The neuropsychological and neurophysiological profile of women with pseudoseizure

Almış, Behice Han; Cumurcu, Birgül Elbozan; Ünal, Süheyla; Ozcan, A. Cemal; Aytaş, Özgür

doi:10.1016/j.comppsych.2012.12.027

Cited by 16 publications

(14 citation statements)

References 37 publications

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“…As such, it is unclear whether these findings indicate an active avoidance of emotional material, which is a central component of the original conversion and somatization models, or something less motivated, such as a heightened awareness of normal bodily events. Evidence suggesting a link between PNES and problems filtering out irrelevant stimuli (Pouretemad, Thompson, & Fenwick, 1998;Almis, Cumurcu, Unal, Ozcan, & Aytas, 2013) could be seen as more consistent with the latter interpretation.…”

Section: Somatization and Emotional Processingmentioning

confidence: 63%

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Brown

Reuber

2016

Clinical Psychology Review

217

208

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Current models of PNES can account for some but not all of the available data.• Automatic activation of seizure representations in memory may be a unifying process.• Suppression of arousal and distress are typical maintaining factors for PNES.• Inhibitory dysfunction, often arising from chronic stress, is a key vulnerability. • Trauma exposure is common but neither necessary nor sufficient for PNES to occur. a b s t r a c tPsychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on a brief review of the literature on etiology, correlates and phenomenology of PNES, this paper integrates existing approaches and data within a novel explanatory framework that applies to all PNES patients with subjectively involuntary seizures. Following the Integrative Cognitive Model of medically unexplained symptoms, we suggest that the central feature of all PNES is the automatic activation of a mental representation of seizures (the "seizure scaffold") in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual's awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts both for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.

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Section: Somatization and Emotional Processingmentioning

confidence: 63%

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Brown

Reuber

2016

Clinical Psychology Review

217

208

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“…Thirty-one studies included adult subjects (mean age 37.1 yrs, range 18-77yrs) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][44][45][46][48][49][50][51][52][54][55][56][57][58][59][60] , whereas the remaining three studies came from a paediatric setting (mean age 13.7 yrs, range 9-18 yrs) 43,47,53 . In both the cases and control samples, most subjects were female (79.7% cases vs 72.2% controls).…”

Section: Included Studiesmentioning

confidence: 99%

“…In 25 out of 34 studies the patients were recruited from a neurology setting 27,[29][30][31][32]34,35,[37][38][39][40][41][43][44][45][46][47][48][49][50]52,55,57,58,60 , eight came from psychiatry 28,33,36,42,51,53,54,56 and one study came from a mixed setting 59 . Eighteen studies out of 34 compared the functional patient group with a neurological disease control group 27,29,30,32,34,35,[37][38][39][40][44][45][46]48,[50][51]…”

Section: Included Studiesmentioning

confidence: 99%

“…Fourteen studies reported whether stressors had taken place at any moment in life [30][31][32][33]35,36,38,39,41,48,51,56,59,60 . Two studies specifically reported on stressors in adulthood 49,52 , while eleven studies reported on those having occurred during childhood [27][28][29]37,40,[42][43][44]47,53,58 . Seven studies presented separate rates for stressors occurred during childhood and for those occurred during lifetime or adulthood 34,45,46,50,54,55,57 .…”

Section: Included Studiesmentioning

confidence: 99%

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Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies

Ludwig

Pasman

Nicholson

et al. 2018

The Lancet Psychiatry

323

200

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“…Desynchronization of information integration circuits leads to an emotion regulation and executive control failure where PFC and other related areas are unable to stop the underlying limbic avalanche (Lanius et al, 2014b). In this context, high emotional reactivity arises, consistent with well-known clinical features and personality manifestations in conversion patients suffering from pseudoseizures (Galimberti et al, 2003;Almis et al, 2013).…”

Section: Pseudoseizuresmentioning

confidence: 84%

Excitatory and inhibitory conversive experiences: neurobiological features involving positive and negative conversion symptoms

Río-Casanova

González

Páramo

et al. 2016

Reviews in the Neurosciences

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AbstractPrevious reviews have focused on neurobiological and physiological mechanisms underlying conversion disorder, but they do not usually distinguish between negative and positive conversion symptoms. Some authors have proposed that different phenomena should underlie both situations and that diverse emotion regulation strategies (under- vs. overregulation of affect) should be related to different internal experiences (excitatory experiences with hyperarousal manifestations vs. inhibitory experiences coexisting with hypoarousal states, respectively). After a careful review of the literature, we conclude that there is not a unique theory comprising all findings. Nevertheless, we have also collected some replicated findings that should be salient. Patients manifesting positive conversion symptoms tended to present with limbic hyperfunction, not sufficiently counteracted by prefrontal control. This leads to underregulation of affect mechanisms, increased emotional reactivity and autonomic hyperarousal. The opposite pattern (with a prefrontal overfunction working as a cognitive brake over the limbic system) has been described during negative conversion manifestations. We also highlight the influence of fronto-limbic circuits over cortico-striato-thalamo-cortical circuits’ regulation, whose horizontal and vertical synchronization has been at the spotlight of the genesis of conversion and dissociative disorders.

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The neuropsychological and neurophysiological profile of women with pseudoseizure

Cited by 16 publications

References 37 publications

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies

Excitatory and inhibitory conversive experiences: neurobiological features involving positive and negative conversion symptoms

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