Induction of psychogenic nonepileptic seizures without placebo

Benbadis, Selim R.; Johnson, Kay; Anthony, K.; Caines, G.; Hess, Gregory P.; Jackson, Cherry W.; Vale, Fernando Ĺ.; Tatum, William O.

doi:10.1212/wnl.55.12.1904

Cited by 100 publications

(71 citation statements)

References 8 publications

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“…The use of placebo is by no means necessary, and a reliable induction technique without placebo has been described. 25 This technique uses hyperventilation and photic stimulation in addition to verbal suggestion. Since these maneuvers are performed during most EEGs, most patients have undergone them previously and do not find it unusual or odd.…”

Section: The Pragmatic Solutionmentioning

confidence: 99%

“…Since these maneuvers are performed during most EEGs, most patients have undergone them previously and do not find it unusual or odd. 25 Since hyperventilation and photic stimulation do induce seizures, deception is not inherent to the procedure and the main objections against placebobased provocative techniques are avoided. 20,25 The minimal necessary component of nondisclosure is no different from maneuvers commonly performed during the neurologic examination (eg, the Hoover sign) when nonorganic symptoms are considered among other possibilities.…”

Section: The Pragmatic Solutionmentioning

confidence: 99%

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Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures

Benbadis¹

2001

Arch Neurol

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Section: The Pragmatic Solutionmentioning

confidence: 99%

Section: The Pragmatic Solutionmentioning

confidence: 99%

Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures

Benbadis¹

2001

Arch Neurol

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“…One way of increasing the diagnostic yield and reducing the waiting time of the vEEG is to use the administration of single placebo induction, which has showed a very promising result in a preselected population in one study [13]. Similarly, another study showed that induction can be achieved without placebo [14]. This approach, however, remains a controversial one and creates so much debate from an ethical point of view, which is not the scope of this review article.…”

Section: Diagnosismentioning

confidence: 99%

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

Alsaadi¹,

Shahrour²

2014

Health

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Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.

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“…[7,8] İnt-ravenöz salin uygulaması, hiperventilasyon, fotik uyarım, hipnoz veya telkin yöntemleri ile nöbet provokasyonu birçok merkezde kullanılmaktadır. [12][13][14][15][16][17] İndüksiyon uygulamalarının yaygın olarak kullanılması ve bunu destekleyen görüş-lerin yanı sıra karşısında yer alan görüşlerde bildirilmektedir. [9,18] İndüksiyonu savunan yazarlar, hastanın bu basit ve ucuz yöntemle tanı alma şansı varken yıllarca yanlış tanı ile ve yanlış tedaviler uygulanmasının hastaya daha büyük zararı olacağını belirtmektedirler.…”

Section: Tablo 3 Grup 1 Ve Grup 2 Hastaların Takip Tanılarıunclassified

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

Genç¹,

Yılmaz²,

Gömceli³

et al. 2013

Epilepsi

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SummaryObjectives: Psychogenic non-epileptic seizures (PNES) are reported in 10-30% of patients who are diagnosed as having refractory seizures referred to epilepsy centers. Many epilepsy centers use some sort of provocative techniques to aid in the diagnosis of PNES. In this study we aimed to determine the value of diagnostic effects of seizure induction methods. Methods: We analyzed retrospectively 66 patients who were suspected as PNES and referred by a clinician to our outpatient EEG laboratory between July 2011-January 2013. Intravenous saline was administered for seizure induction which is a routine seizure induction method used in our laboratory. Follow-up data were gathered by telephone interviews or from patient charts. Results: PNES were observed in 39 (59.1%) of 66 patients. Twenty-eight patients were thought to have pure PNES. After 3-17 months (mean: 6.9 months) of induction, 27 of 39 patients were either seizure-free or had significiant reduction in seizure frequency. Conclusion: In this study we conclude that; provocative techniques are useful, cheap and accessible for the diagnosis of PNES. If applied delicately, they may also provide a positive impact on the patient's self-recognition, and also, the prognostic consequences of the condition.Key words: Epilepsy; induction; psychogenic non-epileptic seizure. ÖzetAmaç: Epilepsi merkezlerine dirençli epilepsi tanısı ile gönderilen hastaların yaklaşık %10-30'unun nonepileptik psikojen nöbet (NEPN) tanısı aldığı bildirilmektedir. Birçok epilepsi merkezinde NEPN tanısına yardımcı olmak için bazı provokatif yöntemler kullanılmaktadır. Bu çalışmada nöbet indüksiyonun NEPN tanısı ve prognozu üzerindeki etkisini araştırmayı amaçladık. Sonuç: Bu çalışmada, provakatif yöntemlerin kullanışlı, ucuz ve hatta hastanın tanıyı kabullenmesinde etkisi olabileceği sonucuna vardık. Tanısını kabullenen hastalarda prognoz daha iyi olup, iyi iletişim bu noktada önemlidir. Gereç ve

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Induction of psychogenic nonepileptic seizures without placebo

Cited by 100 publications

References 8 publications

Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures

Provocative Techniques Should Be Used for the Diagnosis of Psychogenic Nonepileptic Seizures

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

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