Psychogenic nonepileptic seizures in adults with epilepsy: a tertiary hospital-based study

Hamed, Sherifa A.; Attiah, Fadia Ahmed; Fawzy, Muhammad

doi:10.1080/00207454.2019.1698566

Cited by 7 publications

(5 citation statements)

References 48 publications

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“…On the other hand, it is suggested that a wide range of psychopathologies may be the basis of PNES and that their treatment could improve clinical outcomes, avoiding the perpetuation of ongoing psychogenic seizures (35). In our series, 11.36% of patients presented isolated PNES, and another 6.69% had concurrent epilepsy and PNES, the total prevalence of PNES was 18.05%, which is consistent with previous reports (24,33,41). Of the total group with epilepsy (428 patients), 7.7% had PNES.…”

Section: Discussionsupporting

confidence: 91%

Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

et al. 2021

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Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center.Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life.Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p < 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015).Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.

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Section: Discussionsupporting

confidence: 91%

Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

et al. 2021

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“…A recently published epidemiological study carried out in the southern region of Egypt found the prevalence of psychogenic seizures to be 4.97% in patients with epilepsy. The study also found a delay in diagnosis of an average 7.12 years from the first seizure and PNES predominance in females [3].…”

Section: Introductionmentioning

confidence: 55%

Psychiatric comorbidities in patients with psychogenic nonepileptic seizures

Rady

Elfatatry

Molokhia

et al. 2021

Epilepsy & Behavior

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Background: Psychogenic nonepileptic seizures (PNES) are major challenges for diagnosis and management. The heterogeneity of psychogenic seizures is attributed to diverse psychopathological comorbidities, and the causal relationship between PNES and underlying psychopathologies is still enigmatic. Objective: Our objective was to study psychiatric comorbidities and personality constructs in patients with PNES and compare them to a control group of patients with epilepsy. Method: We randomly recruited 33 patients with PNES and 33 patients with epilepsy. All patients completed the Mini-International Neuropsychiatric Interview (MINI) to screen for psychiatric comorbidities, the Structured Clinical Interview for psychiatric disorders in Axis II (SCID II) to screen for personality disorders, and Goldberg's International Personality Item Pool (IPIP) Big Five personality questionnaire to study the psychological constructs of extroversion-introversion, agreeableness, conscientiousness, emotional stability-neuroticism, and intellect. Result: Mood and anxiety disorders were highly prevalent in patients with PNES (72.7% and 54.5%, respectively); however, the prevalence of only cluster B personality disorder was higher in patients with PNES (69.7%) compared to 33.3% among patients with epilepsy (p < 0.05). Screening for personality disorders using SCID II showed that the prevalence of borderline and depressive personality disorders was significantly higher in patients with PNES (p < 0.001). Patients with psychogenic seizures were more likely to be receiving polydrug therapy (75.8%) compared to patients with epileptic seizures (45.5%); this difference was statistically significant (p < 0.05). Conclusion: Psychiatric comorbidities are highly prevalent among patients with PNES.

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“… 36 Similarly, in epilepsy, comorbid PNES is the most common functional phenotype with a mean frequency of 12%. 38 , 39 , 40 Following this background, one may speculate that such “functional overlay” is more common in patients with TS than previously thought.…”

mentioning

confidence: 86%

“…For example, in Parkinson's disease (PD) a prevalence of FMD comorbidity of up to 8% has been reported, most commonly presenting with gait disturbances and tremor 36 . Similarly, in epilepsy, comorbid PNES is the most common functional phenotype with a mean frequency of 12% 38–40 . Following this background, one may speculate that such “functional overlay” is more common in patients with TS than previously thought.…”

mentioning

confidence: 97%

Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome

Müller‐Vahl,

Pisarenko,

Fremer

et al. 2023

Movement Disord Clin Pract

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BackgroundComorbid functional tic‐like behaviors (FTB) have been described only rarely in patients with Tourette syndrome (TS).ObjectivesWe present the first large sample of patients suffering from TS and FTB to raise awareness of this clinical presentation and to guide how to differentiate one from the other.MethodsWe analyzed clinical data of 71 patients (n = 27 [38.0%] female, mean age: 21.5, range: 11–55) with TS + FTB.ResultsIn the majority of patients, FTB started abruptly on average 15 years after tic onset with “treatment‐resistant” complex movements and (“coprophenomena‐like”) vocalizations preceded by timely related psychological stressors. Psychological evaluation revealed evidence for internal conflicts (79%), emotional dysregulation (56%), and maintaining factors (70%). About one third of patients had a positive history for further medically unexplained symptoms. Compared to a large TS sample (n = 1032), patients with TS + FTB were more likely to be female, and presented significantly more common with “coprophenomena‐like” symptoms, atypical influential factors, atypical descriptions of premonitory sensations, and higher rates of comorbid obsessive‐compulsive disorder and “self‐injurious” behavior.ConclusionsBased on our data it can be assumed that FTB is a common comorbidity in TS, similar to functional overlay in other movement disorders and epilepsy. Before classifying a patient as suffering from treatment‐resistant TS, FTB should be ruled out.

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Psychogenic nonepileptic seizures in adults with epilepsy: a tertiary hospital-based study

Cited by 7 publications

References 48 publications

Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

Psychiatric comorbidities in patients with psychogenic nonepileptic seizures

Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome

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