Working toward the ideal situation: A pragmatic Epi-Psy approach for the diagnosis and treatment of psychogenic nonepileptic seizures

Hingray, Coraline; Ertan, Deniz; El‐Hage, Wissam; Maillard, Louis; Vignal, Jean–Pierre

doi:10.1016/j.yebeh.2021.108000

Cited by 8 publications

(1 citation statement)

References 19 publications

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“…Recent texts have emphasized the importance of “positive” diagnostic criteria, emphasizing what characterizes FDS disorders themselves rather than what these disorders lack in comparison to epilepsy. 16 The identification of semiological feature clusters has been a major advance for this positive diagnostic approach. 15 , 17 , 18 , 19 One study established five subtypes of FDS based on their clinical signs.…”

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confidence: 99%

Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles

et al. 2022

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Objective: Current concepts highlight the neurological and psychological heterogeneity of functional/dissociative seizures (FDS). However, it remains uncertain whether it is possible to distinguish between a limited number of subtypes of FDS disorders. We aimed to identify profiles of distinct FDS subtypes by cluster analysis of a multidimensional dataset without any a priori hypothesis. Methods:We conducted an exploratory, prospective multicenter study of 169 patients with FDS. We collected biographical, trauma (childhood and adulthood traumatic experiences), semiological (seizure characteristics), and psychopathological data (psychiatric comorbidities, dissociation, and alexithymia) through psychiatric interviews and standardized scales. Clusters were identified by the Partitioning Around Medoids method. The similarity of patients was computed using Gower distance. The clusters were compared using analysis of variance, chi-squared, or Fisher exact tests.Results: Three patient clusters were identified in this exploratory, hypothesisgenerating study and named on the basis of their most prominent characteristics: 1. A "No/Single Trauma" group (31.4%), with more male patients, intellectual disabilities, and nonhyperkinetic seizures, and a low level of psychopathology; 2. A "Cumulative Lifetime Traumas" group (42.6%), with clear female predominance, hyperkinetic seizures, relatively common comorbid epilepsy, and a high level of psychopathology; and 3. A "Childhood Traumas" group (26%), commonly with comorbid epilepsy, history of childhood sexual abuse (75%), and posttraumatic stress disorder, but also with a high level of anxiety and dissociation.Significance: Although our cluster analysis was undertaken without any a priori hypothesis, the nature of the trauma history emerged as the most important differentiator between three common FDS disorder subtypes. This subdifferentiation of FDS disorders may facilitate the development of more specific therapeutic programs for each patient profile.

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