Clinical profile of patients with epileptic and nonepileptic seizures

Devinsky, Orrin; Sanchez-Villasenor, F.; Vázquez, Blanca; Kothari, Milind J.; Alper, Kenneth; Luciano, Daniel

doi:10.1212/wnl.46.6.1530

Cited by 107 publications

(88 citation statements)

References 7 publications

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“…The clinical feature of NES are varied (1)(2)(3)(4)(5), and the clinical diagnosis is frequently difficult and requires experience in recognizing the typical symptoms of NES and differentiating them from epilepsy. LVEM is critical for the diagnosis in difficult cases and, when there is doubt about the nature of the events, prolonged and multiple LVEM studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Psychogenic Seizures in Adults: A Population‐Based Study in Iceland

1998

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Summary: Purpose: We wished to determine the incidence of psychogenic nonepileptic (NES) seizures in a population-based study.Methods: Cases were identified through review of the results of all long-term video-EEG studies made in Iceland during the study period.Results: The incidence of NES was 1.4 in 100,000 personyears of observation. Age-specific incidence was highest in the youngest age group (age 15-24 years) and decreased thereafter. A strong female preponderance was observed.Conclusions: The incidence of NES is equal to almost 4% of that reported for epilepsy from Iceland for persons aged 2 15 years. For people aged 15-24 years, the incidence of NES is equal to -5% of the incidence of epilepsy. Half the patients also had epilepsy. Key Words: Epidemiology-Epilepsy-Psychogenic nonepileptic seizures (NES) constitute a clinical phenomenon that resembles epileptic seizures. The diagnosis is based on recognition of typical clinical symptoms and recording of normal EEG during the episodes. The clinical diagnosis can be very difficult, and NES are frequently misdiagnosed as epileptic seizures. Long-term video-EEG monitoring (LVEM) has revolutionized the diagnosis of NES and several groups of researchers (1-6) have described the various clinical manifestations of NES. Correct diagnosis is important because inappropriate treatment for suspected epilepsy or suspected status epilepticus (SE) may be dangerous or life-threatening to the patient (7-10).The incidence of NES in a defined population is unknown, but investigators (9-1 3) have described the relative frequency of NES in selected patient groups. In Iceland, we conducted a study in which we identified all adult patients in the country first diagnosed with NES in a 5-year period.

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Section: Discussionmentioning

confidence: 99%

Incidence of Psychogenic Seizures in Adults: A Population‐Based Study in Iceland

1998

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“…On completion of PVEM, we divided patients into four groups: definite PNESs, possible PNESs, possible epilepsy, and definite epilepsy. As previously, we used the following criteria: definite PNESs is defined as habitual spells recorded on video-EEG without an ictal EEG discharge and normal background alpha rhythm during the events; possible PNESs is defined as no events recorded and continuously normal interictal EEGs; possible epilepsy is defined as no events recorded with interictal epileptiform discharges; definite epilepsy is defined as recorded stereotypic events with an ictal EEG discharge (17,18,20,29). Only the data on patients with definite PNESs and definite epilepsy were used in this study.…”

Section: Methodsmentioning

confidence: 99%

“…The majority of PNES research has focused on the clinical characteristics of PNESs or on predicting the diagnosis based on MMPI and clinical history data (16,(27)(28)(29). Other studies evaluated the association between PNESs and psychological or sexual trauma or other psychiatric comorbities (30,31), outcome after the diagnosis of PNESs (13,(24)(25)(26), or the incidence of PNESs (20,21).…”

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confidence: 99%

Quality of Life in Psychogenic Nonepileptic Seizures

Szaflarski¹,

Hughes²,

et al. 2003

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Summary:Purpose: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs.Methods: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n ‫ס‬ 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs.Results: In our sample, 45 patients had PNESs, and 40 hadESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP.Conclusions: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.

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“…Although previous studies have reported a high prevalence (5%-50%) of ES in PNES patients (PNES/ES) (Sigurdardottir and Olafsson, 1998;Benbadis et al, 2001;Martin et al, 2003), few authors investigated PNES and PNES/ES patients separately to determine the possible influence of this comorbidity on psychological and clinical aspects (Devinsky et al, 1996;Owczarek and Jederzejczak, 2001;Reuber et al, 2002;Kuyk et al, 2003;Galimberti et al, 2003).…”

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confidence: 99%

Video‐EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy

Mari

Bonaventura

Vanacore³

et al. 2006

Epilepsia

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Summary:Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video-EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video-EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow-up).Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow-up.Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients.

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Clinical profile of patients with epileptic and nonepileptic seizures

Cited by 107 publications

References 7 publications

Incidence of Psychogenic Seizures in Adults: A Population‐Based Study in Iceland

Incidence of Psychogenic Seizures in Adults: A Population‐Based Study in Iceland

Quality of Life in Psychogenic Nonepileptic Seizures

Video‐EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy

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