Nonepileptic Seizures After Head Injury

Department of Neurology, New York University School of Medicine, New York, USA.
Epilepsia (Impact Factor: 4.57). 10/1998; 39(9):978-82. DOI: 10.1111/j.1528-1157.1998.tb01447.x
Source: PubMed


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.

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Available from: Romergryko G Geocadin, Nov 21, 2014
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    • "The vulnerability of the brain to behavioral dysfunction after neurologic insult is often cited as a causal pathogenesis model [27]. Many studies correlate the probability of developing seizures with severity of the head injury suggesting that PNES onset is more common after mild THI and epileptic seizures after more serious THI [28, 45–47]. "
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    ABSTRACT: Psychogenic nonepileptic seizures (PNESs) are diagnosed when disruptive changes in behaviour, thinking, or emotion resemble epileptic seizures (ESs), but no paroxysmal discharges are seen on electroencephalogram (EEG) and do not originate from another medical illness. The gold standard for PNES diagnosis is video electroencephalogram (Video-EEG). PNESs are defined by modern psychiatry as conversion and dissociative disorders but these disorders may coexist with many others psychiatric disorders, including depression, posttraumatic stress disorder, and personality disorders. It is well known that epileptic seizures are a frequent and well-studied complication of traumatic head injury (THI). However, THI may also generate psychic symptoms including PNES. In this paper we describe a patient who developed PNES after THI in a bus accident and received a diagnosis of refractory epilepsy for 24 years until she underwent Video-EEG.
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    • "The phenomenology of NES is well defined, with systematic assessments of diagnostic comorbidities and psychological testing[1,2]. Studies have informed us of risk factors for NES (e.g., sexual or physical abuse, work-related injury)[3,4]and good prognostic features for NES resolution (e.g., female, independent lifestyle, short-duration of NES)5678(see Table 1). Negative prognostic factors include longer duration of NES, comorbid neurologic and/or psychiatric disease, and pending litigation, among others. "
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    ABSTRACT: Studies on nonepileptic seizures (NES) provide dichotomous data sets: extensive observational findings, but a paucity of controlled treatment data. Psychosocial stressors, whose full impact may lie outside a patient's awareness, often underlie NES. These stressors, along with patient's learned patterns of coping, may bring forth or potentiate comorbid psychiatric disorders. Patients with NES often have dysfunction in emotion regulation and family dynamics, as well as unemployment/disability. High percentages of comorbid disorders such as major depressive disorder, post-traumatic stress disorder, and cluster B personality with impulsivity (all disorders associated with serotonin system function) also exist in the NES population. The preliminary observational evidence suggests that specific psychotherapies and pharmacotherapy directed at comorbid conditions may be the most effective treatment for NES.
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