Evaluation of the "non-epileptic" patient in a tertiary center epilepsy clinic

Pana, Raluca; Labbe, Aurélie; Dubeau, François; Kobayashi, Eliane

doi:10.1016/j.yebeh.2017.11.001

Cited by 8 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In epilepsy specialty centers, > 80% of patients with NES may be of psychogenic etiology, that is, PNES. [2][3][4] NES of physiological origin includes both neurological and non-neurological conditions that may mimic ES. Neurological causes include migraine, cerebrovascular disorders such as limb shaking, transient ischemic attack (TIAs), and movement disorder.…”

Section: Nesmentioning

confidence: 99%

“…Unfortunately, delay in the definite diagnosis and appropriate management of patients with PNES is common, in some cases for decades. 3,4 It is essential to differentiate between the ES and NES since a misdiagnosis could lead to iatrogenic injury, morbidity, and cost to patients and health care. An algorithm for the classification of paroxysmal spells is provided in Figure 1.…”

Section: Introductionmentioning

confidence: 99%

“…Also, it has been reported that 20% to 30% of inpatients in epilepsy monitoring units have PNES. Unfortunately, delay in the definite diagnosis and appropriate management of patients with PNES is common, in some cases for decades 3,4 . It is essential to differentiate between the ES and NES since a misdiagnosis could lead to iatrogenic injury, morbidity, and cost to patients and health care.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures

Feyissa

Bower

2022

The Neurologist

View full text Add to dashboard Cite

Background: The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting. Review Summary: Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders. Conclusions: Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.

show abstract

Section: Nesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures

Feyissa

Bower

2022

The Neurologist

View full text Add to dashboard Cite

show abstract

“…Diagnosis is often difficult in patients with suspected epilepsy, and about 20% of all patients referred to diagnostic centers may incorrectly be considered as epilepsy. 31,32 In most cases, the diagnosis of epilepsy is critical and depends on the description of the attack by a witness, but the accuracy and validity of this part of the diagnostic procedure are largely unknown. 33 Thus, when there is structural brain damage, treatment is continued for a lifetime, and in cases, the cause of epilepsy is idiopathic (genetic), depending on the case, treatment should be given for two to five years.…”

Section: Diagnostic Evaluation Medical Historymentioning

confidence: 99%

Experimental Therapeutic Strategies in Epilepsies Using Anti-Seizure Medications

Rahim¹,

Azizimalamiri²,

Sayyah³

et al. 2021

JEP

View full text Add to dashboard Cite

Epilepsies are among the most common neurological problems. The disease burden in patients with epilepsy is significantly high, and epilepsy has a huge negative impact on patients’ quality of life with epilepsy and their families. Anti-seizure medications are the mainstay treatment in patients with epilepsy, and around 70% of patients will ultimately control with a combination of at least two appropriately selected anti-seizure medications. However, in one-third of patients, seizures are resistant to drugs, and other measures will be needed. The primary goal in using experimental therapeutic medication strategies in patients with epilepsy is to prevent recurrent seizures and reduce the rate of traumatic events that may occur during seizures. So far, various treatments using medications have been offered for patients with epilepsies, which have been classified according to the type of epilepsy, the effectiveness of the medications, and the adverse effects. Medications such as Levetiracetam, valproic acid, and lamotrigine are at the forefront of these patients’ treatment. Epilepsy surgery, neuro-stimulation, and the ketogenic diet are the main measures in patients with medication-resistant epilepsies. In this paper, we will review the therapeutic approach using anti-seizure medications in patients with epilepsy. However, it should be noted that some of these patients still do not respond to existing treatments; therefore, the limited ability of current therapies has fueled research efforts for the development of novel treatment strategies. Thus, it seems that in addition to surgical measures, we should look for more specific agents that have less adverse events and have a greater effect in stopping seizures.

show abstract

“…Outside of the acute window, misdiagnosis can lead to the initiation of long-term antiepileptic drug therapy. Pana et al found that 26% of patients referred to their Canadian tertiary care epilepsy clinic were non-epileptic cases [3]. In an earlier study, Smith et al found that 26% of patients referred for "refractory epilepsy" had incorrectly been diagnosed as epileptic [4].…”

Section: Introductionmentioning

confidence: 99%

The first-line management of psychogenic non-epileptic seizures (PNES) in adults in the emergency: a practical approach

Toffa

Poirier

Nguyen

2020

Acta Epileptologica

View full text Add to dashboard Cite

Distinguishing non-epileptic events, especially psychogenic non-epileptic seizures (PNES), from epileptic seizures (ES) constitutes a diagnostic challenge. Misdiagnoses are frequent, especially when video-EEG recording, the gold-standard for PNES confirmation, cannot be completed. The issue is further complicated in cases of combined PNES with ES. In emergency units, a misdiagnosis can lead to extreme antiepileptic drug escalade, unnecessary resuscitation measures (intubation, catheterization, etc.), as well as needless biologic and imaging investigations. Outside of the acute window, an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy. Early recognition is thus desirable to initiate adequate treatment and improve prognosis. Considering experience-based strategies and a thorough review of the literature, we aimed to present the main clinical clues for physicians facing PNES in non-specialized units, before management is transferred to epileptologists and neuropsychiatrists. In such conditions, patient recall or witness-report provide the first orientation for the diagnosis, recognizing that collected information may be inaccurate. Thorough analysis of an event (live or based on home-video) may lead to a clinical diagnosis of PNES with a high confidence level. Indeed, a fluctuating course, crying with gestures of frustration, pelvic thrusting, eye closure during the episode, and the absence of postictal confusion and/or amnesia are highly suggestive of PNES. Moreover, induction and/or inhibition tests of PNES have a good diagnostic value when positive. Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures, especially following bilateral tonic-clonic seizures. Finally, regardless the level of certainty in the diagnosis of the PNES, it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.

show abstract

Evaluation of the "non-epileptic" patient in a tertiary center epilepsy clinic

Cited by 8 publications

References 13 publications

Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures

Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures

Experimental Therapeutic Strategies in Epilepsies Using Anti-Seizure Medications

The first-line management of psychogenic non-epileptic seizures (PNES) in adults in the emergency: a practical approach

Contact Info

Product

Resources

About