Psychogenic nonepileptic seizures

Ali A. Asadi-Pooya, Fateme Ziyaee.  Outcome of patients with psychogenic nonepileptic seizures with limited resources: A longitudinal study.  Seizure:  European Journal of Epilepsy, 2018-07-01, Volume 59, Pages 1-4. DOI: https://doi.org/10.1016/j.seizure.2018.04.017

Highlights

•We investigated 86 patients with PNES.

•86% patients did not receive appropriate psychotherapy.

•54.7% patients were seizure-free during the past 12 months.

•Age at onset, education, and taking psychiatric drugs were associated with the outcome.

Abstract

Purpose

The aim of the current study was to investigate the long-term outcome of patients with psychogenic nonepileptic seizures (PNES) and factors potentially associated with their outcome in Iran.

Methods

We investigated all patients with PNES admitted to the epilepsy monitoring unit at the Shiraz Comprehensive Epilepsy Center from 2008 through 2013. Patients included in this study had a confirmed diagnosis of PNES. In a phone call interview to the patients in December 2017, we obtained the following information: seizure outcome (seizure-free during the past 12 months or not), history of receiving any psychotherapy after confirming their diagnosis in the past, and number of psychotherapy sessions the patient had received.

Results

Eighty-six patients (54 females and 32 males) met the inclusion criteria. Seventy-four (86%) patients did not receive appropriate psychotherapy. Forty-seven (54.7%) patients were seizure-free during the past 12 months. Age at onset (P = 0.02), education (P = 0.01), and taking psychiatric drugs (P = 0.007) were associated with this outcome.

Conclusions

Resources to treat patients with PNES are limited in Iran; however, more than half of the patients became free of seizures. Lower education, comorbid psychiatric problems, and a later age at the onset of seizures may affect the seizure outcome in patients with PNES. Well-designed multi-center cross-cultural long-term studies should address factors associated with outcome in patients with PNES, considering that seizure frequency should not be the only outcome measure.

Courtesy of:  https://www.mdlinx.com/neurology/medical-news-article/2018/04/30/psychogenic-nonepileptic-seizures-psychogenic-outcome-seizure/7512059

Priyanka Madaan, Sheffali Gulati, Biswaroop Chakrabarty, Savita Sapra, Rajesh Sagar, Akbar Mohammad, RM Pandey and Manjari Tripathi.  Clinical spectrum of Psychogenic non epileptic seizures in children; an observational study.  Seizure: European Journal of Epilepsy.  In press.

Highlights

• Distinction of PNES from epileptic seizures is of utmost clinical significance.

• Commonest semiology among Pediatric PNES was dialeptic [seizure characterized by
   impaired awareness of, interaction with, or memory of ongoing events].

• There was no significant correlation between semiology and stressors among children with
   PNES.

• In resource constrained settings, short term vEEG with induction can identify PNES

Abstract

Purpose

The current study was designed to analyze the clinical spectrum of Psychogenic non-epileptic seizures (PNES) in children.

Methods

Children aged 6-16years with clinically suspected PNES, confirmed by short-term VEEG (STVEEG{video electroencephalogram}) and induction were classified as per Seneviratne classification. Stressors, associated co morbidities, Verbal IQ (Intelligence Quotient) and behavioral abnormalities were assessed using HTP(House tree person) test, DSM IV (Diagnostic and statistical manual of mental disorders) TR criteria, MISIC (Malin intelligence scale for Indian children) and CBCL (Child behavior checklist).

Results

Eighty children with PNES {45 boys; mean age: 10.5 (±1.6) years} were enrolled. Median delay in diagnosis was 5 months {IQR(interquartile range)- 0.5 to 48 months}) and 45% patients were already on AEDs (antiepileptic drugs). Commonest semiology was dialeptic (42.5%), followed by mixed (28.8%), motor (15%) and nonepileptic aura (13.8%). Family stressors were the commonest followed by school related issues. The most common psychiatric comorbidity was adjustment disorder. Somatic complaints were observed in 50% children.

Conclusions

Dialeptic PNES is commonest in children. In resource constrained settings, STVEEG along with induction is a reliable method to diagnose PNES. A comprehensive assessment protocol (including assessment of stressors) is needed for holistic management of pediatric PNES.