Clinical Characteristics and Outcome in Patients With Psychogenic Nonepileptic Seizures

Jones, Simon; O’Brien, Terence J.; Adams, Sophia J.; Mocellin, Ramon; Kilpatrick, Christine; Yerra, Raju; Lloyd, John; Velakoulis, Dennis

doi:10.1097/psy.0b013e3181d96550

Cited by 85 publications

(87 citation statements)

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“…Firstly, the commonly lengthy process of reaching a diagnosis of PNES can be a lot more expensive, when compared to the diagnostic process of other chronic conditions [11]. Financially these patients are often confronted with a delay in confirming a diagnosis of PNES due to numerous doctors' visits, inappropriate treatment and medication that changes constantly [4,5,10,17]. In addition, hospitalizations in speciality units, extensive testing and monitoring with specialised equipment such as video-EEG can be expensive [4,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, many healthcare providers do not have the expertise to diagnose and treat PNES and subsequently, patients with PNES may find themselves on the border between neurology and psychiatry with neither of these professions prepared to take responsibility for treating this complex condition [1]. Studies indicate that the average period between seizure manifestation and correct 2 diagnosis of PNES is about seven years [10]. During the diagnostic process patients are often confronted with extensive and expensive testing [11] as well as a lack of understanding of this condition from healthcare providers [1,5,8,12].…”

Section: Introductionmentioning

confidence: 99%

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What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies

Rawlings

Reuber

2016

Seizure

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Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. AbstractPurpose: This qualitative study aimed at examining the subjective experiences of patients during the complicated and often prolonged diagnostic process of psychogenic non-epileptic seizures (PNES).Methods: Thematic analyses were used to explore the semi-structured interviews that were conducted with ten individuals who have been diagnosed with PNES.Results: Six main themes, namely inexpert healthcare providers, limited medical insurance and loss of independence were identified as barriers, while social support, comprehensive medical insurance and knowledgeable healthcare providers were identified as facilitators through the process of thematic analysis. Conclusions:The patients' perspectives revealed that an earlier diagnosis of PNES is essential to address the loss of independence and limit inappropriate and potentially harmful treatment as well as the costly burden of this condition on both the patient and the healthcare system. It was evident in this study that healthcare providers play an essential role in the subjective experiences of these individuals during the diagnostic process. The implementation of continuous education programmes for healthcare providers in particular could contribute positively to the diagnostic process of PNES for patients. Methods: Thematic analyses were used to explore the semi-structured interviews that were conducted with ten individuals who have been diagnosed with PNES.Results: Six main themes, namely inexpert healthcare providers, limited medical insurance and loss of independence were identified as barriers, while social support, comprehensive medical insurance and knowledgeable healthcare providers were identified as facilitators through the process of thematic analysis. Conclusions:The patients' perspectives revealed that an earlier diagnosis of PNES is essential to address the loss of independence and limit inappropriate and potentially harmful treatment as well as the costly burden of this condition on both the patient and the healthcare system. It was evident in this study that ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies

Rawlings

Reuber

2016

Seizure

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“…Patients with NES were classified into those who had psychogenic NES (PNES) and those who did not. PNES were defined as typical episodes with no corresponding epileptiform activity on the EEG during the episodes or episodes that were secondary to a suspected conversion or dissociative mechanism [21]. All episodes secondary to a medical cause or other psychiatric conditions such as panic attacks were excluded.…”

Section: Nonepileptic Seizuresmentioning

confidence: 99%

“…Patients with nonepileptiform seizures (NES), particularly psychogenic nonepileptic seizures (PNES), constitute a large proportion of patients assessed in epilepsy services [20,21], and suffer significant medical and psychiatric morbidity, a poor quality of life, and a poor functional outcome [22,23]. Patients with NES often do not differ in their level of cognitive impairment from patients with proven epilepsy [24], with both groups generally performing worse on tests of overall cognitive function than the healthy population [25].…”

Section: Introductionmentioning

confidence: 99%

Utility and validity of a brief cognitive assessment tool in patients with epileptic and nonepileptic seizures

Walterfang

Choi

O’Brien

et al. 2011

Epilepsy & Behavior

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“…Research of patients with PNES diagnosed with video EEG has consistently shown that only about 10% of patients have concurrent epileptic seizures (Jones 2010;McKenzie 2010). It is important to stress that even in cases where comorbidity is confirmed, the clinical picture is generally of frequent PNES in the context of underlying well-controlled epilepsy (Duncan 2008).…”

Section: Declaration Of Interestmentioning

confidence: 99%

Psychogenic non-epileptic seizures: aetiology, diagnosis and management

Oto¹,

Reuber²

2014

Adv. psychiatr. treat

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SummaryPsychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient's history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.

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Clinical Characteristics and Outcome in Patients With Psychogenic Nonepileptic Seizures

Abstract: These results demonstrate the need for earlier diagnosis of PNES and comorbidities and highlight the need for diagnostic and therapeutic approaches that combine neurological and psychiatric perspectives.

Cited by 85 publications

References 43 publications

What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies

What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies

Utility and validity of a brief cognitive assessment tool in patients with epileptic and nonepileptic seizures

Psychogenic non-epileptic seizures: aetiology, diagnosis and management

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