Differentiation of psychogenic nonepileptic attacks from status epilepticus among patients intubated for convulsive activity

Viarasilpa, Tanuwong; Panyavachiraporn, Nicha; Osman, Gamaleldin; Kowalski, Robert G.; Miller, Joseph; Barkley, Gregory L.; Mayer, Stephan A.

doi:10.1016/j.yebeh.2020.107679

Cited by 5 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this retrospective study of 148 consecutive patients, approximately one in six had PNES rather than status epilepticus. The research team compared clinical features and investigation results between the two groups and identified risk factors similar to those identified in our study (including history of psychiatric disorder and absence of intracranial abnormalities), which significantly increased the chance of presentations being due to PNES 12 . The same author published a study looking at outcomes of patients with PNES who are intubated in the ED for prolonged seizures.…”

Section: Discussionmentioning

confidence: 60%

“…The research team compared clinical features and investigation results between the two groups and identified risk factors similar to those identified in our study (including history of psychiatric disorder and absence of intracranial abnormalities), which significantly increased the chance of presentations being due to PNES. 12 The same author published a study looking at outcomes of patients with PNES who are intubated in the ED for prolonged seizures. In this study, 15% of patients with VEEG-proven PNES were intubated and unsurprisingly several key outcome factors were worse compared to the group of patients that were not intubated: length of stay was longer, there were more in-hospital complications, and they had a higher rate of rehospitalization.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department

et al. 2021

View full text Add to dashboard Cite

Objectives:We aimed to estimate the rate of psychogenic nonepileptic seizures (PNES) among patients presenting to an emergency department with presumed seizures. We also wanted to identify factors that can assist health care professionals in determining whether these events are likely to be epileptic or nonepileptic. Methods:We performed two retrospective audits on patients who were treated for seizures in the department of emergency medicine at the Princess Alexandra Hospital, Brisbane, Australia. Exploratory analyses and logistic regressions were conducted to investigate the characteristics of the presentations and the relationships between our variables of interest. Results:In the group of all presentations with presumed seizures over a 3-month period (n = 157), a total of 151 presentations (96.2%) presentations were given a primary diagnosis of epileptic seizures. Of these 151 presentations, only 84 (55.6%) presented with epileptic seizures and 40 (26.5%) actually presented with PNES.In the group of patients who presented with prolonged and/or multiple events (n = 213) over a 1-year period, 196 (92.0%) were treated as epileptic seizures. Of these 196 presentations, only 85 (43.4%) presented with epileptic seizures and 97 (49.5%) actually presented with PNES. Several factors were identified to help risk stratify between epileptic seizures and PNES: Duration of events and of the postictal phase, number of events, presence of a structural brain pathology, mental health history, lactate levels and presence of tongue bite, incontinence, and/or vomiting.Significance: A large proportion of people who present to emergency departments with events resembling epileptic seizures actually have PNES rather than epilepsy-particularly those patients who present with prolonged and/or multiple events. The rate of misdiagnosis was high. Efforts need to be made to recognize patients with psychogenic nonepileptic seizures earlier and diagnose them correctly to avoid unnecessary iatrogenic harm and to provide adequate treatment.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department

et al. 2021

View full text Add to dashboard Cite

show abstract

“…PNES is one of the most common spells misdiagnosed with ES, often leading to a wrong diagnosis, unnecessary AED treatment, and even more aggressive therapeutic measures [ 29 ]. In the case of PNES, its signs are determined mainly through the objective observation of clinical episodes, achieving diagnostic certainty during V-EEG recording.…”

Section: Discussionmentioning

confidence: 99%

Long-Term V-EEG in Epilepsy: Chronological Distribution of Recorded Events Focused on the Differential Diagnosis of Epileptic Seizures and Psychogenic Non-Epileptic Seizures

Vázquez-Sánchez

García-López

Gómez-Menéndez

et al. 2021

JCM

View full text Add to dashboard Cite

Differential diagnosis in epilepsy is sometimes challenging. Video-electroencephalography (V-EEG) is an essential tool in the diagnosis and management of epilepsy. The prolonged duration of V-EEG recording increases the diagnostic yield of a conventional V-EEG. The right length of monitoring for different indications is still to be established. We present a retrospective descriptive study with a sample of 50 patients with long-term V-EEG monitoring, with a mean age of 36.1 years, monitored from 2013 to 2019 at the Burgos University Hospital. The mean monitoring time was 3.6 days. Events were obtained in 76% of the patients, corresponding to epileptic seizures (ES) in 57.9% of them, with psychogenic non-epileptic seizures (PNES) in 39.5%, and with episodes of both pathologies in 2.6% of the patients. We found that the first event was highly representative, and it correlated with the rest of the events that would be recorded. Moreover, 92% of the first PNES had been captured at the end of the second day, and 89% of the first ES by the end of the third day. V-EEG for differential diagnosis between ES and PNES can be performed in hospitals without specialized epilepsy surgery units. For this indication, the duration of long-term V-EEG can be adjusted individually depending on the nature of the first event.

show abstract

“…A study by Jungilligens et al [10 ▪ ] analysed data from two large clinical trials of medication regimes for convulsive status epilepticus (ESTT and RAMPART): 8.1% in children and up to 20.1% in adolescents and young adults were ultimately found to have PNES [10 ▪ ]. Viarasilpa et al [11] identified demographic features which could facilitate the diagnosis of PNES in the acute setting, including female preponderance, age <50 years, history of psychiatric disorders and haemodynamic parameters (systolic BP < 140). Janacko et al [12] listed eight key demographic, clinical and diagnostic factors, capable of helping clinicians differentiate ES from PNES in emergency department (sensitivity: 0.95 and specificity: 0.70).…”

Section: Diagnostic Processmentioning

confidence: 99%

An update on psychogenic nonepileptic seizures

Vijay,

Reuber

2024

Current Opinion in Neurology

View full text Add to dashboard Cite

Purpose of review The understanding of psychogenic nonepileptic seizures (PNES) has advanced steadily over recent decades. This update summarizes new insights from the last three years. Recent findings The process of diagnosing PNES has shifted from the exclusion of epilepsy to one based on the recognition of typical clinical features. While the diagnosis cannot rely on any single feature in isolation, a range of semiological features characterising PNES are now recognised and a number of studies hint at the potential for machine learning and AI to improve the diagnostic process. Advances in data processing and analysis may also help to make sense of the heterogeneity of PNES populations demonstrated by recent studies focussing on aetiology and patient subgroups. It is now clear that PNES are associated with high rates of mental and physical comorbidities and premature death, highlighting that they are only one manifestation of a complex disorder extending beyond the nervous system and the seizures themselves. Summary PNES are now understood as a manifestation of dysfunction in interacting brain networks. This understanding provides an explanation for the psychopathological and semiological heterogeneity of PNES patient populations. New insights into medical comorbidities and increased rates of premature death call for more research into associated pathological processes outside the nervous system.

show abstract

Differentiation of psychogenic nonepileptic attacks from status epilepticus among patients intubated for convulsive activity

Cited by 5 publications

References 29 publications

Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department

Psychogenic nonepileptic seizures treated as epileptic seizures in the emergency department

Long-Term V-EEG in Epilepsy: Chronological Distribution of Recorded Events Focused on the Differential Diagnosis of Epileptic Seizures and Psychogenic Non-Epileptic Seizures

An update on psychogenic nonepileptic seizures

Contact Info

Product

Resources

About