Nonepileptic seizures treatment workshop summary

LaFrance, W. Curt; Alper, Kenneth; Babcock, Debra; Barry, John J.; Benbadis, Selim R.; Caplan, Rochelle; Gates, John R.; Jacobs, Margaret P.; Kanner, Andrés M.; Martin, Roy C.; Rundhaugen, Lynn; Stewart, Randy; Vert, Christina

doi:10.1016/j.yebeh.2006.02.004

Cited by 70 publications

(62 citation statements)

References 41 publications

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“…Although the findings need to be replicated, preferably in larger patient samples, the present results provide the first evidence of a direct relationship between the biological stress marker cortisol and cognitive threat sensitivity in PNES and provide a starting point, as well as preliminary support, for integrated psychoneurobiological theories for this complex disorder [2]. If replicated, these findings, together with evidence for increased basal cortisol levels in PNES [9], may help to fine-tune psychological as well as pharmacological interventions for PNES [19].…”

Section: Discussionsupporting

confidence: 56%

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

Bakvis

Spinhoven

Roelofs

2009

Epilepsy & Behavior

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a b s t r a c tPrevious studies have provided evidence for a vigilant attentional bias toward threat stimuli and increased basal diurnal cortisol levels in patients with psychogenic nonepileptic seizures (PNES). Because cortisol levels may be predictive of threat vigilance, we reanalyzed previous data on threat vigilance in 19 unmedicated patients with PNES and found a positive correlation between baseline cortisol levels and attentional bias scores for threat stimuli (r = 0.49, P = 0.035). There was no such relationship in healthy matched controls (n = 20) or in patients with epileptic seizures (n = 17). These findings provide the first evidence linking an endocrine stress marker to increased threat sensitivity in PNES and support new integrated psychoneurobiological models of PNES.

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Section: Discussionsupporting

confidence: 56%

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

Bakvis

Spinhoven

Roelofs

2009

Epilepsy & Behavior

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“…Prior to the NINDS/ NIMH/AES supported NES Workshop in 2005, only class III and IV level treatment data existed 24,49 . The NES workshop set the NES research benchmarks, and PNES treatment is a target of the NINDS Epilepsy Research Benchmarks 49 . Our group and others have been systematically developing treatments for patients with PNES and studying biomarkers of PNES.…”

Section: Treatment Of Pnes and Pmdmentioning

confidence: 99%

“…This is being accomplished through multi-disciplinary, multi-modal, multi-site work. Examples of advances in PNES treatment over the last decade include examining clinical trial methodology in PNES in an open label study of sertraline for PNES 49 , followed by a pilot placebo-controlled Luciano De Paola et al Psychogenic nonepileptic seizures and psychogenic movement disorders RCT with sertraline 49 . Standard medical care (SMC) or treatment as usual (TAU) is in the US,and in a cross-cultural comparison with Chile has been described 50 .…”

Section: Treatment Of Pnes and Pmdmentioning

confidence: 99%

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Paola

Marchetti

Teive

et al. 2014

Arq. Neuro-Psiquiatr.

