Comparison of postictal semiology and behavior in psychogenic nonepileptic and epileptic seizures

Izadyar, Shahram; Shah, Vishal; James, Brandon

doi:10.1016/j.yebeh.2018.08.020

Cited by 17 publications

(8 citation statements)

References 34 publications

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“…This case further highlights the importance of separating and defining ictal and postictal periods. The recorded post-ictal state felt to reflect an “ictal” event was prolonged and involved violent and disorganized movements of the extremities, both features that suggested FS [30] especially because ictal violence is rare and often very brief [31] . On the other hand, if viewed as a postictal recording, epilepsy would be a more likely explanation than a FS as the postictal state tends to have a longer duration of confusion prior to return to baseline in people with epileptic seizures [30] .…”

Section: Discussionmentioning

confidence: 99%

Pitfalls using smartphones videos in diagnosing functional seizures

Freund

Tatum

2021

Epilepsy & Behavior Reports

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Highlights Smartphone videos are useful cost-effective means to evaluate and characterized epileptic and nonepileptic seizures. Convulsive and motor semiologies are particularly well-suited for accurate interpretation using smartphone videos but require ictal-post-ictal separation. Patients and caregivers should be educated on optimal smartphone video recording focused on capturing the onset of the event. Long-term video-EEG monitoring remains the gold standard when discordant video information is presented or diagnostic questions remain after clinical evaluation.

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Section: Discussionmentioning

confidence: 99%

Pitfalls using smartphones videos in diagnosing functional seizures

Freund

Tatum

2021

Epilepsy & Behavior Reports

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“…These signs should be highly specific, to avoid misdiagnosis, while high sensitivity is also required to maximize their applicability. Of the many published PNES signs that may be appreciated in a smartphone video, many are highly specific but have a lower sensitivity [11,[22][23][24][25][26][27][28]. Absent postictal deep, heavy breathing (stertor) and ictal eye closure, however, are both highly specific and relatively sensitive findings [22][23][24][25][26]28].…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with PNES exhibit stereotypy in semiology, which can include characteristic and reproducible artefactual EEG findings [17][18][19][20][21]. The plethora of signs described in PNES includes fluctuating course, ictal eye closure, crying, duration exceeding two minutes, non-stertorous postictal breathing pattern, lack of amnesia or postictal state, and several motor signs [11,[22][23][24][25][26][27][28]. Patients with PNES have more variable seizure durations in comparison to ES [21].…”

Section: Introductionmentioning

confidence: 99%

Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit

et al. 2021

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Introduction The diagnosis of psychogenic nonepileptic seizures (PNES) is a common clinical dilemma. We sought to assess the diagnostic value of four ictal signs commonly used in differentiating PNES from epileptic seizures (ES). Methods We retrospectively reviewed consecutive adult video-electroencephalogram (VEM) studies conducted at a single tertiary epilepsy center between May 2009 and August 2016. Each event was assessed by a blinded rater for the presence of four signs: fluctuating course, head shaking, hip thrusting, and back arching. The final diagnosis of PNES or ES was established for each event based on clinical and VEM characteristics. All ES were pooled regardless of focal or generalized onset. We analyzed the odds ratio of each sign in PNES in comparison to ES with adjustment for repeated measures using logistic regression. Additionally, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of each sign to diagnose PNES. Results A total of 742 events from 140 VEM studies were assessed. Fluctuating course (odds ratio (OR) 37.37, 95% confidence interval (CI) 13.56–102.96, P < 0.0001), head shaking (OR 2.95, 95% CI 1.26–6.79, P = 0.012), and hip thrusting (OR 4.28, 95% CI 1.21–15.18, P = 0.02) were each significantly predictive of PNES. Fluctuating course had the highest sensitivity (76.16%). Back arching (OR 1.06, 95% CI 0.35–3.20, P = 0.92) was not significantly associated with PNES. Conclusion Fluctuating course, head shaking, and hip thrusting are semiological features significantly more common in PNES than ES. Fluctuating course is the most reliable sign. Back arching does not appear to differentiate PNES from ES.

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“…For the review of positive signs, we summarized in table 2 and table 3 those which had some form of validation (controlled designs to test for specificity and sensitivity or data on inter-rater reliability). To this end, we selected 22 studies45464748495051525354555657585960616263919293 reporting on 37 bedside clinical tests or groups of tests for motor FND (functional weakness and functional movement disorder) as well as 27 studies646566676869707172737475767778798081828384858687909495 reporting on 23 bedside clinical tests or group of tests for seizure type FND. In addition, we also discuss important case series or reviews that highlight relevant bedside clinical tests.…”

Section: Incidence and Prevalence Of Fndmentioning

confidence: 99%

Diagnosis and management of functional neurological disorder

Aybek

Perez

2022

BMJ

116

107

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Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery—albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.

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Comparison of postictal semiology and behavior in psychogenic nonepileptic and epileptic seizures

Cited by 17 publications

References 34 publications

Pitfalls using smartphones videos in diagnosing functional seizures

Pitfalls using smartphones videos in diagnosing functional seizures

Predictive semiology of psychogenic non-epileptic seizures in an epilepsy monitoring unit

Diagnosis and management of functional neurological disorder

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