The coexistence of psychogenic nonepileptic and epileptic seizures in the same patient is more frequent than expected: Is there any clinical feature for defining these patients?

Yon, Mehmet Ilker; Azman, Filiz; Tezer, F. İrsel; Saygı, Serap

doi:10.1016/j.yebeh.2020.106940

Cited by 15 publications

(17 citation statements)

References 24 publications

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“…Historically, functional motor disorders (FMDs) have been stigmatized as disorders of "mind" as opposed to the so-called "organic" disorders, which were considered the quintessential "brain" disorders. This dichotomy is misleading for two main reasons: several abnormalities in brain networks associated with motor control, sensory integration and emotional processing have been demonstrated in people with FMDs [1,2]; the boundaries between FMDs and other neurological disorders have become less defined, as FMDs may co-exist with other neurological disorders such as epilepsy, [3] Parkinson's disease (PD), [4][5][6][7] multiple sclerosis, [8] and stroke [9].…”

Section: Introductionmentioning

confidence: 99%

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of “organic” neurology

Tinazzi

Geroin

Erro

et al. 2021

Euro J of Neurology

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Background and purpose The aims of this study were to describe the clinical manifestations of functional motor disorders (FMDs) coexisting with other neurological diseases (“comorbid FMDs”), and to compare comorbid FMDs with FMDs not overlapping with other neurological diseases (“pure FMDs”). Methods For this multicenter observational study, we enrolled outpatients with a definite FMD diagnosis attending 25 tertiary movement disorder centers in Italy. Each patient with FMDs underwent a detailed clinical assessment including screening for other associated neurological conditions. Group comparisons (comorbid FMDs vs. pure FMDs) were performed in order to compare demographic and clinical variables. Logistic regression models were created to estimate the adjusted odds ratios (95% confidence intervals) of comorbid FMDs (dependent variable) in relation to sociodemographic and clinical characteristics (independent variables). Results Out of 410 FMDs, 21.7% of patients (n = 89) had comorbid FMDs. The most frequent coexisting neurological diseases were migraine, cerebrovascular disease and parkinsonism. In the majority of cases (86.5%), FMDs appeared after the diagnosis of a neurological disease. Patients with comorbid FMDs were older, and more frequently had tremor, non‐neurological comorbidities, paroxysmal non‐epileptic seizures, major depressive disorders, and benzodiazepine intake. Multivariate regression analysis showed that diagnosis of comorbid FMDs was more likely associated with longer time lag until the final diagnosis of FMD, presence of tremor and non‐neurological comorbidities. Conclusions Our findings highlight the need for prompt diagnosis of FMDs, given the relatively high frequency of associated neurological and non‐neurological diseases.

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Section: Introductionmentioning

confidence: 99%

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of “organic” neurology

Tinazzi

Geroin

Erro

et al. 2021

Euro J of Neurology

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“…There is conflicting evidence about the effect of the age of onset of epilepsy on the risk of subsequent PNES development. A later onset of epileptic seizures has been proposed as a predisposing factor for PNES development [14,15], but this was not confirmed in two other studies [5,8].…”

Section: Demographic Features Of Patients With Pnes and Epilepsymentioning

confidence: 84%

“…One study comparing similarly investigated groups of patients with epilepsy alone and patients with mixed epileptic/nonepileptic seizure disorder found that patients with mixed seizure disorder were more likely to have a low intelligence quotient (IQ) and neuropsychological deficits than those with epilepsy alone [8]. Yon et al reported a lower educational status in patients with comorbid PNES and epilepsy than those with PNES alone [5]. ID per se, the stigma and discrimination associated with this or institutional care settings may be additional risk factors [19,[33][34][35].…”

Section: Educational Level and Neuropsychological Impairmentsmentioning

confidence: 99%

“…Excessive or inappropriate use of ASMs and their adverse effects may lead to PNES in patients with epilepsy [5,31,32,36]. There is also some evidence that ASMs can worsen dissociative states acutely and prolong PNES 'status' [11].…”

