The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy

Kemp, Steven; Graham, Christopher D.; Chan, Rebecca; Kitchingman, Hayley; Vickerman, Kirsty; Reuber, Markus

doi:10.1111/epi.14040

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…The seizures of NES can be as disabling (Karakis et al, 2014) and as frequent (Kemp et al, 2018) as those in epilepsy, though their impact on driver safety is far less clear. Perhaps because of this, and certainly compounding it, the regulations are usually also less clear -to the extent that it may be unclear whether those regulations even exist.…”

Section: Can You Drive If You Have Non-epileptic Seizures?mentioning

confidence: 99%

“…This balances the safety of the public with the cost to the patient with epilepsy, and discussions around it often form a critical part of the ongoing management of epilepsy. But what about the other primary seizure disorder, nonepileptic seizures (NES)?The seizures of NES can be as disabling (Karakis et al, 2014) and as frequent (Kemp et al, 2018) as those in epilepsy, though their impact on driver safety is far less clear. Perhaps because of this, and certainly compounding it, the regulations are usually also less clear -to the extent that it may be unclear whether those regulations even exist.…”

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confidence: 99%

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The regulation of driving with non-epileptic seizures must be made clearer

Kanaan

Kozlowska

Lehn

2021

Aust N Z J Psychiatry

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Patients with epilepsy have their authorisation to drive restricted under detailed guidelines, but the rules for those with non-epileptic seizures are far less clear. We surveyed specialist clinicians in Australia and found little agreement as to whether such guidelines existed for non-epileptic seizures or what they might be. A number of possible interpretations of the Australian fitness to drive guidelines are explored, and these are often vague in themselves, as well as uncertain in their scope. This means clinicians making momentous driving decisions for their patients with non-epileptic seizures are doubly challenged, first in interpreting what guidelines exist, and second in what they mean. The International League Against Epilepsy proposed specific guidelines for driving with non-epileptic seizures, which reflect the range of presentations of non-epileptic seizures in a decision-making algorithm. We believe a specific algorithm such as this is essential in removing one level of uncertainty and responsibility for clinicians, and restoring equity for patients with non-epileptic seizures.

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Section: Can You Drive If You Have Non-epileptic Seizures?mentioning

confidence: 99%

mentioning

confidence: 99%

The regulation of driving with non-epileptic seizures must be made clearer

Kanaan

Kozlowska

Lehn

2021

Aust N Z J Psychiatry

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“…PNES episodes frequently occur in settings with others, including medical waiting rooms and examining rooms. These events "are much more common in patients with PNES than in those with epilepsy," and their providers should "have safe management plans in place" [48]. Green, Norman, and Reuber note that "patients with PNES report higher rates of trauma and neglect, poorer health-related quality of life (HRQoL), and an increased prevalence of insecure attachment" [49].…”

Section: Pnes: a Communication Disordermentioning

confidence: 99%

Breaking the spell: Narrative Medicine applications for Psychogenic Nonepileptic Seizures (PNES)

Slocum

2021

Seizure

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“…For instance, it has been reported that certain environments may make PNES more likely; PNES appear to occur more commonly than epileptic seizures during clinic attendances (and show greater response to suggestion when patients have experienced seizures in clinical settings). PNES are also more likely than epileptic seizures to happen in interpersonally challenging situations such as during psychotherapy sessions . One previous study examined the influence of social environment on ictal phenomena, finding that the intensification or alleviation of seizures by the presence of others is a specific marker of PNES .…”

Section: Introductionmentioning

confidence: 99%

Peri‐ictal responsiveness to the social environment is greater in psychogenic nonepileptic than epileptic seizures

Wardrope

Wong

McLaughlan³

et al. 2020

Epilepsia

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Objective: To look for evidence of peri-ictal social interaction in psychogenic nonepileptic seizures (PNES) and epileptic seizures exploring the notion of PNES as a form of nonverbal communication. Methods: Video recordings of typical seizures experienced by patients with epilepsy and PNES were obtained in a naturalistic social setting (residential epilepsy monitoring unit). Video analysis by three nonexpert clinicians identified 18 predefined semiological and interactional features indicative of apparent impairment of consciousness or of peri-ictal responsiveness to the social environment with assessment of interrater reliability using Fleiss κ. Features were compared between epileptic seizures and PNES. Results: One hundred eighty-nine seizures from 50 participants (24 epilepsy, 18 PNES, eight combined) were analyzed. At least fair (κ > 0.20) interrater agreement was achieved for 14 features. The PNES and epileptic seizures compared were of similar severity in terms of ictal impairment of consciousness (κ = 0.34, odds ratio [OR] = 1.11, 95% confidence interval [CI] = 0.62-1.96) and responsiveness (κ = 0.52, OR = 1.01, 95% CI = 0.55-1.86). PNES were more likely to be preceded by attempts to alert others (κ = 0.52, OR = 12.4, 95% CI = 3.2-47.7, P < .001), to show intensity affected by the presence of others (κ = 0.44, OR = 199.4, 95% CI = 12.0-3309.9, P < .001), and to display postictal behavior affected by the presence of others (κ = 0.35, OR = 91.1, 95% CI = 17.2-482.1, P < .001). Significance: Nonexpert raters can, with fair to moderate reliability, rate features characterizing ictal impairment of consciousness and responsivity in video recordings of seizures. PNES are associated with greater peri-ictal responsiveness to the social environment than epileptic seizures. These findings are consistent with a potential communicative function of PNES and could be of differential diagnostic significance. K E Y W O R D S communication, dissociative disorders, nonepileptic seizures, psychology | 759 WARDROPE Et Al. How to cite this article: Wardrope A, Wong S, McLaughlan J, Wolfe M, Oto M, Reuber M. Peri-ictal responsiveness to the social environment is greater in psychogenic nonepileptic than epileptic seizures. Epilepsia. 2020;61:758-765. https://doi.

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The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy

Cited by 14 publications

References 32 publications

The regulation of driving with non-epileptic seizures must be made clearer

The regulation of driving with non-epileptic seizures must be made clearer

Breaking the spell: Narrative Medicine applications for Psychogenic Nonepileptic Seizures (PNES)

Peri‐ictal responsiveness to the social environment is greater in psychogenic nonepileptic than epileptic seizures

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