Psychogenic nonepileptic seizures (PNES) — multidisciplinary problem

November 25, 2020
811
Specialities :
Resume

All paroxysmal states can be rather conditionally divided into 3 main categories: epileptic seizures, psychogenic nonepileptic seizures (PNES) and physiological nonepileptic paroxysmal phenomena. The International League Against Epilepsy (ILAE) has recognized PNES as one of the top 10 neuropsychiatric issues associated with epilepsy. Treatment of patients with PNES begins with an accurate diagnosis. The diagnostics erroneous of PNES leads to inappropriate treatment for suspected epilepsy which constitutes a significant risk of iatrogenic injury, complications and increased cost of treatment for patients and for the health care system. PNES can occur as a manifestation of independent conversion disorder that requires adequate diagnosis and differential diagnosis or it can be comorbid with other neurological, psychiatric and somatic disorders. The comorbidity of PNES with paroxysmal events, which are had in the clinical picture of a particular disease is quite common. The most studied and most likely common such comorbidity in patients with epilepsy.

References:

  • Reiter J.M., Andrews D.J. (2000) A neurobehavioral approach for treatment of complex partial epilepsy: efficacy. Seizure, 9(3): 198–203. doi: 10.1053/seiz.1999.0374.
  • Avbersek A., Sisodiya S. (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J. Neurol. Neurosurg. Psychiatr., 81: 719–725.
  • De Paola L., Silvado C., Mäder M.J. et al. (2006) Clinical features of Psychogenic Nonepileptic Seizures (PNES): analysis of a Brazilian series. J. Epilepsy Сlin. Neurophysiol., 12(1): 37–40.
  • Devinsky O., Gazzola D., LaFrance W.C.Jr. (2011) Differentiating between nonepileptic and epileptic seizures. Nat. Rev. Neurol., 7: 210–220.
  • Diprose W., Sundram F., Menkes D.B. (2016) Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy. Epilepsy Behav., 56: 123–130. doi: 10.1016/j.yebeh.2015.12.037.
  • Duncan R., Anderson J., Cullen B., Meldrum S. (2016) Predictors of 6-month and 3-year outcomes after psychological intervention for psychogenic non epileptic seizures. Seizure, 36: 22–26. DOI:10.1016/j.seizure.2015.12.016.
  • Duncan R., Oto M., Russell A.J.C., Conway P. (2004) Pseudosleep events in patients with psychogenic non-epileptic seizures: prevalence and associations. J. Neurol. Neurosurg. Psychiatr., 75: 1009–1012.
  • Gates J.R. (1998) Diagnosis and treatment of nonepileptic seizures. In: H.W. McConnell, P.J. Snyder (Eds.) Psychiatric comorbidity in epilepsy basic mechanisms, diagnosis, and treatment. 1st ed. Am. Psychiatr. Press, Washington, 187–204 pp.
  • Goldstein L.H., Chalder T., Chigwedere C. et al. (2010) Cognitive-behavioral therapy for psychogenic nonepileptic seizures. A pilot RCT. Neurology, 74(24): 1986–1994. doi: 10.1212/WNL.0b013e3181e39658.
  • Kerr M.P., Mensah S., Besag F. et al. (2011) International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia, 52: 2133–2138.
  • LaFrance W.C.Jr., Baker G.A., Duncan R. et al. (2013) Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia, 54(11): 2005–2018. doi: 10.1111/epi.12356.
  • LaFrance W.C.Jr., Devinsky O. (2004) The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia, 45: 15–21.
  • McKenzie P., Oto M., Russell A. et al. (2010) Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks, 74(1): 64–9. DOI: 10.1212/WNL.0b013e3181c7da6a.
  • Orbach D., Ritaccio A., Devinsky O. (2003) Psychogenic, nonepileptic seizures associated with video-EEG-verified sleep. Epilepsia, 44: 64–68.
  • Pintor L., Bailles E., Matrai S. et al. (2012) Efficiency of venlafaxine in patients with psychogenic nonepileptic seizures and anxiety and/or depressive disorders. J. Neuropsychiatry Clin. Neurosci., 22: 401–408.
  • Reuber M., Elger C.E. (2003) Psychogenic nonepileptic seizures: review and update. Epilepsy Behav., 4: 205–216.
  • Salinsky M., Rutecki P., Parko K. et al. (2018) Psychiatric comorbidity and traumatic brain injury attribution in patients with psychogenic nonepileptic or epileptic seizures: a multicenter study of US veterans. Epilepsia, 59(10): 1945–1953.
  • Stagno S.J., Smith M.L. (1997) The use of placebo in diagnosing psychogenic seizures: who is being deceived? Semin. Neurol., 17(3): 213–218. doi: 10.1055/s-2008-1040931.
  • Syed T.U., LaFrance W.C.Jr., Kahriman E.S. et al. (2011) Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann. Neurol., 69(6): 997–1004. doi: 10.1002/ana.22345.
  • Szabo L., Siegler Z., Zubek L. et al. (2012) A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia, 53: 565–570.
  • Yang C.H., Lee Y.C., Lin C.H., Chang K. (1996) Conversion disorders in childhood and adolescence: a psychiatric consultation study in a general hospital. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi (Acta Paediatrica Sinica), 37: 405–409.