Teddy bears: An observational finding in patients with non-epileptic events

Burneo, JG; Martin, Roy C.; Powell, Tykeysha; Greenlee, S.; Knowlton, Robert C.; Faught, R. Edward; Prasad, Asuri N.; Mendez, Mario F.; Kuzniecky, Ruben

doi:10.1212/wnl.61.5.714-a

Cited by 36 publications

(9 citation statements)

References 4 publications

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“…Patients with PNES with pure sensory phenomena or unresponsiveness were often excluded from the primary studies, and consequently information on these two types of PNES is scarce. Other potentially useful clinical signs such as ictal stuttering and the ‘teddy bear sign’ can be found in the literature; some of them have only been described by single authors and have not been included in our review 47 48. One of the criteria for inclusion was observation of events in the video-EEG monitoring unit.…”

Section: Discussionmentioning

confidence: 99%

Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?

Avberšek

Sisodiya

2010

Journal of Neurology, Neurosurgery & Psychiatry

206

116

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Psychogenic nonepileptic seizures (PNES) represent a diagnostic challenge. When trying to distinguish between PNES and epileptic seizures (ES), clinicians rely on the presence or absence of several clinical signs. Our purpose is to establish the extent to which these signs are supported by primary data from the literature. A Medline search was used to identify primary studies that used video-EEG to define the presence or absence of different clinical signs in PNES and ES. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. 34 studies matched the inclusion criteria. A specific sign was considered well supported by the data from the primary literature if we were able to identify at least two controlled studies demonstrating its usefulness and if the data from other studies were supportive. There is good evidence from the literature that long duration, occurrence from apparent sleep with EEG-verified wakefulness, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, closed eyes during the episode, ictal crying, memory recall and absence of postictal confusion are signs that distinguish PNES from ES. Post-ictal stertorous breathing proved to distinguish convulsive PNES from generalised tonic clonic seizures (GTCS) and should be added to the list of useful clinical signs. The final clinical diagnosis should encompass all available data, and should not rely on any single sign alone.

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Section: Discussionmentioning

confidence: 99%

Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?

Avberšek

Sisodiya

2010

Journal of Neurology, Neurosurgery & Psychiatry

206

116

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“…Seizure semiology is important in the diagnostic algorithm, and a plethora of features have been reported as being more likely associated with PNES. These have included a stable ictal heart rate (9), induction of the event with suggestion (10), eyes closed versus open, pelvic thrusting or “no‐no” head shaking during the event (11), and even the presence of a teddy bear brought in during EEG monitoring (12). However, none of these features alone is diagnostic of PNES, as all can be seen on occasions during epileptic seizures.…”

mentioning

confidence: 99%

“Convulsive” Nonepileptic Seizures Have a Characteristic Pattern of Rhythmic Artifact Distinguishing Them from Convulsive Epileptic Seizures

et al. 2004

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Summary:Purpose: Approximately 30% of patients admitted for video-EEG monitoring have psychogenic nonepileptic seizures (PNES). Differentiation of "convulsive" PNES from convulsive seizures can be difficult. The EEG often displays rhythmic movement artifact that may resemble seizure activity and confound the interpretation. We sought to determine whether time-frequency mapping of the rhythmic EEG artifact during "convulsive" PNES reveals a pattern that differs from that of epileptic seizures.Methods: EEGs from 15 consecutive patients with "convulsive" PNESs were studied with time-frequency mapping by using NEUROSCAN and compared with 15 patients with convulsive epileptic seizures. Fast Fourier transforms (FFTs) were performed to determine the dominant frequency for 1-to 2-s windows every 2 s through the seizures. Results:The dominant frequency remained stable within a narrow range for the duration of the PNES, whereas in the epileptic seizures, it evolved through a wide range. The coefficient of variation of the frequency during the seizures was considerably less for patients without epilepsy (median, 15.0%; range, 7.2-23.7% vs. median, 58.0%; range, 34.8-92.1%; p < 0.001). The median frequency did not differ significantly between groups (4.2 vs. 4.6 Hz; p = 0.290).Conclusions: "Convulsive" PNES display a characteristic pattern on time-frequency mapping of the EEG artifact, with a stable, nonevolving frequency that is different from the evolving pattern seen during an epileptic seizure. Key Words: Psychogenic nonepileptic seizures-Time-frequency mapping-EEG.Individuals with psychogenic nonepileptic seizures (PNES) have recurrent episodes of altered movement, sensation, or experience that resemble epileptic seizures but are not associated with abnormal electrical activity in the brain (1). The etiology of PNES remains unclear; however, they are presumed to relate to underlying psychogenic disturbances, with multiple factors including personality traits playing a role in both etiology and prognosis (2).PNES represent a common diagnostic and management problem, not just for the neurologist, but also for general practitioners, emergency departments, and other treating physicians. The estimated prevalence of PNES is between 2 to 33 per 100,000 individuals, making PNES one of the more common conversion disorders in the community (3).

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“…32 A high association exists between patients older than 14 years bringing soft toys (for example teddy bears) during video EEG (vEEG) monitoring and a diagnosis of PNES. 33 …”

Section: Historymentioning

confidence: 99%