Non-epileptic attack disorder and clinical outcome: a pilot study

Riaz, Hamira; Comish, S.; Lawton, Lorraine; Scheepers, Bruce

doi:10.1016/s1059-1311(05)80004-4

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…Of the studies with over 50% seizure remission, three contained paediatric cases only [5–7] and one had a relatively short followup period of two weeks [8]. Riaz and colleagues found that the majority of patients with PNES (67%) had a good outcome [9], but this was defined as either seizure cessation or greater-than-50% reduction in seizure frequency.…”

Section: Resultsmentioning

confidence: 99%

Prognosis and Outcome Predictors in Psychogenic Nonepileptic Seizures

Durrant

Rickards

Cavanna

2011

Epilepsy Research and Treatment

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It is estimated that one in five patients referred to specialist epilepsy clinics for refractory seizures have psychogenic nonepileptic seizures (PNES). Despite the high prevalence, little is known about the prognosis of patients with PNES. In this paper we set out to systematically assess published original studies on the prognosis and outcome predictors of patients with PNES. Our literature search across the databases Medline, PsycINFO, and EMBASE generated 18 original studies meeting the search criteria. Prognosis was found to be poor in adults, but good in children. Predictors of poor outcome included the presence of coexisting epilepsy or psychiatric comorbidities, violent seizure phenomenology, dependent lifestyle, and poor relationships. Overall, too much reliance is placed on seizure remission as an outcome measurement for patients with PNES, and the impact of many of the outcome predictors requires evaluation using larger studies with longer followup.

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Section: Resultsmentioning

confidence: 99%

Prognosis and Outcome Predictors in Psychogenic Nonepileptic Seizures

Durrant

Rickards

Cavanna

2011

Epilepsy Research and Treatment

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“…Following diagnosis, their feelings about care were neutral or negative. At one year follow-up, however, satisfaction was more positive 23 .…”

Section: Resultsmentioning

confidence: 91%

Health Care Utilization and Poor Reassurance: Potential Predictors of Somatoform Disorders

Puri

Dimsdale

2011

Psychiatric Clinics of North America

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Objective Somatoform disorders are common conditions, but the current diagnostic criteria are considered to be unreliable, based largely on medically unexplained symptoms. DSM-5 is considering other possible characteristics of somatizers including high utilization, dissatisfaction with care, and poor response to reassurance. This paper reviews the available literature for evidence to support these criteria, and evaluates if distinctive aspects of these characteristics exist in somatizers. Methods The Pubmed database was searched combining terms such as “somatoform disorder” with “reassurance,” “satisfaction,” and “utilization.” Articles were individually inspected. Results Many studies report a deficit in long-term response to reassurance in somatizers; there was some evidence that patients respond initially to reassurance, followed by return of anxiety, leading to further reassurance seeking. There was insufficient evidence to support poor satisfaction with care as a characteristic of somatizers. While there is no standard criterion for high utilization, regardless of definition, evidence was found to support over-utilization, particularly in outpatient visits. However, no unique pattern of utilization was found that could identify somatizers within a broader group of high utilizers. Conclusions This review revealed evidence of over-utilization in many areas of healthcare, as well as poor long term response to reassurance in somatizers. Dissatisfaction with care, though, was not a consistent finding. It is difficult to study alternative diagnostic criteria for somatoform patients when the current criteria rest on so many problematic assumptions. Future research should attempt to validate criteria empirically in patient groups, with selection not based on medically unexplained symptoms.

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“…In general, NEAD has a good prognosis. Riaz et al 12 showed that over an 8 week follow-up 25% of NEAD patients were seizure-free following psychiatric treatment, 50% were improved and 25% worse or unchanged. Over a longer followup, the improvement may be even more marked.…”

Section: Discussionmentioning

confidence: 99%

Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures

Zaidi

Crampton²,

Clough³

et al. 1999

Seizure

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Differentiating psychogenic non-epileptic attack disorder (NEAD) from true epilepsy is difficult. This often results in a misdiagnosis and unnecessary and ineffective treatment. Prolonged EEG/video recording is the most sensitive tool for differentiating NEAD from epilepsy, but is costly and therefore limited in availability. Provocative tests, particularly the use of saline injection, can reduce the length of monitoring but give rise to ethical dilemmas. This study assesses the value of head-up tilt testing as a provocative test for NEAD. Twenty-one patients (17 female, mean age 34.6 +/- 11.5 years) with recurrent seizure-like episodes and a clinical diagnosis of NEAD were studied. Patients were tilted to 80( composite function )on an electric tilt table with footplate support for up to 45 minutes during continuous ECG, EEG and blood pressure monitoring. Seventeen patients (81%) experienced typical symptoms (non-epileptiform limb shaking in 15 patients, absence in one patient, myoclonic jerking in one patient) during head-up tilt without significant EEG abnormalities or haemodynamic changes. The mean time to onset of seizure-like activity was 13.2 +/- 11 minutes (range 0-31 minutes). No patients suffered injury or any other significant side-effect. Provocative testing using suggestion and head-up tilt is a sensitive tool for diagnosing NEAD and represents a safe, simple and inexpensive outpatient technique for investigating patients with suspected NEAD.

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Non-epileptic attack disorder and clinical outcome: a pilot study

Cited by 11 publications

References 10 publications

Prognosis and Outcome Predictors in Psychogenic Nonepileptic Seizures

Prognosis and Outcome Predictors in Psychogenic Nonepileptic Seizures

Health Care Utilization and Poor Reassurance: Potential Predictors of Somatoform Disorders

Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures

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