Inferences from a community study about non-epileptic events

Abstract

-Objective: To demonstrate the epidemiological importance of the different types of non-epileptic events (NEE) in a low-income urban community. Method: The patients suspected of having epilepsy, who were detected in the first phase (screening one) of this prevalence study, were interviewed by a neurologist in a non-structured neurological interview. These NEE were classified as physiological and psychogenic, subdivided by various types. The psychogenic NEE were classified according to the DSM-IV criteria. Results: We compared the cases suspected of having epilepsy (n=176) with those not suspected (n=806) and discovered that those cases suspected of having epilepsy had a greater median age (<0.01) and female predominance (p<0.01). Among the cases suspected of having epilepsy there were different diagnosis: epileptic events without identifiable cause (n=20) or with identifiable causes (e.g., febrile convulsions and eclampsia). The most prevalent diagnosis for those suspected of having epilepsy was syncope (n=63; 35.8%). In terms of physiological events, the most frequent were: epileptic seizures, paroxysmal toxic phenomena (including alcoholism) and brain trauma, besides syncope; in terms of psychogenic events the most frequent were: dissociative and anxiety disorders. Regarding gender differences, paroxysmal toxic problems were significantly more prevalent in men (p= 0.02), and dissociative disorders (p=0.01) in women. Conclusion: This survey confirms the epidemiological importance of syncope in a populational sample with NEE. However, among the psychogenic disorders of this NEE sample, the most frequent were dissociative and anxiety phenomena. This finding contrasts with the literature based on samples from tertiary epileptic centers with video-EEG resources, which found somatoform disorders to be more prevalent than dissociative and anxiety phenomena.KEY WORDS: epilepsy, non-epileptic events, community study. Inferências de estudo populacional sobre eventos não epilépticosRESUMO -Objetivo: Demonstrar a importância epidemiológica dos diferentes tipos de eventos não epilépticos (ENE) em uma comunidade urbana de baixa renda. Metodo: Os casos suspeitos de terem epilepsia foram detectados na primeira fase de um estudo de prevalência de epilepsia, de triagem. Na segunda fase, eles foram entrevistados por um neurologista em entrevista não estruturada. Os casos de ENE foram classificados como fisiológicos ou psicogênicos e divididos em vários tipos. Esses últimos foram classificados segundo o DSM-IV. Resultados: Entre os suspeitos de terem epilepsia (176, mais idosos do que os outros casos, <0.01, com predominância feminina, p<0.01) existem diferentes diagnósticos: eventos epilépticos sem causa aguda subjacente conhecida (20) ou com (convulsão febril e eclâmpsia). O diagnóstico mais prevalente é o de síncope (n=63; 35,8%), crises epilépticas, fenômeno tóxico paroxístico (incluso alcoolismo) e trauma craniano, nos eventos fisiológicos, e transtornos dissociativos, ansiedade, entre os psicogênicos. O predomínio ...

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

“…We explored what resources are available when vEEG is not available. In rural areas, ES and PNES have been diagnosed in patients using surveys and interviews with neurologists [17,24,27]. Appropriate diagnosis of PNES and ES is essential for the correct treatment and also when diagnosing children and adolescents [18,35,49].…”

“…The co-existence of epilepsy and PNES in 10% of patients may also complicate making accurate diagnoses. Patients with seizures are misdiagnosed often [13,14,24,27], even with the availability of vEEG technology [50], resulting in treatment delay and possible unnecessary treatment. This delay may promulgate incorrect treatment with AEDs and put the patient with PNES at iatrogenic risk [51].…”

“…Reviewing existing literature in LA reveals that a few studies focused on the prevalence of ES in patients diagnosed with PNES [10,11,26], and some have reviewed retrospective data for PNES identification purposes [13,27]. Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34].…”

“…Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34]. Studies in LA have identified higher frequencies of psychiatric comorbid diagnoses, such as anxiety and dissociation, than studies in the US [11,15,25,27,35,36]. Moreover, reports in LA of trauma and abuse, such as physical or sexual abuse, reveal lower frequencies [13,25,35] than those reported in the US [14,37].…”

Aspectos epidemiológicos das comorbidades psiquiátricas em epilepsia

“…Isso nos reporta a estudo epidemiológico realizado no Rio de Janeiro que teve a grande preocupação da análise meticulosa de caso a caso. 15 Nele, houve a demonstração de em que vários sujeitos com suspeita de epilepsia na primeira fase de estudo de porta-a-porta se demonstrou, na segunda fase, tratar-se apenas de eventos não epilépticos, muitos deles transtornos psiquiátricos. Assim, há de se questionar se principalmente os estudos que demonstram altas taxas de epilepsia, mais do que a média usual de 0,5 a 1,0%, apresentariam indevidas altas taxas de comorbidades psiquiátricas, pois na verdade, o transtorno índice já seria de natureza básica psiquiátrica.…”