Demographic and historical backgrounds of the elderly with nonepileptic seizures: A comparative study

Acar, Göksemin; Salinsky, Martin

doi:10.4103/0028-3886.60396

Cited by 6 publications

(9 citation statements)

References 16 publications

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“…Women form around three-quarters of all patients with DSs, 11 with onset typically occurring in the late teens/twenties, 12 although DSs can occur in both the old and the young. [13][14][15] It is thought that around 12-20% of patients presenting at epilepsy clinics may have DSs. 16 Video electroencephalography (EEG) is the gold standard diagnostic technique for DSs, with the key signs 17 being the absence of typical epileptic EEG abnormalities and the presence of an intact alpha rhythm.…”

Section: Dissociative Seizuresmentioning

confidence: 99%

Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT

Robinson

Pilecka

Perdue

et al. 2021

Health Technol Assess

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Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. Interventions Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive–behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. Main outcome measures The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. Results In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive–behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1–35 dissociative seizures); cognitive–behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0–20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive–behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7–12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect –0.39, 95% confidence interval –0.61 to –0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive–behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval –0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive–behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. Limitations Unlike outcome assessors, participants and clinicians were not blinded to the interventions. Conclusions There was no significant additional benefit of dissociative seizure-specific cognitive–behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive–behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive–behavioural therapy. Future work Examination of moderators and mediators of outcome. Trial registration Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information.

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Section: Dissociative Seizuresmentioning

confidence: 99%

Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT

Robinson

Pilecka

Perdue

et al. 2021

Health Technol Assess

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“…Typically PNES onset occurs in the late twenties (Ettinger et al., 1999a); however, it can occur in both young and old populations (Patel et al., 2007; Acar & Salinsky, 2010). In pediatric cases, difficulties in school and family (conflict between parents), interpersonal conflict, and sometimes sexual or physical abuse are factors associated with PNES onset (Patel et al., 2007).…”

Section: Introductionmentioning

confidence: 99%

“…In older populations there are no major demographic differences compared to the young adult population. Diagnosis appears to be significantly delayed for older patients (Acar & Salinsky, 2010). The age of onset is later in PNES than epilepsy, but earlier than for motor conversion patients (Brown et al., 1991; Stone et al., 2004).…”

Section: Introductionmentioning

confidence: 99%

Psychogenic nonepileptic seizures: A current overview

Looper

2012

Epilepsia

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SUMMARYPsychogenic 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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“…As reasonably expected, the diagnostic delay before establishing the correct diagnosis is significantly longer in patients with PNES suffering also from epileptic seizures and/or with interictal EEG abnormalities (43,44). Furthermore, diagnosis appears to be significantly delayed for older patients (27). Interestingly, a subgroup of patients with PNES and a remarkably short referral time to an epilepsy centre have been recently identified; these patients seem to be characterized by a more active attitude towards medical investigations of their symptoms, more previous psychological complaints and more previous psychological/psychiatric treatments (22).…”

Section: Challenges In the Differential Diagnosis Between Pnes And Epmentioning

confidence: 66%

“…Age at onset of PNES is at about 20-30 years (20,24,25), although it can occur both in young (23) and old patients (26,27). The age of PNES onset is later than for epilepsy, but earlier than for motor conversion patients (28,29).…”

Section: Age Of Onsetmentioning

confidence: 99%

Psychogenic non-epileptic seizures: an overview on terminology, epidemiology and diagnostic features

Brigo¹

2017

CCRE

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Psychogenic non-epileptic seizures (PNES) are paroxysmal events which may be misdiagnosed as epileptic seizures. However, unlike epileptic seizures, PNES are not caused by an excessive and hypersynchronous electrical activity in the brain and therefore are not accompanied by ictal electroencephalographic changes; they are common disorders, considered as an involuntary response to emotional, physical, psychological or social distress. This review focuses on terminology, epidemiology, and diagnostic difficulties encountered by physicians facing with this condition. It also provides a comprehensive overview of the diagnostic accuracy values (sensitivity and specificity) for clinical signs commonly used to support the diagnosis of PNES. The differential diagnosis between PNES and epileptic seizures may represent a diagnostic challenge, complicated by the coexistence of both conditions in some patients (up to 50%). The diagnostic delay for PNES is worrisome as a correct and prompt diagnosis is essential for an adequate therapy and to prevent unnecessary, costly and potentially harmful drug treatment. The diagnostic "gold standard" is a video-EEG recording of the paroxysmal event. Several physical signs have different sensitivity and specificity values in the differential diagnosis between PNES and epileptic seizures, but the diagnosis should never be driven by any single clinical sign alone. In doubtful cases, diagnosis should be carefully reconsidered checking event description and semiology at each visit, and not forgetting the possibility of a coexistence of both epilepsy and PNES.

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Demographic and historical backgrounds of the elderly with nonepileptic seizures: A comparative study

Abstract: In demographic and historical aspects old and young patients do not display major differences; however, the diagnosis is significantly delayed in the elderly. Early diagnosis with video EEG is recommended to avoid potential long-term risks associated with inappropriate treatments.

Cited by 6 publications

References 16 publications

Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT

Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT

Psychogenic nonepileptic seizures: A current overview

Psychogenic non-epileptic seizures: an overview on terminology, epidemiology and diagnostic features

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