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Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.Keywords: psychogenic nonepileptic seizures, psychogenic movement disorders, conversion disorder, hysteria. RESUMOCrises não-epilépticas psicogênicas (CNEP) e distúrbios do movimento psicogênicos (DMP) são comuns na prática e na atualidade são melhor categorizados no DSM-V como distúrbios neurológicos funcionais/desordens de conversão. Esta revisão enfatiza os principais dados históricos, epidemiológicos, clínicos, critérios diagnósticos, tratamento e o prognóstico destes pacientes, frequentemente negligenciados e desafiadores, os quais, como um grupo, tem intrigado gerações de neurologistas e psiquiatras, caracterizando, de forma justificada o elo definitivo entre estas especialidades.Palavras-chave: crises não-epilépticas psicogênicas, distúrbios do movimento psicogênicos, distúrbio conversivo, histeria.In the medical sciences, a diagnosis is established when a level of certainty regarding the nature of a condition is achieved. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) share a slightly less linear diagnostic route. Historically, making a conversion diagnosis required ruling out the originally considered medical diagnosis, i.e., it is neither epilepsy, nor a neurogenic movement disorder. Only then a non-neurologic (in the sense of not resulting from epileptogenic or known motor circuitry imbalance) condition is suspected and raised to the level of diagnosis 1 . This kind of diagnosis has intrigued generations of physicians and spared no culture, gender or age. A diversity of symptoms, including motor, sensory, cognitive, and/or behavior symptoms are present in these presentations. Patients with PNES or PMD frequently are misdiagnosed as having their initial suspected neurological diseases, and ultimately pose a diagnostic and treatment challenge to many clinicians. Interestingly, it was perhaps this varied presentation that has captured the attention of many professionals through the centuries and lead to the construction and recognition of a very particular diagnosis. Two rather advanced historic civilizations, Egyptians first, and then the Greeks, posited that a displaced hystera (womb), and the consequent suffocation that it produced, was the source of choking, mutism, paralysis and fainting 1 . Hysteria, a natural development on this concept, was claimed as an explanation for similar phenomena in women and reached almost epidemic proportions in the late 19 th century. By th...

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“…[3][4][5][6] Some medically unexplained symptoms (presumed psychogenic) have been shown to be responsive to pharmacologic interventions. [7][8][9][10][11] In addition to their established efficacy for treating depression and anxiety, 12 serotonin selective reuptake inhibitors (SSRIs) have shown promise in trials for conversion or somatoform disorders 11,13 and some personality disorders.…”

mentioning

confidence: 99%

Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

LaFrance¹,

Keitner²,

Papandonatos³

et al. 2010

Neurology

143

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Objective: There have been few treatment trials for psychogenic nonepileptic seizures (PNES).Some psychotherapies have been shown to improve PNES and comorbid symptom outcomes. We evaluated a pharmacologic intervention to test the hypothesis that sertraline would reduce PNES. Methods:We conducted a pilot, double-blind, randomized, placebo-controlled trial in an academic medical hospital with epilepsy center outpatients. Subjects aged 18 to 65 years diagnosed with video-EEG-confirmed PNES were treated with flexible-dose sertraline or placebo over 12 weeks. Seizure calendars and symptom scales were charted prospectively. Secondary outcome measures included psychiatric symptom scales and psychosocial variables.Results: Thirty-eight subjects enrolled, and 26 (68%) completed the trial. Thirty-three subjects with nonzero nonepileptic seizure rates at baseline were included in intent-to-treat analysis of the primary outcome. Subjects assigned to the sertraline arm experienced a 45% reduction in seizure rates from baseline to final visit (p ϭ 0.03) vs an 8% increase in placebo (p ϭ 0.78). Secondary outcome scales revealed no significant between-group differences in change scores from baseline to final visit, after adjustment for differences at baseline.Conclusions: PNES were reduced in patients treated with a serotonin selective reuptake inhibitor, whereas those treated with placebo slightly increased. This study provides feasibility data for a larger-scale study. Level of evidence:This study provides Class II evidence that flexible-dose sertraline up to a maximum dose of 200 mg is associated with a nonsignificant reduction in PNES rate compared with a placebo control arm (risk ratio 0.51, 95% confidence interval 0.25-1.05, p ϭ 0.29), adjusting for differences at baseline. Neurology ® 2010;75:1166-1173 GLOSSARY AED ϭ antiepileptic drug; CI ϭ confidence interval; DSM-IV ϭ Diagnostic and Statistical Manual of Mental Disorders, 4th edition; ES ϭ epileptic seizures; ITT ϭ intent to treat; PNES ϭ psychogenic nonepileptic seizures; PTSD ϭ posttraumatic stress disorder; QOL ϭ quality of life; RCT ϭ randomized controlled trial; RIH ϭ Rhode Island Hospital; RR ϭ risk ratio; SSRI ϭ serotonin selective reuptake inhibitor; vEEG ϭ video-EEG.

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Nonepileptic seizures treatment workshop summary

Cited by 70 publications

References 41 publications

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

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