Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth

LaFrance, W. Curt; Ho, Wing Lam N.; Bhatla, Alana; Baird, Grayson L.; Altalib, Hamada; Godleski, Linda

doi:10.1111/epi.16689

Cited by 33 publications

(21 citation statements)

References 47 publications

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“…Conversely, a patient with sudden onset disabling physical symptoms may need to make some initial progress with physical therapy (eg, to regain sitting balance) before engaging well in psychotherapy. Additional research should explore the development of techrehabilitation adjuncts (informed by advances in elucidating mFND pathophysiology) and innovations to improve access to specialist treatment (eg, tele/remote health as has been used in other FND subtypes, 50 virtual reality, wearable technology, biofeedback, TMS, etc). More aggressive focus on psychosocial factors might also be useful.…”

Section: Future Directionsmentioning

confidence: 99%

Decade of progress in motor functional neurological disorder: continuing the momentum

Perez

Edwards

Nielsen

et al. 2021

J Neurol Neurosurg Psychiatry

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Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurology–psychiatry intersection. After being marginalised in the late 20th century, there has been renewed interest in this field. In this article, we review advances that have occurred over the past decade (2011–2020) across diagnosis, mechanisms, aetiologies, treatments and stigma in patients with motor FND (mFND, that is, functional movement disorder and functional limb weakness). In each content area, we also discuss the implications of recent advances and suggest future directions that will help continue the momentum of the past decade. In diagnosis, a major advance has been the emphasis on rule-in physical signs that are specific for hyperkinetic and hypokinetic functional motor symptoms. Mechanistically, greater importance has been given to determining ‘how’ functional neurological symptoms develop, highlighting roles for misdirected attention, expectation and self-agency, as well as abnormal influences of emotion/threat processing brain areas on motor control circuits. Aetiologically, while roles for adverse life experiences remain of interest in mFND, there is recognition of other aetiologic contributors, and efforts are needed to investigate links between aetiological factors and mechanisms. This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. Across patients, clinicians, healthcare systems and society, stigma remains a major concern. While challenges persist, a patient-centred integrated clinical neuroscience approach is primed to carry forward the momentum of the past decade into the future.

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Section: Future Directionsmentioning

confidence: 99%

Decade of progress in motor functional neurological disorder: continuing the momentum

Perez

Edwards

Nielsen

et al. 2021

J Neurol Neurosurg Psychiatry

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“…Scattered evidence suggests that rehabilitation might further decrease healthcare costs by reducing symptom severity and improving quality of life (34,35). Nielsen et al (2017) found an improvement in motor symptoms in 72% of the patients attending physiotherapy (n = 30) compared with 18% of patients who did not (n = 30) over 6 months (34).…”

Section: Discussionmentioning

confidence: 99%

Economic Costs of Delayed Diagnosis of Functional Motor Disorders: Preliminary Results From a Cohort of Patients of a Specialized Clinic

et al. 2021

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Background: Functional motor disorders (FMDs) are prevalent and highly disabling conditions in young adults that can result in reduced independence. Despite advances in diagnosis and treatment, the economic burden of FMDs is largely unknown.Objective: This pilot retrospective study provides a real-world overview of the economic costs related to delayed diagnosis of FMDs from a cohort of patients of a specialized clinic in Italy, based on Italian healthcare costs.Methods: Sociodemographic data, clinical history, healthcare service utilization, and associated direct costs were collected for a period of up to 5 years before a definite diagnosis of FMDs in 40 patients.Results: The mean time lag between the onset of FMDs symptoms and diagnosis was 6.63 years (±8.57). The mean annual use of recourses per patient was three specialist visits (95% CI 2.4–3.4) and three diagnostic examinations (95% CI 2.2–3.6) that made up a total of six investigations and over seven (95% CI 5.5–9.7) rehabilitation contacts per year per patient were used before a diagnosis of FMDs was established. In more than 50% of the cases, patients had been hospitalized or made an ER visit at least once before receiving the correct diagnosis. The average annual costs for delayed diagnosis, taking into account only direct healthcare costs (without medications), was about €2,302 (CI 95% €1,570–2,830) per patient [€1,524 covered by the NHS (CI 95% €1,214–1,834) and € 778 by the patient (CI 95% €606–960)]. Hospitalization accounted for €916 (CI 95% €670–1,160) per patient per year, followed by rehabilitation €493 (CI 95% €345–641) and diagnostic tests € 387 (CI 95% €314–460).Conclusion: These preliminary results shed some light on the high healthcare services volume and direct healthcare costs from clinic to clinic for visits, unnecessary tests, and prescribed treatments in a real-world overview from a cohort of patients of a specialized clinic in Italy. It may represent a starting point for future studies to statistically test and quantify cost reduction after implementing appropriate healthcare pathways.

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“…The intervention was 12 sessions of weekly manual-based psychotherapy given through video telehealth. Seizure reduction after treatment was 46% ( p = 0.0001) per month over the course of treatment [48] .…”

Section: Cbt Teletherapy For Fndmentioning

confidence: 94%

Remote delivery of cognitive behavioral therapy to patients with functional neurological disorders: Promise and challenges

Lin

Espay

2021

Epilepsy & Behavior Reports

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Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth

Cited by 33 publications

References 47 publications

Decade of progress in motor functional neurological disorder: continuing the momentum

Decade of progress in motor functional neurological disorder: continuing the momentum

Economic Costs of Delayed Diagnosis of Functional Motor Disorders: Preliminary Results From a Cohort of Patients of a Specialized Clinic

Remote delivery of cognitive behavioral therapy to patients with functional neurological disorders: Promise and challenges

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