Nonepileptic seizures and childhood sexual and physical abuse

Alper, Kenneth; Devinsky, Orrin; Perrine, Kenneth; Vázquez, Blanca; Luciano, Daniel

doi:10.1212/wnl.43.10.1950

Cited by 222 publications

(123 citation statements)

References 6 publications

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“…As indicated in Table 3, factor 1 showed a significant difference between C-NES and CPE, an effect that appeared to be mediated to a significant degree by the higher prevalence of childhood abuse in C-NES (10). It is unlikely that childhood abuse was the sole causative factor in the elevated scores on the depersonalization-derealization factor in C-NES.…”

Section: Discussionmentioning

confidence: 90%

Dissociation in Epilepsy and Conversion Nonepileptic Seizures

et al. 1997

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Summary: Purpose:We examined the dimensionality of the item content of the Dissociative Experiences Scale (DES) in relation to the clinical diagnosis of conversion nonepileptic seizures (C-NES) versus complex partial epilepsy (CPE).Methods: The DES was administered to a sex-and agematched sample of 132 patients with C-NES and 169 with CPE and was factor analyzed with principal components analysis (PCA) with varimax rotation.Results: The mean total DES score was 15.1 in the C-NES group and 12.7 in the CPE group (p = 0.079). The factors obtained by PCA differentiated the CPE and C-NES groups more strongly than did the total DES score. The factor accounting for the most variance, interpreted as "depersonalizationderealization," was significantly greater in C-NES than CPE (p = 0.005). An "absorption-imaginative involvement" factor, which included some of the clinical features of posttraumatic stress disorder was elevated only in subjects reporting histories of childhood abuse (p = 0.001) regardless of the diagnosis of CPE or C-NES. An "amnestic" factor appearing to represent memory problems related to neurologic impairment showed a trend toward elevation in CPE (p = 0.056) and may have confounded the CPE versus C-NES distinction using total DES scores.Conclusions: The DES has separate underlying dimensions that appear to relate distinctively to depersonalization and derealization, childhood trauma, and neurologic impairment. The heterogeneous item content of the DES is a potential confound that should be appreciated when this instrument is used to study dissociation in neuropsychiatric populations.

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Section: Discussionmentioning

confidence: 90%

Dissociation in Epilepsy and Conversion Nonepileptic Seizures

et al. 1997

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“…The Glasgow Coma Scale interval of 9-13 (or LOC >5 min or focal neurologic deficit) corresponds to the moderate severity category, with the added complication of an intracranial lesion evident on neuroimaging. The serious head injury category on the HISS includes severe (scale interval [5][6][7][8], with complications such as brainstem hemorrhage or effacement of brainstem cistern, and critical (scale interval of 3-4), with loss of pupillary reflex or severe nonneurologic injury. Severity level of head injury did not restrict patient selection.…”

Section: Methodsmentioning

confidence: 99%

Nonepileptic Seizures After Head Injury

1998

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Summary: Purpose:To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics.Methods: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report.Results: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor.Conclusions: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.

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“…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). Only two studies evaluated HRQOL in patients with PNESs (14,32).…”

mentioning

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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Nonepileptic seizures and childhood sexual and physical abuse

Cited by 222 publications

References 6 publications

Dissociation in Epilepsy and Conversion Nonepileptic Seizures

Dissociation in Epilepsy and Conversion Nonepileptic Seizures

Nonepileptic Seizures After Head Injury

Quality of Life in Psychogenic Nonepileptic Seizures

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