Psychological Treatment of Nonepileptic Events

Rusch, Mark D.; Morris, George L.; Allen, Linda; Lathrop, LeeAnn

doi:10.1006/ebeh.2001.0180

Cited by 78 publications

(49 citation statements)

References 15 publications

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“…It is notable that a physical precipitating event is commonly reported close to the onset of FMSS; and we believe that this provides an important explanation as to why particular FMSS develop. For example, viral infections commonly precede chronic fatigue syndrome or neurasthenia (Wessely et al ., 1998), somatic symptoms associated with panic attacks are commonly reported prior to onset of non-epileptic seizures (Rusch et al ., 2001) and physical injury to a limb (causing pain and immobilization) is commonly reported at the onset of fixed abnormal limb postures or limb paralysis (Schrag et al ., 2004; Stone et al ., 2009 b , 2012 a ). …”

Section: A Unified Theory For Functional Motor and Sensory Symptomsmentioning

confidence: 99%

A Bayesian account of 'hysteria'

Edwards

Adams

Brown

et al. 2012

Brain

633

586

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This article provides a neurobiological account of symptoms that have been called ‘hysterical’, ‘psychogenic’ or ‘medically unexplained’, which we will call functional motor and sensory symptoms. We use a neurobiologically informed model of hierarchical Bayesian inference in the brain to explain functional motor and sensory symptoms in terms of perception and action arising from inference based on prior beliefs and sensory information. This explanation exploits the key balance between prior beliefs and sensory evidence that is mediated by (body focused) attention, symptom expectations, physical and emotional experiences and beliefs about illness. Crucially, this furnishes an explanation at three different levels: (i) underlying neuromodulatory (synaptic) mechanisms; (ii) cognitive and experiential processes (attention and attribution of agency); and (iii) formal computations that underlie perceptual inference (representation of uncertainty or precision). Our explanation involves primary and secondary failures of inference; the primary failure is the (autonomous) emergence of a percept or belief that is held with undue certainty (precision) following top-down attentional modulation of synaptic gain. This belief can constitute a sensory percept (or its absence) or induce movement (or its absence). The secondary failure of inference is when the ensuing percept (and any somatosensory consequences) is falsely inferred to be a symptom to explain why its content was not predicted by the source of attentional modulation. This account accommodates several fundamental observations about functional motor and sensory symptoms, including: (i) their induction and maintenance by attention; (ii) their modification by expectation, prior experience and cultural beliefs and (iii) their involuntary and symptomatic nature.

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Section: A Unified Theory For Functional Motor and Sensory Symptomsmentioning

confidence: 99%

A Bayesian account of 'hysteria'

Edwards

Adams

Brown

et al. 2012

Brain

633

586

View full text Add to dashboard Cite

show abstract

“…Outcome measures that may be more sensitive to postintervention short-term change (i.e., weeks/months) may include (but are not limited to) seizure frequency, mood status, medical resource utilization, anxiety symptoms, self-report of somatic complaints, and reduced avoidance behaviors. Other outcome measures that may not be sensitive to change until a longer postintervention interval has elapsed include change in vocational status, medical disability status, or dynamic relationships between patient and therapist [44].…”

Section: What Are the Preferred Characteristics Of A Given Outcome Mementioning

confidence: 99%

“…Finally, we discussed the possibility of patients crossing over into the CBT or pharmacological arm after the 4-month intervention was completed. Another possibility is tailored intervention, perhaps based on specific diagnostic comorbidities in NES (see Rusch [44]). …”

Section: Nes Treatment Trial Subgroup Summarymentioning

confidence: 99%

Nonepileptic seizures treatment workshop summary

LaFrance

Alper

Babcock

et al. 2006

Epilepsy & Behavior

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In May 2005, an international, interdisciplinary group of researchers gathered in Bethesda, MD, USA, for a workshop to discuss the development of treatments for patients with nonepileptic seizures (NES). Specific subgroup topics that were covered included: pediatric NES; presenting the diagnosis of NES, outcome measures for NES trials; classification of NES subtypes; and pharmacological treatment approaches and psychotherapies. The intent was to develop specific research strategies that can be expanded to involve a large segment of the epilepsy and psychiatric treatment communities. Various projects have resulted from the workshop, including the initial development of a prospective randomized clinical trial for NES.

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“…31 Patients who have had nonepileptic seizures for less than 12 months required fewer treatment sessions to reach cessation of events than those who had their events for more than a year. 32 A number of factors could account for NES diagnosis to treatment delay. Patients may not accept the diagnosis, moving from a "neurological problem to a psychiatric one."…”

Section: Discussionmentioning

confidence: 99%

Methodological Issues in Conducting Treatment Trials for Psychological Nonepileptic Seizures

LaFrance

Blum²,

Miller³

et al. 2007

JNP

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A randomized, placebo-controlled trial has yet to be completed in patients with psychological nonepileptic seizures (NES). Treatment publications for NES are limited to class III trials and class IV reports. Little is written on the methodology of treatment trials in NES. The authors describe the procedures and limitations of such a trial to inform future NES treatment trials, based on their prospective, open-label pharmacological, feasibility trial. The authors review the recruitment, enrollment, completion of surveys, compliance, and follow-up of patients with NES. The majority of patients who enrolled, readily completed surveys and took the medication during the trial. Twelve patients were screened, eight enrolled, and six completed the trial. The authors discuss the use of outcomes and the various symptoms scales in the trial. A comprehensive neuropsychiatric initial assessment and assessing cognitive, emotional, behavioral, and psychosocial measures are important for monitoring the outcomes in NES treatment RCTs.Patients with psychological nonepileptic seizures are often severely disabled, refractory to treatment, and frequently are encountered in neurology, psychiatry, and emergency departments. Nonepileptic seizures (NES), also referred to as pseudoseizures, are paroxysmal behaviors which have psychological comorbidities and are unresponsive to treatment with antiepileptic drugs. The phenomenology of NES is well delineated, including a preliminary understanding of risk factors and prognostic features. 1 A number of studies exist on the diagnosis of NES, ictal semiology, comorbid psychiatric diagnoses, and neurological and neuropsychological characteristics of patients with NES. To date, no double-blinded, randomized, placebo-controlled trial has been completed for patients diagnosed with NES.Given the paucity of systematic treatment trials for NES, much less is known about treatments of NES. A review of the literature reveals that only class III and IV studies are available, and no effective treatments have been developed. 2 Patients with NES present unique challenges, given the overlap of neurological and psychiatric presentations. The number of papers in journals addressing clinical trial methodology in individual neurological or psychiatric disorders is limited. [3][4][5] The few present do not adequately address when combined neuropsychiatric issues are present in a single trial. The purpose of this report is to describe Address correspondence to Dr. LaFrance, Rhode Island Hospital, 593 Eddy Street, Potter 3, Neuropsychiatry, Providence, RI 02903; William_LaFrance_Jr@Brown.edu (e-mail). Portions of this paper were presented at a poster session at the NINDS/American Neurological Association Symposium, in Toronto, Ontario, Canada, October 2, 2004. Patients with NES often have comorbid psychiatric conditions, such as major depressive disorder and anxiety disorders, including PTSD, or symptoms of depression, anxiety, and impulsivity seen in characterological disorders. 6 Mood, anxiety, and impulsi...

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Psychological Treatment of Nonepileptic Events

Cited by 78 publications

References 15 publications

A Bayesian account of 'hysteria'

A Bayesian account of 'hysteria'

Nonepileptic seizures treatment workshop summary

Methodological Issues in Conducting Treatment Trials for Psychological Nonepileptic Seizures

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