Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks

McKenzie, Paul S.; Oto, Maria; Russell, Aline; Pelosi, Anthony J.; Duncan, Roderick

doi:10.1212/wnl.0b013e3181c7da6a

Cited by 190 publications

(168 citation statements)

References 21 publications

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“…12,13 Our cohort was similar to those in prior studies of PNES, which were also disproportionately female (85% vs 75%-91%), with high rates of unemployment (61% vs 65%-90%), psychiatric comorbidities, and history of sexual abuse (42% vs 33%-76%). 9,11,12 Adherence at the first outpatient visit was similar to that seen in on the initial visit in prior studies (80% vs 72%-80%) but worsened significantly at each subsequent visit to a nadir of 14% adherence by the fourth visit. In addition, our results suggest that patients previously diagnosed with PNES, returning for a second opinion or | after the failure of a first treatment regimen, have significantly increased odds of long-term nonadherence.…”

Section: Discussionsupporting

confidence: 77%

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Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

2017

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SummaryWe conducted a prospective cohort study, examining long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures (PNES).Subjects diagnosed with documented PNES were scheduled for 4 psychiatric visits. Survival analysis was performed, and covariates were assessed for association with time to nonadherence using Cox proportional hazard regression analysis. One hundred twenty-three subjects were recruited and followed for up to 17 months. Eighty percent of subjects attended the first outpatient visit, 42% attended the second, 24% attended the third, and only 14% remained adherent through the fourth visit. Two covariates were associated with nonadherence: (1) a prior diagnosis of PNES (hazard ratio 1.57, P-value .046); (2) a lower score on the Brief Illness Perception Questionnaire (BIPQ), signifying lower concern about one's illness (hazard ratio 0.77 for every 10-point increment on the 80-point scale, P-value .008). Adherence with psychiatric treatment among patients with PNES is initially reasonably good but worsens rapidly over visits 2-4. Risk factors for nonadherence include a history of a prior diagnosis of PNES, and a lower level of concern about the illness as assessed by a lower score on the BIPQ. and ratings of disability in PNES are as severe as those in epilepsy.5 Patients with PNES experience long-term economic and social dependence, have frequent emergency department visits and hospital admissions, and incur high medical care costs. [6][7][8] The prognosis for the untreated illness is poor, with 71% of patients having ongoing psychogenic seizures and 56% of patients on disability at 1-to 10-year follow-up. Psychotherapy has been shown to reduce psychogenic seizure frequency and improve quality of life. The strongest evidence basis, including two randomized trials, demonstrates the efficacy of cognitive behavioral therapy.9,10 Yet 20%-30%of patients fail to attend their first appointment after the diagnosis of PNES, and small studies and clinical experience suggest that adherence may significantly deteriorate over longer periods. [11][12][13] Long-term adherence with behavioral health treatments of PNES has received limited attention, and longterm dropout rates are unknown. We therefore conducted a prospective cohort study, measuring adherence with psychiatric follow-up for up to 17 months after diagnosis of PNES.

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Section: Discussionsupporting

confidence: 77%

“…[11][12][13] Long-term adherence with behavioral health treatments of PNES has received limited attention, and longterm dropout rates are unknown. We therefore conducted a prospective cohort study, measuring adherence with psychiatric follow-up for up to 17 months after diagnosis of PNES.…”

Section: Introductionmentioning

confidence: 99%

Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

2017

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“…of patients may stop having spells after being given the diagnosis and explanation of NES, with no other intervention [38][39][40][41], underlining the crucial nature of some patient-doctor conversations in epilepsy practice. CA could be used to improve our understanding of the "machinery" of such conversations and to maximize their therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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Using Conversation Analysis (CA), we studied conversations between one UK-based epilepsy specialist and thirteen seizure patients in whom there was uncertainty about the diagnosis, and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g. to address patient resistance). Close linguistic and interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician-dominated.

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“…Son yıllarda yapılan bir çalışmada ise NEPN'si olan 260 hastanın, tanı sonrası 6-12 ay süre ile takip edildiği ve sadece %38'inde nöbetlerin izlenmediği bildirilmiştir. [24] Carton ve ark. [25] tarafından 84 NEPN hastasında tanıyı anlama ve tanıya karşı reaksiyonun prognoz üzerine etkileri araştırılmıştır.Olguların %63'ü tanıyı anlamadıklarını ifade ederken, üçte ikisinden fazlası tanıyı tam anlamamalarına rağmen NEPN olduğunu kabul etmişlerdir.…”

Section: Tablo 3 Grup 1 Ve Grup 2 Hastaların Takip Tanılarıunclassified

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

Genç¹,

Yılmaz²,

Gömceli³

et al. 2013

Epilepsi

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SummaryObjectives: Psychogenic non-epileptic seizures (PNES) are reported in 10-30% of patients who are diagnosed as having refractory seizures referred to epilepsy centers. Many epilepsy centers use some sort of provocative techniques to aid in the diagnosis of PNES. In this study we aimed to determine the value of diagnostic effects of seizure induction methods. Methods: We analyzed retrospectively 66 patients who were suspected as PNES and referred by a clinician to our outpatient EEG laboratory between July 2011-January 2013. Intravenous saline was administered for seizure induction which is a routine seizure induction method used in our laboratory. Follow-up data were gathered by telephone interviews or from patient charts. Results: PNES were observed in 39 (59.1%) of 66 patients. Twenty-eight patients were thought to have pure PNES. After 3-17 months (mean: 6.9 months) of induction, 27 of 39 patients were either seizure-free or had significiant reduction in seizure frequency. Conclusion: In this study we conclude that; provocative techniques are useful, cheap and accessible for the diagnosis of PNES. If applied delicately, they may also provide a positive impact on the patient's self-recognition, and also, the prognostic consequences of the condition.Key words: Epilepsy; induction; psychogenic non-epileptic seizure. ÖzetAmaç: Epilepsi merkezlerine dirençli epilepsi tanısı ile gönderilen hastaların yaklaşık %10-30'unun nonepileptik psikojen nöbet (NEPN) tanısı aldığı bildirilmektedir. Birçok epilepsi merkezinde NEPN tanısına yardımcı olmak için bazı provokatif yöntemler kullanılmaktadır. Bu çalışmada nöbet indüksiyonun NEPN tanısı ve prognozu üzerindeki etkisini araştırmayı amaçladık. Sonuç: Bu çalışmada, provakatif yöntemlerin kullanışlı, ucuz ve hatta hastanın tanıyı kabullenmesinde etkisi olabileceği sonucuna vardık. Tanısını kabullenen hastalarda prognoz daha iyi olup, iyi iletişim bu noktada önemlidir. Gereç ve

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Early outcomes and predictors in 260 patients with psychogenic nonepileptic attacks

Cited by 190 publications

References 21 publications

Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

Offering patients choices: A pilot study of interactions in the seizure clinic

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

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