Psychogenic nonepileptic seizures that remit when the diagnosis is given: Just good luck?

Duncan, Roderick; Horwood, L. John; Razvi, Saif; Mulhern, Sharon

doi:10.1016/j.yebeh.2019.106667

Cited by 10 publications

(13 citation statements)

References 10 publications

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“…Therefore, the interventions and any information or explanation received during inpatient admission did not reduce future acute healthcare utilization in our cohort. It is known that acute healthcare demand can respond sharply to appropriate explanation of the diagnosis of functional seizures [13,14], but this does not appear to have extrapolated to our cohort of patients with mixed FND, a finding consistent with behaviours in similar populations [15,16]. Lack of psychological support and intervention is a potential cause, even if the therapeutic effect of psychological interventions remains poorly understood (see below).…”

Section: Discussionmentioning

confidence: 78%

Functional neurological disorders presenting as emergencies to secondary care

Beharry

Palmer

et al. 2021

Euro J of Neurology

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Background Functional neurological disorders (FND) represent a significant proportion of presentations to outpatient adult neurology services. There is little information relating to patients presenting to acute inpatient care. Methods We identified patients presenting as acute admissions with FND to Christchurch Hospital, Christchurch, New Zealand, from 2016 to 2018. We analyzed relevant demographic and clinical data from electronic records and measured incidence of presentation to secondary care and healthcare utilization. Results One hundred sixty‐two patients presented on 173 occasions with FND, representing 9% of all admissions to the neurology service during the 3‐year study period. The mean age was 40 (SD 17) years, 111 (69%) patients were female and the median length of stay was 3 (IQR 2–4) days. A total of 92 computed tomography brain scans, 77 magnetic resonance imaging brain scans and 42 electroencephalograms were carried out. On 22 (13%) occasions, patients were referred for outpatient psychological therapy. In the 3 years prior to each patient's last presentation in the study period, these 162 patients had a total of 671 presentations to the emergency department. Healthcare demand did not decrease after the index admission. The rate of acute inpatient admission for FND was 10 per 100,000 per year for the total Christchurch Hospital catchment, 6/100,000/year in rural areas, and 11/100,000/year in urban areas. Conclusion FND represented almost 1 in 10 acute neurology admissions with significant inpatient healthcare resource utilization.

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Section: Discussionmentioning

confidence: 78%

Functional neurological disorders presenting as emergencies to secondary care

Beharry

Palmer

et al. 2021

Euro J of Neurology

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“…In addition, for treating PNES, psychotherapy is the first-line treatment. 67 , 69 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, for treating PNES, psychotherapy is the first-line treatment. 67,69 In the last decades psychotherapeutic interventions have been proposed from different theoretical models (cognitive behavioral therapy, psychoanalysis, interpersonal therapy, etc.). However, more controlled studies are needed to increase empirical support for these treatments.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a brief and clear communication of the diagnosis can remit the symptoms in a certain proportion of patients. 69 It is important that the communication of the diagnosis refers to an adequate, clear and understandable explanation for the patient and relatives, and ideally, both neurologist and mental health professionals should participate. 4 , 8 , 28 In sum, how the diagnosis is communicated is very important.…”

Section: Methodsmentioning

confidence: 99%

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Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders

Lanzillotti

Sarudiansky

Lombardi

et al. 2021

NDT

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Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES.

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“…In patients with seizure type FND, delivery of the diagnosis has been shown in a small minority of patients to result in cessation of seizures or decreased seizure frequency 184185186187188189. For example, in 54 patients with seizure type FND, 27% achieved seizure remission in the week following communication of the diagnosis 185.…”

Section: Treatmentsmentioning

confidence: 99%

Diagnosis and management of functional neurological disorder

Aybek

Perez

2022

BMJ

115

107

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Functional neurological disorder (FND), previously regarded as a diagnosis of exclusion, is now a rule-in diagnosis with available treatments. This represents a major step toward destigmatizing the disorder, which was often doubted and deemed untreatable. FND is prevalent, generally affecting young and middle aged adults, and can cause severe disability in some individuals. An early diagnosis, with subsequent access to evidence based rehabilitative and/or psychological treatments, can promote recovery—albeit not all patients respond to currently available treatments. This review presents the latest advances in the use of validated rule-in examination signs to guide diagnosis, and the range of therapeutic approaches available to care for patients with FND. The article focuses on the two most frequently identified subtypes of FND: motor (weakness and/or movement disorders) and seizure type symptoms. Twenty two studies on motor and 27 studies on seizure type symptoms report high specificities of clinical signs (64-100%), and individual signs are reviewed. Rehabilitative interventions (physical and occupational therapy) are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence based treatment across FND subtypes. The literature to date highlights heterogeneity in responses to treatment, underscoring that more research is needed to individualize treatments and develop novel interventions.

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Psychogenic nonepileptic seizures that remit when the diagnosis is given: Just good luck?

Cited by 10 publications

References 10 publications

Functional neurological disorders presenting as emergencies to secondary care

Functional neurological disorders presenting as emergencies to secondary care

Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders

Diagnosis and management of functional neurological disorder

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