How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures?

Seneviratne, Udaya; Minato, Erica; Paul, Eldho

doi:10.1016/j.yebeh.2016.10.024

Cited by 46 publications

(27 citation statements)

References 27 publications

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“…Notably, urinary incontinence or tongue biting are nonspecific for either diagnosis. 61,62 Additionally, the ability of bystanders to intensify or alleviate the event favors PNES over ES. 63 That an event of longer duration is more likely to signify PNES than ES is significant, as an extended psychogenic event may be misdiagnosed as status epilepticus.…”

Section: Psychogenic (Dissociative) Nonepileptic Seizuresmentioning

confidence: 99%

“…Furthermore, the authors of this study noted that if an event lasted at least 5 minutes, its odds of being PNES over ES are 24 times higher. 62 This information should be used with caution; however, as an alternative to PNES in this situation is status epilepticus which is a neurological emergency. Documenting in the medical chart that an individual has a confirmed history of prolonged PNES events (nonepileptic status epilepticus) may help prevent iatrogenic injury from unnecessary urgent medical procedures such as intubation.…”

Section: Psychogenic (Dissociative) Nonepileptic Seizuresmentioning

confidence: 99%

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Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

et al. 2019

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Functional neurological disorders (FND, a.k.a. conversion disorder) are increasingly recognized as highly prevalent neurobehavioral-neuropsychiatric conditions. While patients with FND are frequently seen in outpatient neurology and primary care clinics, 1,2 these conditions are also common in emergency department (ED) settings. 3 While large-scale epidemiologic studies of incidence and prevalence are lacking, 4 there is robust evidence of high utilization of primary care, subspecialty, ED, and acute hospital services by patients with FND, resulting in considerable healthcare and societal costs. 5 Notably, patients with FND show elevated repeat ED visit rates in comparison to other conditions. 3 A variety of FND symptoms may lead to ED presentations, particularly those with paroxysmal or acute onset such as psychogenic nonepileptic seizures (PNES, a.k.a. dissociative seizures) or sensorimotor changes that mimic stroke. 6,7 Other FND symptoms that may lead to ED visits include functional movement disorders (FMDs), including functional tremor, gait disturbance, and/or dystonia. Appropriate triage of FND-related cases in the ED is not yet standardized and is often complex, requiring a time-sensitive, concurrent evaluation of neurological emergencies, as well as elements of shared neurology and neuropsychiatry expertise to provide an appropriate disposition and discharge plan.The assessment of FND has traditionally been a lengthy process utilizing tests that are not routinely performed in EDs Keywords ► conversion disorder ► psychogenic nonepileptic seizures ► functional movement disorders ► functional paralysis Abstract Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a "rule-out" diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a "rule-in" diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.While the clinical history is nonspecific for a diagnosis of FND, certain clues may help raise one's index of suspicion. 15 With regard to FND overall (including functional weakness,

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Section: Psychogenic (Dissociative) Nonepileptic Seizuresmentioning

confidence: 99%

Section: Psychogenic (Dissociative) Nonepileptic Seizuresmentioning

confidence: 99%

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

et al. 2019

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“…In a study aiming at evaluating the efficacy of psychological disorders in management of non-epileptic seizures it was revealed that 47% of people with epilepsy also suffer from other psychiatric disorders, and results of 10 other studies showed that 82% of people, who completed treatment in psychology, had a seizure reduction of 50% (11). A study from France showed that people with psychological disorders had a higher rate of seizure decline (82%) and freedom from seizures (47%) in non-epileptic seizure compared with those, who did not have psychological disorders (9).…”

Section: Introductionmentioning

confidence: 99%

“…Chronic non-epileptic seizures are a challenge in epilepsy diagnosis (6). The results show that the accuracy of correct diagnosis between these two types of epilepsy depends on the experience of professionals (7)(8)(9). Brown and Reuber found that non-epileptic seizures do not have a brain cause and are physiological or psychological, and the patient's personality traits affect response to treatment and the number of seizures (10).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Alexithymia, Perceived Stress and Emotion Regulation Between Patients with Epileptic and Non-Epileptic Seizures

