Nonepileptic seizures after head injury
ABSTRACT To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics.
Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report.
Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor.
Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.
SourceAvailable from: Oleg Semenovich Zaĭtsev09/2011; DOI:10.14412/2074-2711-2011-160
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ABSTRACT: Following a traumatic brain injury (TBI), the brain undergoes numerous electrophysiologic changes. The most common techniques used to evaluate these changes include electroencepalography (EEG) and evoked potentials. In animals, EEGs immediately following TBI can show either diffuse slowing or voltage attenuation, or high voltage spiking. Following a TBI, many animals display evidence of hippocampal excitability and a reduced seizure threshold. Some mice subjected to severe TBI via a fluid percussion injury will eventually develop seizures, which provides a useful potential model for studying the neurophysiology of epileptogenesis. In humans, the EEG changes associated with mild TBI are relatively subtle and may be challenging to distinguish from EEG changes seen in other conditions. Quantitative EEG (QEEG) may enhance the ability to detect post-traumatic electrophysiologic changes following a mild TBI. Some types of evoked potential (EP) and event related potential (ERP) can also be used to detect post-traumatic changes following a mild TBI. Continuous EEG monitoring (cEEG) following moderate and severe TBI is useful in detecting the presence of seizures and status epilepticus acutely following an injury, although some seizures may only be detectable using intracranial monitoring. CEEG can also be helpful for assessing prognosis after moderate or severe TBI. EPs, particularly somatosensory evoked potentials, can also be useful in assessing prognosis following severe TBI. The role for newer technologies such as magnetoencephalography and bispectral analysis (BIS) in the evaluation of patients with TBI remains unclear. © 2015 Elsevier B.V. All rights reserved.Handbook of Clinical Neurology 01/2015; 127:319-39. DOI:10.1016/B978-0-444-52892-6.00021-0
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ABSTRACT: Background Previous studies have identified numerous biological, psychological and social characteristics of persons with psychogenic non-epileptic seizures (PNES) however the strength of many of these factors have not been evaluated to determine which are predictive of the diagnosis compared to those that may only be stereotypes with limited clinical utility. Method A retrospective chart review of persons admitted to our epilepsy monitoring unit over a six year period was conducted to examine predictors of a video-EEG confirmed PNES diagnosis. Results A total of 689 patients had events leading to a diagnosis, 47% (n = 324) with PNES only, 12% (n = 84) with PNES & Epilepsy and 41% (n = 281) with Epilepsy only. Five biological predictors of a PNES only diagnosis were found; number of years with events (OR = 1.10), history of head injury (OR = 1.91), asthma (OR = 2.94), gastro-esophageal reflux disease (OR = 1.72) and pain (OR = 2.25). One psychological predictor; anxiety (OR = 1.72) and two social predictors; being married (OR = 1.81) and history of physical/sexual abuse (OR = 3.35). Two significant biological predictors of a PNES & Epilepsy diagnosis were found; migraine (OR = 1.83) and gastro-esophageal reflux disease (OR = 2.17). Conclusions Our findings support the importance of considering the biopsychosocial model for the diagnosis and treatment of PNES or PNES with concomitant epilepsy.Epilepsy Research 09/2014; 108(9). DOI:10.1016/j.eplepsyres.2014.09.003 · 2.19 Impact Factor