Psychogenic nonepileptic seizures and movement disorders

Abstract

Purpose of review: Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are usually investigated and managed separately by different neurology subspecialists. We review the main epidemiologic and clinical features of both PNES and PMD, aiming to highlight their similarities and differences and to see whether a common framework for these disorders exists. Recent findings:Data from the literature show that there is a profound overlap between PNES and PMD, which would argue for a larger unifying pathophysiology with variable phenotypic manifestations. Summary: Collaborative and integrated research among epileptologists, movement disorders experts, psychiatrists, psychologists, and physiotherapists may increase our collective knowledge about the pathophysiologic mechanisms of PNES and PMD and therefore improve outcomes for these patients. Neurol Clin Pract 2016;6:138-149 N eurologic symptoms due to a functional or psychogenic cause are common in clinical practice, accounting for up to 16% of patients presenting to neurology outpatient clinics, depending on the clinical definitions and methodology used for case ascertainment.1,2 The yearly costs of patients with medically unexplained symptoms in the United States have been estimated at approximately $256 billion per year.3 Despite their prevalence and associated economic and social burden, appropriate treatments for these disorders are an unmet need. This may reflect the absence of research interest and lack of discourse between neurology and psychiatry regarding these patients. Notably, although approximately 50% of the patients with somatoform disorders are identified by neurologists at the time of first contact, only 1.5% are referred to a psychiatrist or a psychologist.

Cognitive Behavioural Therapy and Adjunctive Physical Activity for Functional Movement Disorders (Conversion Disorder): A Pilot, Single-Blinded, Randomized Study

“…The only factors influencing the outcome were a severer motor phenotype at baseline and longer disease duration. The latter, in line with previous results [8], strongly reflects the need for avoiding delay in diagnosis and referral to appropriate treatments. While our results show that CBT is effective in chronic FMD (mean disease duration of our patients was in fact about 1.5 years), it remains to be assessed whether the magnitude of therapeutic response would be even greater in de novo patients (only 2 of our patients had disease duration of - and received their first diagnosis from - less than 6 months to be considered de novo and to directly test this hypothesis).…”

Gender Differences in Functional Movement Disorders

“…Although PNES are over‐represented in women, men constitute around 30% of cases without major differences in demographic and clinical characteristics . Thus, PNES should be considered within the continuum of FMDs, and both are within the spectrum of FNDs …”

“…[23][24][25][26] Thus, PNES should be considered within the continuum of FMDs, and both are within the spectrum of FNDs. 27 There is currently no clear scientific explanation for the differences in gender prevalence favoring females and phenomenology type of FMDs; it can be argued that neurobiological, hormonal, cultural, social, and previous history of psychological or sexual trauma may contribute, although similar gender distribution in patients aged ≥50 years would suggest convergence of neurobiological conditions predisposing to FMDs at this age in both genders. Some researchers have claimed that FNDs are linked to sexual issues in women, including sexual abuse, which may increase their predisposition to FNDs [28][29][30] ; however, this may be an oversimplification, considering emerging evidence attributing a complex and multidimensional nature to FNDs.…”

Psychogenic non-epileptic seizures in early Huntington's disease

“…In the general population, psychogenic non-epileptic seizures and psychogenic movement disorders are among the most frequent psychologically-mediated syndromes seen by neurologists, 3 and this is also our experience in the HD clinic. It is often difficult to distinguish between psychogenic movement disorders and psychogenic non-epileptic seizures, since both share causative factors and clinical features; some authors classify both conditions under the same spectrum.…”

“…It is often difficult to distinguish between psychogenic movement disorders and psychogenic non-epileptic seizures, since both share causative factors and clinical features; some authors classify both conditions under the same spectrum. 3 In this particular case, the altered higher mental function and the complexity of the movements made psychogenic non-epileptic seizures more likely.…”