Taking Control of Your Seizures

Reiter, Joel; Andrews, Donna; Reiter, Charlotte; LaFrance, W. Curt

doi:10.1093/med:psych/9780199335015.001.0001

Cited by 44 publications

(33 citation statements)

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“…The results of a fully powered trial of cognitive behavioral therapy (CBT) for PNES currently being conducted in the United Kingdom and the availability of a manualized therapy for PNES should encourage more providers to facilitate access to this treatment modality. 29,30 Only 5% thought antidepressants to be the best option, reflecting the limited evidence for the effectiveness of medications for PNES. 31 Of note, 40% of Japanese respondents thought that "environmental control" was most effective.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Hingray¹,

et al. 2017

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SummaryObjective: Studies from a small number of countries suggest that patients with psychogenic nonepileptic seizures (PNES) have limited access to diagnostic and treatment services. The PNES Task Force of the International League Against Epilepsy (ILAE) carried out 2 surveys to explore the diagnosis and treatment of PNES around the world. Methods: A short survey (8 questions) was sent to all 114 chapters of the ILAE.A longer survey (36 questions) was completed by healthcare professionals who see patients with seizures. Questions were separated into 5 sections: professional role, diagnostic methods, management, etiology, and access to health care. Results: Responses were received from 63 different countries. The short survey was completed by 48 ILAE chapters, and the long survey by 1098 health professionals from 28 countries. PNES were recognized as a diagnostic and therapeutic problem in all countries. Trauma and mental health issues were most commonly recognized as etiologic factors. There was a clear relationship between income and access to diagnostic tests and expertise. Psychological therapy was most commonly considered the treatment of choice. Although financial difficulties were the most commonly reported problem with service access in low-income countries, in

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Hingray¹,

et al. 2017

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“…This multi-center study helps to further characterize these two patient populations, highlighting important differences that could be targeted during psychological therapy -- addressing not only Axis I disorders but also underlying personality factors. The differing psychological profiles may inform differing treatment approaches, such as psychological therapies for PNES (60, 61) and physiotherapy (with or without psychotherapy) for PMD. (62, 63) Greater levels of Neuroticism in patients with PNES and lower levels of Conscientiousness than in those with PMD, more anxiety disorders in PNES, along with differences in the type of trauma and timing in relation to critical developmental periods, may provide insight into why the physical manifestations of their illnesses are different.…”

Section: Discussionmentioning

confidence: 99%

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

Ekanayake

Kranick

LaFaver

et al. 2017

Journal of Psychosomatic Research

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Objective Psychogenic movement disorder (PMD) and psychogenic non-epileptic seizures (PNES) are two subtypes of conversion disorder (CD). In this case-control study, we asked whether these subtypes varied as a function of personality and history of childhood abuse, using the NEO Personality Inventory Revised (NEO PI-R). Methods Fifty-nine patients with PMD from the Human Motor Control Section Clinic at the National Institutes of Health, 43 patients with PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Division, and 26 healthy volunteers (HC) received a battery of neurological, psychiatric and psychological assessments. Results One-way ANOVA between the three groups indicated significant differences in overall domains of Neuroticism (p=0.001) and Conscientiousness (p=0.009): Patients with PNES reported significantly greater levels of Neuroticism (p=0.002) and lower levels of Conscientiousness (p=0.023) than patients with PMD. Levels of Neuroticism remained significantly higher in both PMD and PNES than HC following correction for multiple comparisons. Patients with PNES reported greater levels of depressive and anxiety symptoms, overall psychopathology, greater history of sexual abuse, greater levels of alexithymia, higher levels of dissociative symptoms, and an earlier age at which they experienced their most distressing traumatic event than patients with PMD. Conclusions These findings suggest that personality traits, type of abuse and age of onset of trauma varies as a function of CD subtype. Patients with PNES rated greater Neuroticism and lower Conscientiousness than patients with PMD. These differing psychological profiles may inform differing treatment approaches such as psychological therapies for PNES and physiotherapy (with/without psychotherapy) for PMD.

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“…The inclusion of organic neurological disorders or other psychiatric disorders (e.g., dissociative disorders or anxiety disorders) as a control could allow the identification of disease-specific characteristics. One intervention is being used for both ES and PNES 171 and can address systemic and somatoform disorders. Because most of the neurophysiological studies reviewed here are cross-sectional in nature, whether these observations are state or trait related is not clear; studies should begin to address whether a finding is a state-(e.g., secondary to the symptom or lack of use) or trait-related effect (e.g., predictor or causal of FND).…”

Section: Summary and Recommendationsmentioning

confidence: 99%

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Voon¹,

Cavanna²,

Coburn³

et al. 2016

JNP

131

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Much is known regarding the physical characteristics, comorbid symptoms, psychological makeup, and neuropsychological performance of patients with functional neurological disorders (FNDs)/conversion disorders. Gross neurostructural deficits do not account for the patients' deficits or symptoms. This review describes the literature focusing on potential neurobiological (i.e. functional neuroanatomic/neurophysiological) findings among individuals with FND, examining neuroimaging and neurophysiological studies of patients with the various forms of motor and sensory FND. In summary, neural networks and neurophysiologic mechanisms may mediate "functional" symptoms, reflecting neurobiological and intrapsychic processes. J Neuropsychiatry Clin Neurosci 2016; 28:168-190; doi: 10.1176/appi.neuropsych.14090217 Functional neurological disorders (FNDs; or psychogenic neurological symptoms), also known as conversion disorder, are a classic neuropsychiatric disorder, existing in the border between neurology and psychiatry. Unexplained neurological symptoms are common, occurring in up to one-third of patients in neurological outpatient clinics.1 Relative to disorders such as Parkinson's disease, FND is associated with similar levels of disability and physical quality of life with poorer mental health quality of life. 2 The prognosis is poor, with a recent reviewshowing that up to 40% of patients with FND report similar or worse outcomes at 7-year follow-up. 3 Given the frequency, consequences, prognosis, and burden, FND has been called a "crisis for neurology." 4 Despite this, FND is poorly understood. In the last decade, an increasing number of studies have focused on underlying neurobiological mechanisms. FND is defined in DSM-5 as the presence of one or more symptoms of altered voluntary or sensory function, with clinical findings providing evidence of incompatibility between the symptom and recognized neurological or medical conditions.5 The DSM-5 diagnosis differs from that of the DSM-IV diagnosis of conversion disorder by adding the criterion of incorporating physical diagnostic features and by relegating to the accompanying text the criteria requiring (a) an association with psychological stressors and (b) the exclusion of malingering or factitious disorder to make the diagnosis. DSM-5 FND diagnosis criteria now allow for potential greater interrater reliability, making them appropriate for research studies and greater compatibility with specialtyspecific diagnoses including psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES). 6The putative biopsychosocial mechanisms underlying FND are complex and have been extensively reviewed.7 Our review focuses on the physiological mechanisms that may underlie FND and does not specifically focus on the extensive literature on the antecedents of early childhood experiences and temperament (Figure 1). At the outset, regarding the proposed model, we acknowledge that predisposing factors for functional neurological symptoms are not limited to genetics, te...

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Taking Control of Your Seizures

Cited by 44 publications

References 0 publications

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

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