Comparing standard medical care for nonepileptic seizures in Chile and the United States

LaFrance, W. Curt; Marinis, Alejandro J. de; Webb, Anne Frank; Machan, Jason T.; Rusch, Mark D.; Kanner, Andrés M.

doi:10.1016/j.yebeh.2012.07.028

Cited by 24 publications

(45 citation statements)

References 49 publications

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“…Having completed these projects, the ILAE task force turned its attention to the topic of PNES around the world. Prior studies have described treatment practices for PNES in the U.S.A., United Kingdom, Chile, and Brazil . The present paper summarizes presentations at a joint meeting of the ILAE PNES Task Force and the Japan Epilepsy Society in Nagasaki, Japan, in October 2015.…”

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confidence: 96%

PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report

et al. 2017

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SummaryAn international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES—in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence‐based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.

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PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report

et al. 2017

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“…The "long" survey was based on an original survey originally administered to members of the American Epilepsy Society (AES). 11 Similar surveys were later used to assess provision in other countries (Chile and Brazil) 15,16 before the survey was adapted for this project by the ILAE PNES Task Force. The questions in the "long" survey were in 5 sections: (1) the role of the respondent and their exposure to PNES, (2) diagnostic methods, (3) management of PNES, (4) perceived etiologic factors, and (5) perceived problems accessing health care (see Appendix S2).…”

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confidence: 99%

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Hingray¹,

et al. 2017

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SummaryObjective: Studies from a small number of countries suggest that patients with psychogenic nonepileptic seizures (PNES) have limited access to diagnostic and treatment services. The PNES Task Force of the International League Against Epilepsy (ILAE) carried out 2 surveys to explore the diagnosis and treatment of PNES around the world. Methods: A short survey (8 questions) was sent to all 114 chapters of the ILAE.A longer survey (36 questions) was completed by healthcare professionals who see patients with seizures. Questions were separated into 5 sections: professional role, diagnostic methods, management, etiology, and access to health care. Results: Responses were received from 63 different countries. The short survey was completed by 48 ILAE chapters, and the long survey by 1098 health professionals from 28 countries. PNES were recognized as a diagnostic and therapeutic problem in all countries. Trauma and mental health issues were most commonly recognized as etiologic factors. There was a clear relationship between income and access to diagnostic tests and expertise. Psychological therapy was most commonly considered the treatment of choice. Although financial difficulties were the most commonly reported problem with service access in low-income countries, in

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“…Examples of advances in PNES treatment over the last decade include examining clinical trial methodology in PNES in an open label study of sertraline for PNES 49 , followed by a pilot placebo-controlled Luciano De Paola et al Psychogenic nonepileptic seizures and psychogenic movement disorders RCT with sertraline 49 . Standard medical care (SMC) or treatment as usual (TAU) is in the US,and in a cross-cultural comparison with Chile has been described 50 . A psychotherapy initially used in epilepsy has been modified for PNES and was used to conduct an open label trial for PNES 51 .…”

Section: Treatment Of Pnes and Pmdmentioning

confidence: 99%

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

Paola

Marchetti

Teive

et al. 2014

Arq. Neuro-Psiquiatr.

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Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are commonly seen in Neurology practice and are categorized in the DSM-5 as functional neurological disorders/conversion disorders. This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. As a group they have puzzled generations of neurologists and psychiatrists and in some ways continue to do so, perhaps embodying and justifying the ultimate and necessary link between these specialties.Keywords: psychogenic nonepileptic seizures, psychogenic movement disorders, conversion disorder, hysteria. RESUMOCrises não-epilépticas psicogênicas (CNEP) e distúrbios do movimento psicogênicos (DMP) são comuns na prática e na atualidade são melhor categorizados no DSM-V como distúrbios neurológicos funcionais/desordens de conversão. Esta revisão enfatiza os principais dados históricos, epidemiológicos, clínicos, critérios diagnósticos, tratamento e o prognóstico destes pacientes, frequentemente negligenciados e desafiadores, os quais, como um grupo, tem intrigado gerações de neurologistas e psiquiatras, caracterizando, de forma justificada o elo definitivo entre estas especialidades.Palavras-chave: crises não-epilépticas psicogênicas, distúrbios do movimento psicogênicos, distúrbio conversivo, histeria.In the medical sciences, a diagnosis is established when a level of certainty regarding the nature of a condition is achieved. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) share a slightly less linear diagnostic route. Historically, making a conversion diagnosis required ruling out the originally considered medical diagnosis, i.e., it is neither epilepsy, nor a neurogenic movement disorder. Only then a non-neurologic (in the sense of not resulting from epileptogenic or known motor circuitry imbalance) condition is suspected and raised to the level of diagnosis 1 . This kind of diagnosis has intrigued generations of physicians and spared no culture, gender or age. A diversity of symptoms, including motor, sensory, cognitive, and/or behavior symptoms are present in these presentations. Patients with PNES or PMD frequently are misdiagnosed as having their initial suspected neurological diseases, and ultimately pose a diagnostic and treatment challenge to many clinicians. Interestingly, it was perhaps this varied presentation that has captured the attention of many professionals through the centuries and lead to the construction and recognition of a very particular diagnosis. Two rather advanced historic civilizations, Egyptians first, and then the Greeks, posited that a displaced hystera (womb), and the consequent suffocation that it produced, was the source of choking, mutism, paralysis and fainting 1 . Hysteria, a natural development on this concept, was claimed as an explanation for similar phenomena in women and reached almost epidemic proportions in the late 19 th century. By th...

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Comparing standard medical care for nonepileptic seizures in Chile and the United States

Cited by 24 publications

References 49 publications

PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report

PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report

Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force

Psychogenic nonepileptic seizures and psychogenic movement disorders: two sides of the same coin?

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