Mirlohian

Haghayegh

2018

Zahedan J Res Med Sci

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Background: Different psychological factors may explain the differences between epileptic and non-epileptic seizures. Accordingly, the present study was conducted to compare alexithymia, perceived stress, and emotion regulation between patients with epileptic and non-epileptic seizures. Methods: In the present cross-sectional research, 82 patients (39 with epileptic seizures and 43 with non-epileptic seizures) were selected. Using the Toronto Alexithymia Scale (TAS) (Bagby et al., 1994), Perceived Stress Scale (PSS) (Cohen et al., 1983) and cognitive emotion regulation questionnaire (CERQ) (Garnefski and Kraaij, 2006), the required data were collected and then analyzed using the SPSS-19 software. Results: According to the results, patients with non-epileptic seizures had significantly higher scores in TAS, especially in the subscales of difficulty identifying feelings and externally oriented thinking, PSS and CERQ, especially in the subscales of catastrophizing and other-blame and lower scores in CERQ's subscales of acceptance, positive reappraisal, and positive refocusing compared to patients with epileptic seizures (P < 0.05). The non-epileptic seizure group score was higher in the event acceptance subscale (as a positive emotion regulation) (P < 0.05). Conclusions: The results of this study showed that patients with epileptic seizures have a more favorable condition in terms of alexithymia, emotion regulation, and perceived stress compared to those with non-epileptic seizures.

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“…7 Many researchers have been evaluating different approaches to improve the diagnosis and classification of ES versus PNES. [8][9][10] These approaches can improve the accuracy of visual discrimination of seizures short term and medium term. 10 In hypothetical treatment scenarios, this newly learnt knowledge did not necessarily translate to logical decision-making in the use of medication for the management of PNES.…”

Section: Introductionmentioning

confidence: 99%

Discovering themes in medical records of patients with psychogenic non-epileptic seizures

et al. 2020

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IntroductionEpileptic and psychogenic non-epileptic seizures (PNES) are common diagnostic problems encountered in hospital practice. This study explores the use of unsupervised machine learning in discovering themes in medical records of patients presenting with PNES. We hypothesised that themes generated by machine learning are comparable with the classification by human experts.MethodsThis is a retrospective analysis of the medical records in the emergency department of patients (age >18 years) with PNES who underwent inpatient video-electroencephalography monitoring from May 2009 to June 2014 and received a final diagnosis of PNES. Prior to machine learning of written text, we applied a standardised approach in natural language processing to create a document-term matrix (removal of numbers, stop-words and punctuations, transforming fonts to lower case). The words were separated into tokens and treated as if existing within a bag-of-words. A probability of each word existing within a topic (theme) was modelled on multivariate Dirichlet distribution (R Foundation, V.3.5.0). Next, we asked four experts to independently provide a clinical interpretation of the generated topics. When the majority of (≥3) experts agreed, it was regarded as highly congruent. Interactive data are available on the web at (https://gntem2.github.io/PNES/%23topic=1&lambda=0.6&term=).ResultsThere were 39 patients (74.4% women, median age 35 years with range 20–82). A total of 121 documents were converted to text files for text mining. There were 15 generated topics with 12/15 topics rated as highly congruent. The main themes were about descriptors of seizures and medication use.ConclusionsThe findings from machine learning on PNES-related documentation provides evidence for the feasibility of applying machine-learning methodology to analyse large volumes of medical records. The topics generated by machine learning were congruent with interpretations by clinicians indicating this method can be used for screening of medical conditions among large volumes of medical records.

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How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures?

Cited by 46 publications

References 27 publications

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

Comparison of Alexithymia, Perceived Stress and Emotion Regulation Between Patients with Epileptic and Non-Epileptic Seizures

Discovering themes in medical records of patients with psychogenic non-epileptic seizures

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