Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis

Whitehead, Kimberley; Kane, Nick; Wardrope, Alistair; Kandler, Rosalind; Reuber, Markus

doi:10.1016/j.cnp.2017.06.002

Cited by 17 publications

(15 citation statements)

References 84 publications

(149 reference statements)

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“…For psychogenic TLOC, pharmacological provocation may be used as for reflex syncope for two reasons: firstly, VVS occurs more often in psychogenic pseudosyncope than chance predicts (Blad et al, 2015) and the occurrence of psychogenic TLOC may depend on suggestion (Whitehead et al, 2017), which may be aided by a provocation procedure. The same protocol may be used for psychogenic TLOC as for reflex syncope, except for the endpoint.…”

Section: Indication Psychogenic Tlocmentioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

Thijs

Brignole

Falup‐Pecurariu

et al. 2021

Autonomic Neuroscience

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An expert committee was formed to reach consensus on the use of Tilt Table Testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous ones. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to perform (1) additional provocation tests, such as the active standing test carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, ☆ Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). ☆☆ This article is co-published in the journals "Clinical Autonomic Research" and "Autonomic Neuroscience".

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Section: Indication Psychogenic Tlocmentioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN)

Thijs

Brignole

Falup‐Pecurariu

et al. 2021

Autonomic Neuroscience

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show abstract

“…For psychogenic TLOC, pharmacological provocation may be used as for reflex syncope, for two reasons: firstly, VVS occurs more often in psychogenic pseudosyncope than chance predicts [40] and the occurrence of psychogenic TLOC may depend on suggestion [68], which may be aided by a provocation procedure. The same protocol may be used for psychogenic TLOC as for reflex syncope, except for the endpoint.…”

Section: Indication Psychogenic Tlocmentioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

et al. 2021

View full text Add to dashboard Cite

An expert committee was formed to reach consensus on the use of tilt table testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous events. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to the performance of (1) additional provocation tests, such as the active standing test, carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres.

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“…Routine EEG may be helpful to facilitate a diagnosis of psychogenic nonepileptic seizures (PNES) [80] . One study of 74 patients suspected of having PNES on clinical grounds analyzed the yield of short-term, outpatient EEG with video monitoring (OVEM).…”

Section: Routine Eeg and Epilepsy Diagnosismentioning

confidence: 99%

When should we obtain a routine EEG while managing people with epilepsy?

Hasan

Tatum

2021

Epilepsy & Behavior Reports

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Highlights Routine EEG can define epilepsy, classify epilepsy syndromes, and aid in the initiation/withdrawal of ASM. Performing serial routine EEGs increases the yield of interictal discharges. Repeat routine EEG may be utilized as an alternative to continuous EEG in critically ill adults at hospitals with limited resources. Despite COVID-19, EEG services continue, and the value of routine EEG is unchanged.

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Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis

Cited by 17 publications

References 84 publications

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

When should we obtain a routine EEG while managing people with epilepsy?

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