal duration of the long-term video-EEG (LTM) and assess diagnostics utility of LTM in patients with epilepsy and other paroxysmal events in terms of future diagnosis and management. METHODS: Retrospective analysis of 282 LTMs performed in the last 5 years in our Epilepsy Monitoring Unit (EMU), in 202 consecutive patients. The analysis included demographic data, monitoring time, number and type of paroxysmal events, the time until their onset, influence of LTM result on the diagnosis and future management...
2016: Neurologia i Neurochirurgia Polska
Jessica J Falco-Walter, Michael Stein, Maggie McNulty, Lubov Romantseva, Peter Heydemann
We report a 10-year-old boy with mild developmental delay and epilepsy with new events of right back tickling and emotional upset. These initially appeared behavioral, causing postulation of habit behaviors or psychogenic nonepileptic seizures. Several ictal and interictal EEGs were unrevealing. Continuous EEG revealed only poorly localized frontal ictal activity. Given that his clinical symptoms suggested a parietal localization, double-density EEG electrodes were placed to better localize the epileptogenic and symptomatogenic zones...
2016: Epilepsy & Behavior Case Reports
Josef Finsterer, Lässer Stefan
Malingering and factitious disorder (Münchausen-syndrome) has not been reported as a manifestation of a mitochondrial-disorder (MID). Here, we report a 46 years-old female with a MID due to a combined complex I-IV defect, manifesting in the cerebrum, muscle, bone marrow, kidneys, and the endocrine glands. Myopathy showed up as myalgia, easy fatigability, ptosis, and abnormal muscle biopsy. Endocrine involvement manifested as short stature and thyroid dysfunction. Involvement of the kidneys manifested as mild Fanconi syndrome...
July 2016: Indian Journal of Psychological Medicine
Andreu Massot-Tarrús, Richard S McLachlan
OBJECTIVES: Epidemiologic evidence supporting antiseizure properties of cannabis is limited and controversial. We determined the prevalence of marijuana use and its perceived effects in patients with and without epilepsy. METHODS: Information was collected over 14months from consecutive adult patients admitted to an epilepsy monitoring unit using a 27-item anonymous questionnaire. Patients with cognitive impairment unable to understand the questions or give informed consent and readmissions were not recruited...
October 2016: Epilepsy & Behavior: E&B
Hannah Wiseman, Saafi Mousa, Stephanie Howlett, Markus Reuber
RATIONALE: The aim of this study was to add to our understanding of the impact of psychoeducation on patients' acceptance of the diagnosis of psychogenic nonepileptic seizures (PNESs), the frequency of their seizures, and their quality of life. The study also aimed to evaluate the effectiveness of brief manualized psychoeducation interventions for PNESs, delivered by a more diverse range of clinicians and in a wider range of treatment settings. METHOD: The final sample consisted of 25 patients diagnosed with PNESs by a neurologist specializing in the treatment of seizure disorder and referred to the psychotherapy service...
October 2016: Epilepsy & Behavior: E&B
Ali A Asadi-Pooya, Marjan Asadollahi, Jennifer Tinker, Maromi Nei, Michael R Sperling
OBJECTIVES: We investigated the prevalence of post-epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug-resistant epilepsy and the possible influence of risk factors on these seizures. METHODS: In this retrospective study, we examined data from all patients with a clinical diagnosis of drug-resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson Comprehensive Epilepsy Center between 1986 and 2016. Postsurgical outcome was identified for up to 15 years after surgery...
October 2016: Epilepsia
Gregg H Rawlings, Markus Reuber
PURPOSE: This is a narrative systematic synthesis of qualitative research investigating patients' accounts of living with psychogenic nonepileptic seizures (PNES). Qualitative methodologies allow patients to share lived experiences in their own words. The examination of patients' own accounts is likely to offer revealing insights into a poorly understood, heterogeneous disorder. METHODS: We identified 21 separate studies about PNES published after 1996 and based on analyses of patients' own words...
October 2016: Seizure: the Journal of the British Epilepsy Association
Anvesh Jackson, Louise Teo, Udaya Seneviratne
AIMS: (1) To delineate the challenges in seizure diagnosis in the first seizure clinic setting for adult patients of a teaching hospital, and (2) quantify the diagnostic accuracy of the referral source and the yield of routine investigations, including blood tests, EEGs, and neuroimaging. METHODS: We retrospectively reviewed medical records of patients referred by the emergency department to the adult first seizure clinic and seen by the same epilepsy specialist between June 2007 and June 2011...
September 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Cesare Maria Cornaggia, Gabriella Di Rosa, Maria Polita, Adriana Magaudda, Cecilia Perin, Massimiliano Beghi
The differential diagnosis of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is often difficult, especially in pediatric and adolescent settings. Conversation analysis (CA) can be a worthwhile diagnostic tool in adults. The aim of this study was to assess the diagnostic value of CA in Italian children and adolescents. Ten patients (seven females and three males), diagnosed using video-EEG as having either ES or PNES, underwent a video-recorded interview by a physician from outside the center specifically trained for this purpose...
September 2016: Epilepsy & Behavior: E&B
James Anderson, Joanne Hill, Max Alford, Maria Oto, Aline Russell, Saif Razvi
INTRODUCTION: Epilepsy and epilepsy mimics may lead to high healthcare resource utilization (HRU) including diagnostic resources. The William Quarrier Scottish Epilepsy Centre (SEC) provides medium-term residential assessment (MTRA; average length of stay: 28days) and treatment for complex presentations of epilepsy and related conditions (principally psychogenic nonepileptic seizures, PNES). We studied the effect of MTRA on HRU in a defined health board area in Scotland. METHODS: A retrospective audit of individuals admitted to the SEC from a defined health board area using SEC and health board medical records...
September 2016: Epilepsy & Behavior: E&B
Ali A Asadi-Pooya, Amin H Rabiei, Jennifer Tinker, Joseph Tracy
We investigated the utility of a very brief review of system (ROS) questionnaire in differentiating psychogenic nonepileptic seizures (PNES) from epilepsy. In this retrospective study, we investigated all patients with PNES admitted to Jefferson Comprehensive Epilepsy Center from October 2013 through April 2015. Patients with a confirmed diagnosis of PNES or epilepsy based on video-EEG monitoring were included. These were matched with respect to age and sex. All patients had a brief ROS questionnaire in their electronic charts...
July 26, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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
Joon Y Kang, Scott Mintzer
Driving restrictions in people with epilepsy (PWE) is a highly contentious topic. The fundamental difficulty lies in achieving a balance between safety and practicality. The aim of this review is to provide an overview, history, and rationale behind current laws regarding driving restriction in PWE. We also discuss recent findings that may be helpful to practitioners during individual discussions with PWE including seizure recurrence risk after first seizure, recurrent seizure, and anticonvulsant with drawl and driving restrictions in patients with psychogenic non-epileptic seizures (PNES)...
September 2016: Current Neurology and Neuroscience Reports
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