Section: Treatment With Antiseizure Medicinesmentioning

confidence: 99%

“…These prevalence rates of mixed seizure disorders may be overestimates because many of the studies included in the meta-analysis used relatively broad definitions of epilepsy and PNES. Mixed seizure disorders are identified less commonly when more stringent diagostic criteria are applied-such as video-EEG documentation of both seizure types [5]. These percentages may also be overestimates because the majority of studies were from tertiary epilepsy centers where more complex cases would typically be referred.…”

mentioning

confidence: 99%

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Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis

Liampas

Markoula

Zis

et al. 2021

Acta Epileptologica

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Epilepsy is a risk factor for the development of psychogenic non-epileptic seizures (PNES) and comorbid epilepsy is recognized as a comorbidity in about 10–30% of patients with PNES. The combination of epileptic and nonepileptic seizures poses a particular diagnostic challenge. In patients with epilepsy, additional PNES may be suspected on the basis of their typical semiology. The possibility of additional PNES should also be considered if seizures fail to respond to antiepileptic drug treatment, in patients with frequent emergency admissions with seizures and in those who develop new types of seizures. The description of semiological details by patients and witnesses can suggest additional PNES. Home video recordings can support an initial diagnosis, however, especially in patients with mixed seizure disorders it is advisable to seek further diagnostic confirmation by capturing all habitual seizure types with video-EEG. The clinical features of PNES associated with epilepsy are similar to those in isolated PNES disorders and include longer duration, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, persistently closed eyes and mouth, ictal crying, recall of ictal experiences and absence of postictal confusion. PNES can also present as syncope-like episodes with unresponsiveness and reduced muscle tone. There is no unique epileptological or brain pathology profile putting patients with epilepsy at risk of additional PNES. However, patients with epilepsy and PNES typically have lower educational achievements and higher levels of psychiatric comorbidities than patients with epilepsy alone. Psychological trauma, including sexual abuse, appears to be a less relevant aetiological factor in patients with mixed seizure disorders than those with isolated PNES, and the gender imbalance (i.e. the greater prevalence in women) is less marked in patients with PNES and additional epilepsy than those with PNES alone. PNES sometimes develop after epilepsy surgery. A diagnosis of ‘known epilepsy’ should never be accepted without (at least brief) critical review. This narrative review summarises clinical, electrophysiological and historical features that can help identify patients with epilepsy and additional PNES.

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Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome

Müller‐Vahl,

Pisarenko,

Fremer

et al. 2023

Movement Disord Clin Pract

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BackgroundComorbid functional tic‐like behaviors (FTB) have been described only rarely in patients with Tourette syndrome (TS).ObjectivesWe present the first large sample of patients suffering from TS and FTB to raise awareness of this clinical presentation and to guide how to differentiate one from the other.MethodsWe analyzed clinical data of 71 patients (n = 27 [38.0%] female, mean age: 21.5, range: 11–55) with TS + FTB.ResultsIn the majority of patients, FTB started abruptly on average 15 years after tic onset with “treatment‐resistant” complex movements and (“coprophenomena‐like”) vocalizations preceded by timely related psychological stressors. Psychological evaluation revealed evidence for internal conflicts (79%), emotional dysregulation (56%), and maintaining factors (70%). About one third of patients had a positive history for further medically unexplained symptoms. Compared to a large TS sample (n = 1032), patients with TS + FTB were more likely to be female, and presented significantly more common with “coprophenomena‐like” symptoms, atypical influential factors, atypical descriptions of premonitory sensations, and higher rates of comorbid obsessive‐compulsive disorder and “self‐injurious” behavior.ConclusionsBased on our data it can be assumed that FTB is a common comorbidity in TS, similar to functional overlay in other movement disorders and epilepsy. Before classifying a patient as suffering from treatment‐resistant TS, FTB should be ruled out.

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The coexistence of psychogenic nonepileptic and epileptic seizures in the same patient is more frequent than expected: Is there any clinical feature for defining these patients?

Cited by 15 publications

References 24 publications

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of “organic” neurology

Functional motor disorders associated with other neurological diseases: Beyond the boundaries of “organic” neurology

Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis

Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome

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