Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

LaFrance, W. Curt; Keitner, Gabor I.; Papandonatos, George D.; Blum, Andrew S.; Machan, Jason T.; Ryan, Christine E.; Miller, Ivan W.

doi:10.1212/wnl.0b013e3181f4d5a9

Cited by 143 publications

(75 citation statements)

References 35 publications

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“…29,30 Only 5% thought antidepressants to be the best option, reflecting the limited evidence for the effectiveness of medications for PNES. 31 Of note, 40% of Japanese respondents thought that "environmental control" was most effective. This term refers to an approach that aims to reduce pressure on the patient by changing their environment (for instance by working with employers to modify expectations at work or with family members to reduce stress at home) and could be explored in other cultures.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Hingray¹,

et al. 2017

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SummaryObjective: Studies from a small number of countries suggest that patients with psychogenic nonepileptic seizures (PNES) have limited access to diagnostic and treatment services. The PNES Task Force of the International League Against Epilepsy (ILAE) carried out 2 surveys to explore the diagnosis and treatment of PNES around the world. Methods: A short survey (8 questions) was sent to all 114 chapters of the ILAE.A longer survey (36 questions) was completed by healthcare professionals who see patients with seizures. Questions were separated into 5 sections: professional role, diagnostic methods, management, etiology, and access to health care. Results: Responses were received from 63 different countries. The short survey was completed by 48 ILAE chapters, and the long survey by 1098 health professionals from 28 countries. PNES were recognized as a diagnostic and therapeutic problem in all countries. Trauma and mental health issues were most commonly recognized as etiologic factors. There was a clear relationship between income and access to diagnostic tests and expertise. Psychological therapy was most commonly considered the treatment of choice. Although financial difficulties were the most commonly reported problem with service access in low-income countries, in

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Hingray¹,

et al. 2017

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“…Similarly, LaFrance et al 82 showed that 11 of 38 patients (29%) with PNES had interictal EEG abnormalities and 16 of 38 (42%) had abnormalities on MRI, despite the absence of a "focal neurological lesion" associated with their PNES. These EEG findings are nonspecific and do not indicate evidence of epilepsy.…”

Section: Pnesmentioning

confidence: 89%

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Voon¹,

Cavanna²,

Coburn³

et al. 2016

JNP

125

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Much is known regarding the physical characteristics, comorbid symptoms, psychological makeup, and neuropsychological performance of patients with functional neurological disorders (FNDs)/conversion disorders. Gross neurostructural deficits do not account for the patients' deficits or symptoms. This review describes the literature focusing on potential neurobiological (i.e. functional neuroanatomic/neurophysiological) findings among individuals with FND, examining neuroimaging and neurophysiological studies of patients with the various forms of motor and sensory FND. In summary, neural networks and neurophysiologic mechanisms may mediate "functional" symptoms, reflecting neurobiological and intrapsychic processes. J Neuropsychiatry Clin Neurosci 2016; 28:168-190; doi: 10.1176/appi.neuropsych.14090217 Functional neurological disorders (FNDs; or psychogenic neurological symptoms), also known as conversion disorder, are a classic neuropsychiatric disorder, existing in the border between neurology and psychiatry. Unexplained neurological symptoms are common, occurring in up to one-third of patients in neurological outpatient clinics.1 Relative to disorders such as Parkinson's disease, FND is associated with similar levels of disability and physical quality of life with poorer mental health quality of life. 2 The prognosis is poor, with a recent reviewshowing that up to 40% of patients with FND report similar or worse outcomes at 7-year follow-up. 3 Given the frequency, consequences, prognosis, and burden, FND has been called a "crisis for neurology." 4 Despite this, FND is poorly understood. In the last decade, an increasing number of studies have focused on underlying neurobiological mechanisms. FND is defined in DSM-5 as the presence of one or more symptoms of altered voluntary or sensory function, with clinical findings providing evidence of incompatibility between the symptom and recognized neurological or medical conditions.5 The DSM-5 diagnosis differs from that of the DSM-IV diagnosis of conversion disorder by adding the criterion of incorporating physical diagnostic features and by relegating to the accompanying text the criteria requiring (a) an association with psychological stressors and (b) the exclusion of malingering or factitious disorder to make the diagnosis. DSM-5 FND diagnosis criteria now allow for potential greater interrater reliability, making them appropriate for research studies and greater compatibility with specialtyspecific diagnoses including psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES). 6The putative biopsychosocial mechanisms underlying FND are complex and have been extensively reviewed.7 Our review focuses on the physiological mechanisms that may underlie FND and does not specifically focus on the extensive literature on the antecedents of early childhood experiences and temperament (Figure 1). At the outset, regarding the proposed model, we acknowledge that predisposing factors for functional neurological symptoms are not limited to genetics, te...

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“…From a pharmacological point of view, a single pilot randomized controlled trial (RCT) study on the use of SSRIs in the treatment of PNES have shown good positive preliminary results. Cleary, this finding needs to be replicated in a large double blinded study to confirm this finding [43]. On the other hand psychological treatments remain the preferred choice for clinicians involved with PNES as shown in a recent survey [44].…”

Section: Treatmentmentioning

confidence: 93%

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

Alsaadi¹,

Shahrour²

2014

Health

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Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.

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Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures

Cited by 143 publications

References 35 publications

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

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