Non-epileptic attack disorder: a clinical audit

Scheepers, Bruce; Budd, Sue; Curry, Sue; Gregory, Sheila T.; Elson, Sue

doi:10.1016/s1059-1311(05)80203-1

Cited by 25 publications

(26 citation statements)

References 15 publications

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“…Several patients also showed resistance to eye opening, which is an even more conclusive sign [12]. When the pupillary response could be assessed, it was normal (as in around 90% of psychogenic seizures; 13). There was surprisingly swift reorientation after ‘generalised’ convulsions.…”

Section: Discussionmentioning

confidence: 99%

Postoperative pseudostatusNot everything that shakes is epilepsy

Reuber¹,

Enright

Goulding

2000

Anaesthesia

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SummaryDiffuse idiopathic skeletal hyperostosis, otherwise known as Forestier's disease or ankylosing hyperostosis, is a relatively common condition that is distinguished from ankylosing spondylitis by the relative preservation of spinal function and the characteristic 'candle flame' lipping of the vertebrae. We report a patient with this condition and a well-recorded history of impossible intubation who presented for emergency laparotomy. The patient was intubated awake using the intubating laryngeal mask and sedation and anaesthesia were provided by a target-controlled infusion of propofol. Awake fibreoptic intubation has become a key technique in dealing with the anticipated difficult intubation. The recent National Confidential Enquiry into Perioperative Deaths (NCEPOD) [1] has recommended that a fibrescope and personnel skilled in its use are available in all sites where anaesthesia is performed. However, fibreoptic intubation is not a panacea, and difficult fibreoptic intubation is an ever-present problem. The intubating laryngeal mask (ILM), a purpose designed modification of the familiar laryngeal mask airway with a curved steel inlet tube and integral introducing handle, has been used successfully to intubate the trachea in cases of fixed neck deformity [2]. We report its successful use in an awake patient, with diffuse idiopathic skeletal hyperostosis (DISH) and an acute abdominal emergency, in whom there was a recorded history of difficult fibreoptic intubation. Case historyA 48-year-old woman, BMI 34.2, complaining of diarrhoea, vomiting and lower abdominal pain, was presented for anaesthetic assessment and urgent laparotomy. She was reported by the surgical registrar as being 'an anaesthetic nightmare'. Previous medical history included endometriosis, low back pain, migraine and an alaplasty to enlarge her nares. Anaesthetic notes were available from 1994 and 1995 when she had laparoscopies. Three failed intubations were recorded. On one occasion anaesthesia had been abandoned, in another a laryngeal mask airway had been used to maintain the airway during surgery and in a third case an ENT consultant had used a fibrescope to intubate the trachea after induction of anaesthesia. This procedure had been reported as being extremely difficult. View at direct laryngoscopy had been graded as Cormack and Lehane IV by one anaesthetist and another had noted 'impossible direct laryngoscopy due to a small mouth, full set of teeth, large tonsils and a rigid cervical spine'.On examination she appeared well hydrated and, apart from a flushed appearance and a sinus tachycardia of 100 beat.min À1 , not unduly unwell. Examination of the airway revealed that she had a short neck with almost no extension and rotation limited to 30Њ in either direction. She had an interincisor gap of 31 mm, her modified Mallampati score was 4 and thyromental distance 5 cm 70ᮊ 2000 Blackwell Science Ltd (Fig. 1). She was hyperteloric and her posterior hairline was only 2.5 cm above the vertebra prominens. Lateral cervical spine radiogr...

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Section: Discussionmentioning

confidence: 99%

Postoperative pseudostatusNot everything that shakes is epilepsy

Reuber¹,

Enright

Goulding

2000

Anaesthesia

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“…Some other external influences have also been implicated as potential precipitants for NES (20,21). For example, physical trauma, other than HI, and organic brain disease are also recognized as potential factors in the genesis of conversion reactions such as NES (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). In addition, a traumatic experience such as childhood sexual or physical abuse has been recognized in >30% of patients with NES, and this also has implications for both diagnosis and treatment (39)(40)(41).…”

Section: Head Injury Is a Well-established Cause Of Epilepsymentioning

confidence: 99%

Nonepileptic Posttraumatic Seizures

et al. 1998

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“…Pattern recognition of events forms the cornerstone of interpreting video‐EEG findings. Several studies have described various semiologic features of PNES (Gulick et al, 1982; Luther et al, 1982; Gates et al, 1985; Meierkord et al, 1991; Leis et al, 1992; Saygi et al, 1992; Lancman et al, 1993; Scheepers et al, 1994; DeToledo & Ramsay, 1996; Geyer et al, 2000; Vossler et al, 2004; Chung et al, 2006). However, the lack of a classification system of PNES is a major drawback in its recognition and management.…”

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confidence: 99%

Stereotypy of psychogenic nonepileptic seizures: Insights from video‐EEG monitoring

2010

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SUMMARYPurpose: To systematically study the semiology of psychogenic nonepileptic seizures (PNES) captured by videoelectroencephalography (EEG) monitoring (VEM) and categorize the typical patterns observed. Methods: VEM records of patients who underwent evaluation from January 2002 to June 2007 were reviewed to identify those who had PNES with or without a background of epilepsy. The semiology of each event was visually analyzed and entered into a statistical database. Type of movement, anatomic distribution, synchrony, symmetry, onset, offset, course, duration, vocalization, hyperventilation, eye movements, and responsiveness were evaluated. PNES were classified into distinct groups according to the predominant motor manifestation. Results: A total of 330 PNES from 61 patients were studied. Based on semiology, six different types of PNES were observed as follows: (1) rhythmic motor PNES characterized by rhythmic tremor or rigor-like movements (46.7%); (2) hypermotor PNES characterized by violent movements (3.3%); (3) complex motor PNES characterized by complex movements such as flexion, extension, abduction, adduction, rotation, with or without clonic-like and myoclonic-like components of varying combinations and anatomic distribution (10%); (4) dialeptic PNES characterized by unresponsiveness without motor manifestations (11.2%); (5) nonepileptic auras characterized by subjective sensations without any external manifestations, marked in the VEM records as ''seizure button presses'' (23.6%); and (6) mixed PNES where combinations of above seizure types were seen (5.2%). In a given patient, all the seizures belonged to a single type of PNES in 82% of cases. Discussion: PNES can be classified into six stereotypic categories. Contrary to common belief, PNES demonstrates stereotypy both within and across patients.

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Non-epileptic attack disorder: a clinical audit

Cited by 25 publications

References 15 publications

Postoperative pseudostatusNot everything that shakes is epilepsy

Postoperative pseudostatusNot everything that shakes is epilepsy

Nonepileptic Posttraumatic Seizures

Stereotypy of psychogenic nonepileptic seizures: Insights from video‐EEG monitoring

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