Psychogenic nonepileptic seizures: A current overview

Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montréal, Québec, Canada Department of Psychiatry, McGill University, Montréal, Québec, Canada Department of Psychiatry, Jewish General Hospital, Montréal, Québec, Canada.
Epilepsia (Impact Factor: 4.57). 08/2012; 53(10):1679-89. DOI: 10.1111/j.1528-1167.2012.03606.x
Source: PubMed


Psychogenic nonepileptic seizures (PNES) resemble epilepsy, but no pathophysiological explanation has been established. Although there have been recent advances in PNES research and various hypotheses as to the psychopathology, no theory has achieved general acceptance. In this overview of selected literature on PNES, we highlight the often contradictory findings that underline the challenges that confront both practitioner and researcher. We first provide a synopsis of the history, diagnosis, treatment, and outcomes, as well as patient characteristics of PNES and the relevance of communication in the clinical context. In the subsequent sections we discuss recent research that may advance the understanding and diagnosis of this disorder. These themes include the use of qualitative methods as a viable research option, the application of nonlinear methods to analyze heterogeneous observations during diagnosis, recent advances in neuroimaging of PNES, and the development of international databases.

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    • "These results could be of potential importance in conversion disorders like PNES, where patients appeared to express dissociative distress about reported traumatic experiences [6]. For example, dissociative amnesia has been regularly documented in all groups of severely traumatized individuals with PTSD, and has also been postulated in PNES [4] [7]. In addition, OFC lesions are associated with abnormalities in a wide range of affective behaviors including depressed mood, anger, affective instability, irritability, and anxiety symptoms, frequently observed in manic depressive disorder patients and PTSD subjects [56]. "
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    ABSTRACT: Psychogenic nonepileptic seizures (PNES) often mimic epileptic seizures and occur in both people with and without epilepsy. Pathophysiology of conversion disorders such as PNES remains unclear though significant psychological, psychiatric and environmental factors have been correlated with a diagnosis of PNES. Many clinical signs that have been considered typical for PNES can also be found in frontal epileptic seizures. Given the resemblance of seizures and affective changes from Orbitofrontal cortical dysfunction to PNES like events and correlation of psychological and environmental stress to conversion disorders such as PNES, we propose a two-factor model for the pathogenesis of PNES. We hypothesize that patients with PNES could have a higher likelihood of having both Orbitofrontal cortical dysfunction and a history of psychological stressors rather than a higher likelihood of having either one or the other. We further explore the implications of this two-factor model, including possible therapies. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Medical Hypotheses 01/2015; 84(4). DOI:10.1016/j.mehy.2015.01.034 · 1.07 Impact Factor
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    • "These studies revealed that PNES is also correlated with the altered interactions among multiple brain areas and that the network information may be a potential marker for PNES differentiation. The established PNES early diagnostic approaches require detailed information, such as semiology, self-assessed scores or long-recorded video-EEGs [2], [5]–[7], [13], [14], [17], [23]–[25], and the collection of this information is very time consuming. Moreover, the experience of the clinician leads to the use of different criteria to define and select the necessary information, ultimately influencing the diagnosis of PNES. "
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    ABSTRACT: Discriminating psychogenic nonepileptic seizures (PNES) from epilepsy is challenging, and a reliable and automatic classification remains elusive. In this study, we develop an approach for discriminating between PNES and epilepsy using the common spatial pattern extracted from the brain network topology (SPN). The study reveals that 92% accuracy, 100% sensitivity, and 80% specificity were reached for the classification between PNES and focal epilepsy. The newly developed SPN of resting EEG may be a promising tool to mine implicit information that can be used to differentiate PNES from epilepsy.
    IEEE transactions on bio-medical engineering 06/2014; 61(6):1747-55. DOI:10.1109/TBME.2014.2305159 · 2.35 Impact Factor
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    ABSTRACT: : Psychogenic nonepileptic seizures (PNES) are commonly encountered problem in neurological practice and usually are accompanied by other psychiatric comorbidities. Despite its prevalence and profound impact on patients and families, there have been few trials addressing treatment. Cognitive behavioral therapy may be effective but the role of pharmacologic therapy remains unclear. : To critically evaluate evidence that PNES frequency may be reduced by treatment with selective serotonin reuptake inhibitors. : The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, epileptology, and psychiatry content experts. : A pilot randomized control clinical trial was selected for critical appraisal. Thirty-eight PNES patients were randomized to flexible-dose sertraline (target dose, 200 mg/d) or placebo. Only 68% of patients contributed data to the primary analysis and baseline PNES frequency was notably dissimilar. Twelve-week seizure frequency rates, as compared with baseline, were 45% lower in the sertraline group (P=0.03) but unchanged in the placebo group (8% increase; P=0.78). After adjustment for baseline differences, between-treatment group comparison revealed a trend toward lower event frequency in the sertraline group (risk ratio 0.51; 95% confidence interval, 0.25-1.05; P=0.29). Psychosocial and quality of life measures did not differ between treatment groups. : There is insufficient evidence to recommend routine treatment with sertraline to reduce PNES event frequency but these pilot data suggest a possible benefit worthy of further exploration.
    The Neurologist 01/2013; 19(1):30-3. DOI:10.1097/NRL.0b013e31827c6bfd · 1.16 Impact Factor
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