Provocation of Nonepileptic Seizures by Suggestion in a General Seizure Population

Bazil, Carl W.; Kothari, Milind J.; Luciano, Daniel; Moroney, Joan T.; Song, Sharon; Vasquez, Blanca; Weinreb, Herman J.; Devinsky, Orrin

doi:10.1111/j.1528-1157.1994.tb02509.x

Cited by 60 publications

(26 citation statements)

References 14 publications

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“…The early occurrence of PNEE may reflect the fact that such patients are highly suggestible, a phenomenon observed by other investigators (16,23,30). Indeed, on the day of admission to our monitoring unit, we provide every patient a detailed explanation of what VEEG consists of, emphasizing the fact that the ultimate goal is the recording of a typical "seizure.…”

Section: Discussionmentioning

confidence: 99%

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When Should Induction Protocols Be Used in the Diagnostic Evaluation of Patients with Paroxysmal Events?

et al. 1998

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Summary:Purpose: To determine the timing of spontaneous psychogenic nonepileptic events (PNEE) during video-EEG telemetry (VEEG), and the need to use induction protocols (IP).Methods: We studied 100 consecutive patients (75 females, 25 males) admitted to our inpatient VEEG unit from July 1994to June 1996 for differential diagnosis of paroxysmal events. We recorded the time to the first diagnostic spontaneous event, identified by the patient or a family member as typical. Episodes were classified as PNEE, physiologic nonepileptic events (PhysNEE), and epileptic seizures (ES). SD 54.1 h. In 82 patients, a diagnostic event occurred spontaneously. The first event was an ES in 22 patients, a PNEE in 53, and a Results:The mean duration of VEEG was 74 PhysNEE in 7. The time to first diagnostic event was significantly shorter for PNEE than for ES [15.0 ? SD 16.3 h (range 5 min to 58 h) vs. 28.6 ? SD 34.0 h (range 1-110 h) F = 15.621, p < 0.00011. In the first 24 h, 77.4% of the patients with PNEE had an event. By 48 h, all but 2 (96.2%) had had diagnostic events. After the first 58 h of monitoring, all patients with PNEE experienced a spontaneous diagnostic event.Conclusion: Spontaneous events can be expected to occur within 48 h in most patients with PNEE. Therefore, if IP are to be used as a diagnostic tool, we suggest that they be withheld during the initial 48 h of VEEG monitoring.

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Section: Discussionmentioning

confidence: 99%

“…Three of the 40 patients with PNEE had events different from those that motivated the study. Bazil et al (23) studied the induction with saline in a general seizure population. Of 52 patients, 40% had no response, 23% had atypical events, and 37% had a typical event.…”

Section: Discussionmentioning

confidence: 99%

When Should Induction Protocols Be Used in the Diagnostic Evaluation of Patients with Paroxysmal Events?

et al. 1998

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“…The origins of NES include a wide variety of psychogenic and physiologic disorders (1). NES are common, accounting for between 10-20% of all inpatient hdeo-EEG monitoring unit admissions (2,3), and up to 37% of patients diagnosed with possible epilepsy in a city hospital general neurology clinic (4).…”

Section: Nonepileptic Seizures After Head Injurymentioning

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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“…Psychogenic nonepileptic seizures (NESs, also known as pseudoseizures, or psychogenic or hysterical seizures) are clinical events that resemble epileptic attacks but are unassociated with physiologic central nervous system dysfunction (1,2). Although an abundant literature (3)(4)(5)(6)(7)(8) focuses on the clinical distinctions between epileptic and NESs, relatively few studies have examined outcomes in patients with NESs ( Table 1).…”

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A Comprehensive Profile of Clinical, Psychiatric, and Psychosocial Characteristics of Patients with Psychogenic Nonepileptic Seizures

et al. 1999

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Summary:Purpose: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome.Methods: We administered a telephone-based structured questionnaire to 56 patients with NESs (16 male and 40 female patients; mean age, 35 years) at a mean follow-up time of 18 months after making the diagnosis of NES.Results: Mean age of NES onset was 28 years with a mean duration of 8 years. Episodes resolved in 29 (51.8%) cases, decreased in 24 (42.9%), persisted unchanged in two (3.6%), and increased in frequency in one (1.8%). Thirty (53.6%) patients, including 13 (44.8%) of patients whose NESs resolved, were rehospitalized for NESs or for other symptoms. Twentynine (5 1.8%) had significant depressive symptoms, 22 (39.3%) had suicidal ideation, and 11 (19.6%) attempted suicide [including 6 (21%) of the patients whose NESs resolved]. Believing the NES diagnosis was associated with resolution or improvement of NES frequency (p c 0.029), whereas anger in response to receiving the diagnosis did not predict a poorer outcome. Patients' perceptions of having good health (p < 0.02) and good occupational functioning (p < 0.04) were highly correlated with NES resolution. Only patients whose episodes resolved were employed at the time of follow-up.Conclusions: At a mean of 1.5 years, NES outcome was poor, with resolution in only half the group and with frequent rehospitalizations after NES diagnosis, even among patients whose NES resolved. Depressive symptoms, suicidal ideation, and suicide attempts were common. Believing the NES diagnosis and patient perceptions of having good health and good occupational functioning correlated well with NES resolution.

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Provocation of Nonepileptic Seizures by Suggestion in a General Seizure Population

Cited by 60 publications

References 14 publications

When Should Induction Protocols Be Used in the Diagnostic Evaluation of Patients with Paroxysmal Events?

When Should Induction Protocols Be Used in the Diagnostic Evaluation of Patients with Paroxysmal Events?

Nonepileptic Seizures After Head Injury

A Comprehensive Profile of Clinical, Psychiatric, and Psychosocial Characteristics of Patients with Psychogenic Nonepileptic Seizures

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