Psychogenic nonepileptic seizures and chronic pain: A retrospective case-controlled study

Gazzola, Deana M.; Carlson, Chad; Rugino, Angela; Hirsch, Scott; Starner, K.; Devinsky, Orrin

doi:10.1016/j.yebeh.2012.10.008

Cited by 33 publications

(29 citation statements)

References 11 publications

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“…The association of chronic pain with PNES is well established [21, 25–28]. The prevalence of vestibular and coordination problems suggested by the presence of slurred speech, clumsiness, dizziness and vertigo in the top 10 may be related to increased reported side-effect burden in PNES [29].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

Kerr

Janio

Braesch

et al. 2017

Epilepsy & Behavior

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a b s t r a c t a r t i c l e i n f oObjective: Early and accurate diagnosis of patients with psychogenic nonepileptic seizures (PNES) leads to appropriate treatment and improves long-term seizure prognosis. However, this is complicated by the need to record seizures to make a definitive diagnosis. Suspicion for PNES can be raised through knowledge that patients with PNES have increased somatic sensitivity and report more positive complaints on review-of-systems questionnaires (RoSQs) than patients with epileptic seizures. If the responses on the RoSQ can differentiate PNES from other seizure types, then these forms could be an early screening tool. Methods: Our dataset included all patients admitted from January 2006 to June 2016 for videoelectroencephalography at UCLA. RoSQs prior to May 2015 were acquired through retrospective chart review (n = 405), whereas RoSQs from subsequent patients were acquired prospectively (n = 190). Controlling for sex and number of comorbidities, we used binomial regression to compare the total number of symptoms and the frequency of specific symptoms between five mutually exclusive groups of patients: epileptic seizures (ES), PNES, physiologic nonepileptic seizure-like events (PSLE), mixed PNES plus ES, and inconclusive monitoring. To determine the diagnostic utility of RoSQs to differentiate PNES only from ES only, we used multivariate logistic regression, controlling for sex and the number of medical comorbidities. Results: On average, patients with PNES or mixed PNES and ES reported more than twice as many symptoms than patients with isolated ES or PSLE (p b 0.001). The prospective accuracy to differentiate PNES from ES was not significantly higher than naïve assumption that all patients had ES (76% vs 70%, p N 0.1). Discussion: This analysis of RoSQs confirms that patients with PNES with and without comorbid ES report more symptoms on a population level than patients with epilepsy or PSLE. While these differences help describe the population of patients with PNES, the consistency of RoSQ responses was neither accurate nor specific enough to be used solely as an early screening tool for PNES. Our results suggest that the RoSQ may help differentiate PNES from ES only when, based on other information, the pre-test probability of PNES is at least 50%.

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Section: Discussionmentioning

confidence: 99%

Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

Kerr

Janio

Braesch

et al. 2017

Epilepsy & Behavior

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Section: Conversion Disorder and Associated Somatic Complaintsmentioning

confidence: 99%

“…For example, Kozlowska et al [7] found that symptoms of chronic pain and chronic fatigue were reported to present in 56 and 34%, respectively, of children diagnosed with conversion disorder. Additionally, chronic pain syndromes have been reported in patients with psychogenic nonepileptic seizures [7,8]. In fact, patients with psychogenic nonepileptic seizures have been found to experience a more severe form of migraine that is more frequent and longer in duration than patients with epilepsy [9].…”

Section: Conversion Disorder and Associated Somatic Complaintsmentioning

confidence: 99%

“…Studies have found that patients with psychogenic nonepileptic seizures had significantly higher rates of chronic pain disorders in addition to increased use of prescription pain medications compared to patients with epilepsy [7,11]. Similar to individuals with psychogenic nonepileptic seizures, studies have found that individuals with functional weakness/ paralysis also experience more severe levels of chronic pain than controls [12•].…”

Section: Conversion Disorder and Associated Somatic Complaintsmentioning

confidence: 99%

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Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment

Tsui

Deptula

Yuan

2017

Curr Pain Headache Rep

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Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

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“…1 Clinical features such as event provocation by stress or suggestion, reports of ability to control seizure activity, and preservation of consciousness during convulsive motor activity may lead ES to be incorrectly diagnosed as PNES. 4 Psychogenic nonepileptic seizures are associated with increased morbidity and mortality. Anti-seizure medication (ASM) overuse in PNES patients without comorbid ES can cause disabling side effects and exacerbate psychiatric comorbidities.…”

Section: Introductionmentioning

confidence: 99%

SUDEP in patients with epilepsy and nonepileptic seizures

2019

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We report 13 SUDEP cases in the North American SUDEP Registry with both psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) among a consecutive series of 231 cases (excluding epileptic encephalopathies). On average, cases of PNES + ES died at a younger age (23 ± 11 years) than the ES‐only cohort (30 ± 14 years), and died an average of 3 years after PNES diagnosis. We found no statistically significant confounding cardiac, respiratory, or psychiatric comorbidities and equal rates of anti‐seizure medication adherence, although there was a trend for higher rates of psychiatric disorders in the PNES group. Our findings confirm that patients with comorbid ES and PNES can die from SUDEP and that there may be a high‐risk period after the diagnosis of PNES is made in patients with comorbid ES. Such patients should be closely monitored and provided with coordinated care of both their epilepsy and psychiatric disorder(s).

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Psychogenic nonepileptic seizures and chronic pain: A retrospective case-controlled study

Cited by 33 publications

References 11 publications

Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment

SUDEP in patients with epilepsy and nonepileptic seizures

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