Psychogenic nonepileptic seizure manifestations reported by patients and witnesses

Abstract

SUMMARYPurpose: Psychogenic nonepileptic seizures (PNES) continue to represent a serious diagnostic challenge for neurologists. Video-electroencephalography (EEG) studies have provided detailed knowledge of the spectrum of visible PNES manifestations. However, little is known about how patients or seizure witnesses experience PNES, although many diagnoses in seizure clinics are made on the basis of self-reported information rather than video-EEG observations. This study describes the range of PNES manifestations as they are reported by patients or seizure witnesses. Methods: Three hundred eight candidates for this study were consecutively diagnosed with PNES on the basis of video-EEG recordings of habitual seizures involving impairment of consciousness without epileptic ictal EEG activity at the Royal Hallamshire Hospital in Sheffield and the National Hospital for Neurology in London, United Kingdom. One hundred patients responded to a postal questionnaire and participated in this study. Eighty-four of the questionnaires completed by patients were accompanied by questionnaires completed by seizure witness. The patient questionnaire contained 12 demographic and clinical questions and the 86-item Paroxysmal Event Profile (PEP), asking patients to rate statements about their attacks on a five-point Likert scale (''always,'' ''frequently,'' ''sometimes,'' ''rarely,'' ''never''). The Paroxysmal Event Observer (PEO) questionnaire uses 34-items with the same Likert scale. The PEP questionnaire includes inquiries about symptoms of panic or dissociation as well as symptoms previously found to distinguish between generalized tonic-clonic seizures and syncope or thought to differentiate between epilepsy and PNES. Key findings: The item-by-item analysis revealed the inter-and intraindividual variability of PNES experiences.The majority of patients with PNES reported some phenomena, which have traditionally been attributed to epilepsy (such as seizures from sleep, experiencing a rising sensation in their body, postictal myalgia). Although most PNES were experienced as striking without warning and reported to cause loss or impairment of consciousness, most patients also reported seizure warnings in at least some of the seizures. Despite the clinical heterogeneity apparent from these findings, a correlation matrix showed that symptoms were not randomly distributed. Significant correlations were seen between duration of seizures and seizures from reported sleep (r = )0.28, p = 0.006), seizure-related motor activity and seizures from reported sleep (p = )0.48, p < 0.001), flashbacks and anxiety (p = 0.44, p < 0.001) or dissociation (p = 0.66, p < 0.001), and anxiety and dissociation (r = 0.53, p < 0.001). The comparison of similarly worded items on the PEP and PEO questionnaires showed that witnesses were more often aware of seizure triggers and a relationship between PNES and emotional stress than were patients (p = 0.001/p < 0.001). Significance: These findings based on the self-report of patients with well-characterized PNES ...

Differences in relatives' and patients' illness perceptions in functional neurological symptom disorders compared with neurological diseases

“…Our findings are consistent with a study of 100 patient and 84 witness accounts of nonepileptic seizures recorded by questionnaire [30]. Although not directly comparable, this study found that PNES witnesses perceived a closer link between stress and seizures, as well as seizure triggers, than patients themselves.…”

“…In fact, there have been no studies of relatives illness perceptions in FNSD such as PNES or functional weakness. However, clinical experience suggests that it is of vital importance to engage not only patients with FNSD with the rationale for diagnosis and treatment, but also their relatives and friends [30].…”

Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness

“…Possible explanations for the observed differences between NES and FW patients include: (1) the experience of cognitive symptoms such as fear, derealisation or depersonalisation during NES [18,19] or the experience of triggering which may be more likely to be recognised as 'psychological' (2) It is also possible that NES is a problem in which psychological factors are especially relevant for symptom triggering and maintenance as suggested by studies of prior life events and abuse [6,7] and studies of threat perception [20]. (3) FW is continuous whereas NES is episodic, making psychological factors more plausible (i.e.…”

Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention

“…Instead most PNES are considered as a non-wilful dissociative response to distressing internal or external stimuli [4]. In view of the phenomenological similarities between PNES and epilepsy [5], it is not surprising that this differential diagnosis represents a particular clinical challenge. Epilepsy tends to be over-diagnosed, and it typically takes several years before a correct diagnosis of PNES is made: over three quarters of patients with PNES are initially (and inappropriately) started on treatment for epilepsy [6].…”