Psychogenic nonepileptic seizures in children—Prospective validation of a clinical care pathway &amp; risk factors for treatment outcome

Sawchuk, Tyson; Buchhalter, Jeffrey; Senft, Birgit

doi:10.1016/j.yebeh.2020.106971

Cited by 37 publications

(42 citation statements)

References 36 publications

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“…In current clinical practice, pediatric treatment programs for PNES utilize a range of regulation interventions at multiple system levels: breath-training biofeedback and other bottom-up regulation strategies; regular exercise; traumaprocessing interventions; cognitive-behavioral therapy (CBT) and other top-down regulation strategies; pharmacotherapy, and decreasing stress for the child by managing dysfunction in the family system (family therapy). These interventions help regulate and decrease the child's level of arousal (Kozlowska et al, 2018b(Kozlowska et al, , 2020Gray et al, 2020;Sawchuk et al, 2020). The findings from the current study with children lend support to the proposition that PNES need to be understood more broadly as neural network phenomena (Knyazeva et al, 2011;Barzegaran et al, 2012Barzegaran et al, , 2016Szaflarski and LaFrance, 2018); this shift in functional organization takes place in the context of FIGURE 5 | Scatterplots for correlations between the graph theory metrics and the RMSSD-HRV obtained for EEG beta and gamma bands in children with PNES.…”

Section: Discussionsupporting

confidence: 65%

“…The developmental perspective suggests that intervention needs to be prompt, facilitating the shift back to physiological coherence before the long-term complications of allostatic load, epigenetic programming, and neuroplasticity make recovery less likely. A number of PNES outcome studies have shown that children with shorter illness duration and acute vs. chronic stress have better outcomes (Yadav et al, 2015;Kozlowska et al, 2018b;Sawchuk et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

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Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures

Radmanesh

Jalili

Kozlowska

2020

Front. Hum. Neurosci.

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Objectives: Psychogenic non-epileptic seizures (PNES) have been hypothesized to emerge in the context of neural networks instability. To explore this hypothesis in children, we applied a graph theory approach to examine connectivity in neural networks in the resting-state EEG in 35 children with PNES, 31 children with other functional neurological symptoms (but no PNES), and 75 healthy controls. Methods: The networks were extracted from Laplacian-transformed time series by a coherence connectivity estimation method. Results: Children with PNES (vs. controls) showed widespread changes in network metrics: increased global efficiency (gamma and beta bands), increased local efficiency (gamma band), and increased modularity (gamma and alpha bands). Compared to controls, they also had higher levels of autonomic arousal (e.g., lower heart variability); more anxiety, depression, and stress on the Depression Anxiety and Stress Scales; and more adverse childhood experiences on the Early Life Stress Questionnaire. Increases in network metrics correlated with arousal. Children with other functional neurological symptoms (but no PNES) showed scattered and less pronounced changes in network metrics. Conclusion: The results indicate that children with PNES present with increased activation of neural networks coupled with increased physiological arousal. While this shift in functional organization may confer a short-term adaptive advantage-one that facilitates neural communication and the child's capacity to respond self-protectively in the face of stressful life events-it may also have a significant biological cost. It may predispose the child's neural networks to periods of instability-presenting clinically as PNES-when the neural networks are faced with perturbations in energy flow or with additional demands.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures

Radmanesh

Jalili

Kozlowska

2020

Front. Hum. Neurosci.

