Can semiology predict psychogenic nonepileptic seizures? a prospective study

Syed, Tanvir U.; LaFrance, W. Curt; Kahriman, Emine; Hasan, Saba N.; Rajasekaran, Vijayalakshmi; Gulati, Deepak; Borad, Samip; Shahid, Ayaz; Fernandez-Baca, Guadalupe; Garcia, Naiara; Pawlowski, Matthias; Loddenkemper, Tobias; Amina, Shahram; Koubeissi, Mohamad Z.

doi:10.1002/ana.22345

Cited by 204 publications

(198 citation statements)

References 18 publications

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“…16 In PNES, the eyes are also usually closed during apparent TLOC. [16][17][18] Besides eye closure, the distinction from VVS can also be made by measuring the duration of the apparent TLOC, which is longer in PPS. In our series, patients with syncope never remained unresponsive for more than 1 minute, whereas PPS could last up to 14 minutes.…”

mentioning

confidence: 99%

The semiology of tilt-induced psychogenic pseudosyncope

Tannemaat

Niekerk²,

Reijntjes³

et al. 2013

Neurology

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Objectives: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. Methods:We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS).Results: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p , 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p , 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p , 0.01), but jerking movements occurred more frequently in VVS (p , 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p , 0.0001).Conclusions: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis. Neurology â 2013;81:752-758 GLOSSARY BP 5 blood pressure; DBP 5 diastolic blood pressure; HR 5 heart rate; PNES 5 psychogenic nonepileptic seizure; PPS 5 psychogenic pseudosyncope; SBP 5 systolic blood pressure; sMAP 5 smoothed mean arterial pressure; TLOC 5 transient loss of consciousness; VVS 5 vasovagal syncope.Transient loss of consciousness (TLOC) is the reason for approximately 3% of all emergency department visits. 1 The most common major causes of apparent TLOC are syncope, epileptic seizures, and psychogenic events. [2][3][4] The pathophysiology of psychogenic and somatic apparent TLOC is different, but they can be difficult to distinguish clinically.Psychogenic apparent TLOC bears various labels. When episodes involve pronounced movements, they resemble epilepsy and are frequently labeled psychogenic nonepileptic seizures (PNES). 5 Episodes without pronounced movements resemble syncope and are generally labeled psychogenic pseudosyncope (PPS). 3 PNES and PPS are probably manifestations of the same underlying psychiatric disorder, but their different presentation has important consequences for diagnosis. PNES is relatively well known, with a reported prevalence of up to 30% in patients in epilepsy clinics. 5 In contrast, PPS is rarely mentioned in the literature on syncope, and the reported prevalence of PPS in those analyzed for presumed syncope is lower, ranging from 0% to 8%. [6][7][8]

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mentioning

confidence: 99%

The semiology of tilt-induced psychogenic pseudosyncope

Tannemaat

Niekerk²,

Reijntjes³

et al. 2013

Neurology

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“…Farkındalığın korunması, göz kırpıştırma ve nöbet şiddetinin seyirci tarafından etkilenebilir olması NEPN lehine; ani başlangıç, nöbet başlangıcında gözlerde açılma-genişleme, postiktal konfüzyon ve uyku ise epileptik nöbetler lehine en güçlü semiyolojik bulgular olarak belirtilmiştir. [10] İndüksiyon ile NEPN izlenen 39 hastamızın 25'inde enjeksiyon sonrası telkinle nöbetin şiddetinin arttığı, 15 hastada ise nöbetin sadece telkinle sonuçlandığı dikkat çekmiştir. Ayrıca 27 hastanın nöbet sırasında gözlerinin kapalı olduğu, 20 hastanın nöbet sırasında yanıtsız olduğu ve 19 hastada cevaplılığın korunduğu izlendi.…”

Section: Discussionunclassified

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

Genç¹,

Yılmaz²,

Gömceli³

et al. 2013

Epilepsi

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SummaryObjectives: Psychogenic non-epileptic seizures (PNES) are reported in 10-30% of patients who are diagnosed as having refractory seizures referred to epilepsy centers. Many epilepsy centers use some sort of provocative techniques to aid in the diagnosis of PNES. In this study we aimed to determine the value of diagnostic effects of seizure induction methods. Methods: We analyzed retrospectively 66 patients who were suspected as PNES and referred by a clinician to our outpatient EEG laboratory between July 2011-January 2013. Intravenous saline was administered for seizure induction which is a routine seizure induction method used in our laboratory. Follow-up data were gathered by telephone interviews or from patient charts. Results: PNES were observed in 39 (59.1%) of 66 patients. Twenty-eight patients were thought to have pure PNES. After 3-17 months (mean: 6.9 months) of induction, 27 of 39 patients were either seizure-free or had significiant reduction in seizure frequency. Conclusion: In this study we conclude that; provocative techniques are useful, cheap and accessible for the diagnosis of PNES. If applied delicately, they may also provide a positive impact on the patient's self-recognition, and also, the prognostic consequences of the condition.Key words: Epilepsy; induction; psychogenic non-epileptic seizure. ÖzetAmaç: Epilepsi merkezlerine dirençli epilepsi tanısı ile gönderilen hastaların yaklaşık %10-30'unun nonepileptik psikojen nöbet (NEPN) tanısı aldığı bildirilmektedir. Birçok epilepsi merkezinde NEPN tanısına yardımcı olmak için bazı provokatif yöntemler kullanılmaktadır. Bu çalışmada nöbet indüksiyonun NEPN tanısı ve prognozu üzerindeki etkisini araştırmayı amaçladık. Sonuç: Bu çalışmada, provakatif yöntemlerin kullanışlı, ucuz ve hatta hastanın tanıyı kabullenmesinde etkisi olabileceği sonucuna vardık. Tanısını kabullenen hastalarda prognoz daha iyi olup, iyi iletişim bu noktada önemlidir. Gereç ve

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“…Likewise, semiotics also can be used as a screening tool. Studies have shown that semiological differences between PNES and ES are reliable when performed by experts but, unfortunately, they are not as reliable, when obtained from relatives and lay persons [9].…”

Section: Diagnosismentioning

confidence: 99%

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

Alsaadi¹,

Shahrour²

2014

Health

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Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.

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Can semiology predict psychogenic nonepileptic seizures? a prospective study

Abstract: We identified 6 semiological signs that reliably distinguish PNES and ES, and found that eyewitness reports of these signs are unreliable. We offer suggestions to improve the accuracy of eyewitness reports.

Cited by 204 publications

References 18 publications

The semiology of tilt-induced psychogenic pseudosyncope

The semiology of tilt-induced psychogenic pseudosyncope

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

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