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“…In line with broader literature, our two cases of prolonged PNES are associated with significant psychiatric disorders [ 26 ].…”

Section: Discussionsupporting

confidence: 86%

“…The failure to diagnose could also be explained by the following factors: the seizure type strongly resembled that of generalized tonic-clonic epileptic seizures; emergency room treatment was carried out by different treating physicians unaware of the previous clinical history; the lack of ictal video-EEG recordings. Because the diagnosis was incorrect, so was the treatment plan [ 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, there is comorbid depression and the possibility of a suicidal act or attempt [ 16 , 24 ]. However, recent studies report a full or partial remission in about 80% of cases, following a timely diagnosis and a standardized care pathway for PNES [ 26 , 31 ]. Recently Fobian et al (2020) reported that a standardized care pathway for PNES management should be multidisciplinary, including cognitive-bahavioral therapy and family support as frontline treatment and pharmacotherapy for comorbid anxiety and depression.…”

Section: Discussionmentioning

confidence: 99%

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Psychogenic Non-Epileptic Status as Refractory, Generalized Hypertonic Posturing: Report of Two Adolescents

et al. 2020

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Psychogenic non-epileptic seizures (PNES) or dissociative seizures are found under the umbrella headings of functional/dissociative neurological disorders (FND) in psychiatric classifications (DSM-5; ICD-11). PNES are not characterized by any specific ictal or postictal EEG abnormalities. Patients with PNES can present with motor or non-motor symptoms, frequently associated with a change in the level of consciousness. PNES duration is variable, often longer than that of epileptic seizures. Prolonged PNES, sometimes termed PNES status, involve continuous or repetitive events that exceed 30 min. Prolonged PNES are often misdiagnosed as an epileptic event and are often inappropriately treated with high doses of antiseizure drugs. In this report, we describe two adolescent patients who presented with prolonged PNES characterized by generalized hypertonic posturing and low levels of consciousness. Despite multiple presentation to the Emergency department, and multiple normal video-EEG, the patients were misdiagnosed with epilepsy and were inappropriately treated with antiseizure medications. Both patients presented psychiatric comorbidity, consisting of a major depressive disorder, obsessive-compulsive symptoms, social withdrawal, difficulty of social interaction, and anxious-perfectionist personality traits. The episodes of prolonged PNES gradually declined within 18 months in both patients.

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Adolescents' qualitative expressions of functional seizure illness representation

Tanner,

von Gaudecker,

Crowder

et al. 2023

Journal of Adolescence

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IntroductionAdolescents with functional (nonepileptic) seizures experience challenges self‐managing this mental health condition, especially at school where adolescents experience stress, bullying, accusations of faking seizures, and stigma. According to the Common Sense Model of Self‐Regulation, adolescents' self‐management decisions and outcomes may be shaped by their functional seizure illness representation (perceptions or mental depictions formed in response to a health threat). However, current research has only explored adults' functional seizure illness representation; little is known about adolescents. The aim of this study was to explore adolescents' expressions of illness representation characteristics (identity, cause, consequence, controllability/curability, and timeline) when describing their experience attending school with functional seizures.MethodsWe analyzed qualitative data from 10 adolescents (age 12–19 years, 100% female) from the United States with functional seizures. Data collection occurred in 2019 via semistructured interviews about adolescents' school experiences. The theme of illness representation emerged without prompting adolescents to discuss illness representation or its characteristics. This study involved inductive analyses and magnitude coding of adolescents' unsolicited expressions of illness representation.ResultsAll five characteristics of illness representation were mentioned by adolescents; however, not all characteristics were mentioned by all adolescents. Adolescents' expressions of illness representation characteristics resulted in the following descriptive themes: clashing labels and mind‐body façade for identity, stress for cause, gains and losses for consequence, control/lack of control for controllability/curability, and no end of seizures in sight for timeline.ConclusionsAdolescents' expressions of illness representation reveal perceptions considered “threatening” within the Common Sense Model, especially those expressing lack of controllability/curability and condition timelines with no end in sight. The Common Sense Model offers a framework for understanding how these threatening perceptions may impact health and academic outcomes or change with intervention.

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Psychogenic nonepileptic seizures in children—Prospective validation of a clinical care pathway & risk factors for treatment outcome

Cited by 37 publications

References 36 publications

Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures

Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures

Psychogenic Non-Epileptic Status as Refractory, Generalized Hypertonic Posturing: Report of Two Adolescents

Adolescents' qualitative expressions of functional seizure illness representation

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