Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case–control study

Wissel, Benjamin D.; Dwivedi, Alok; Gaston, Tyler E.; Rodríguez‐Porcel, Federico; Aljaafari, Danah; Hopp, Jennifer L.; Krumholz, Allan; Salm, Sandra; Andrade, Danielle M.; Borlot, Felippe; Moseley, Brian D.; Cavitt, Jennifer; Williams, Stevie; Stone, Jon; LaFrance, W. Curt; Szaflarski, Jerzy P.; Espay, Alberto J.

doi:10.1016/j.yebeh.2016.05.032

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…In contrast to the left-sided predominance of motor symptoms (right hemispheric involvement) ascertained for patients with epileptic seizures complicating their course with non-epileptic seizures (psychogenic non-epileptic seizures (PNES)),2 no differences on lateralisation of symptoms were demonstrated in our PD-FND cohort. Right-sided PD onset was more common across both groups but there was similar frequency of left-sided and right-sided onset of functional symptoms and these were more likely to appear in the more affected side.…”

Section: Discussioncontrasting

confidence: 74%

Functional neurological disorders in Parkinson disease

Wissel

Dwivedi

Merola

et al. 2018

J Neurol Neurosurg Psychiatry

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Section: Discussioncontrasting

confidence: 74%

Functional neurological disorders in Parkinson disease

Wissel

Dwivedi

Merola

et al. 2018

J Neurol Neurosurg Psychiatry

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“…Furthermore, our group has reported that in animal models of Rett's syndrome short duration SEDs were associated with non-life-threatening conditions whereas longer duration SEDs showed worse clinical outcomes, and the improvement in the prognosis was concurrent with their decline [2]. Also, another recent study compared psychogenic non-epileptic seizures (PNES) with epileptic seizures (ES) in patients found that longer duration discharges were associated with ES alone, whereas less severe combined ES and psychogenic seizures were of shorter durations [39]. These results suggest a link between excitability, symptom severity, and SED duration, that we explore further in our study.…”

Section: Discussionmentioning

confidence: 99%

Low-to-High Cross-Frequency Coupling in the Electrical Rhythms as Biomarker for Hyperexcitable Neuroglial Networks of the Brain

Grigorovsky

Bardakjian

2018

IEEE Trans. Biomed. Eng.

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Publisher's Statement © 2017 IEEE. Personal use of this material is permitted.Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works. How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters.0018-9294 (c) 2017 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission. See http://www.ieee.org/publications_standards/publications/rights/index.html for more information. This article has been accepted for publication in a future issue of this journal, but has not been fully edited. Content may change prior to final publication. Citation information: DOI 10.1109/TBME. Abstract-Objective: One of the features used in the study of hyperexcitablility are high frequency oscillations (HFOs, >80Hz). HFOs have been reported in the electrical rhythms of the brain's neuro-glial networks under physiological and pathological conditions. Cross-frequency coupling (CFC) of HFOs with low frequency rhythms was used to identify pathologic HFOs (pHFOs) (i) in the epileptogenic zones of epileptic patients, and (ii) as a biomarker for the severity of seizure-like events in genetically modified rodent models. We describe a model to replicate reported CFC features extracted from recorded local field potentials (LFPs) representing network properties. Methods: This study deals with a 4-unit neuro-glial cellular network model where each unit incorporates pyramidal cells, interneurons and astrocytes. Three different pathways of hyperexcitability generation -Na + -K + ATPase pump, glial potassium clearance, and potassium afterhyperpolarization channel -were used to generate LFPs. Changes in excitability, average spontaneous electrical discharge (SED) duration and CFC were then measured and analyzed. Results: Each parameter caused an increase in network excitability and the consequent lengthening of the SED duration. Short SEDs showed CFC between HFOs and theta oscillations (4-8 Hz), but in longer SEDs the low frequency changed to the delta range (1-4 Hz). Conclusion: Longer duration SEDs exhibit CFC features similar to those reported by our team. Significance: (i) Identifying the exponential relationship between network excitability and SED durations, (ii) highlighting the importance of glia in hyperexcitability (as they relate to extracellular potassium), and (iii) elucidation of the ...

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“…Furthermore, PNES may, in a proportion of individuals, coexist with epileptic seizures. If the two different events are not recognized and distinguished, this may further complicate the assessment of therapeutic success and failures . Such diagnostic errors cannot usually be definitively corrected without a video‐monitoring evaluation in which a stereotypical episode is recorded.…”

Section: A Critical Look At the Bidirectional Hypothesismentioning

confidence: 99%

“…If the two different events are not recognized and distinguished, this may further complicate the assessment of therapeutic success and failures. 62,86 Such diagnostic errors cannot usually be definitively corrected without a video-monitoring evaluation in which a stereotypical episode is recorded. Judging from the results reported from EMUs, these individuals may represent a substantial proportion of the patients in the population with "uncontrolled" "epilepsy."…”

Section: Impact On Epidemiologic Studiesmentioning

confidence: 99%

Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal

2017

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Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. The literature upon which most of the field relies contains some biases that must be carefully examined and resolved in future studies: (1) In the pediatric epilepsy literature, many reports find children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. Most of these studies rely on parent-proxy completed instruments to assess these behavioral endpoints. Parents’ reports are not objective but reflect parents’ reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. (2) Peri-ictal phenomena may be mischaracterized as underlying mood disorders. (3) Many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and PNES need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to insure appropriate therapy and avoid unnecessary and potentially harmful treatments and avoid common misconceptions.

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Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case–control study

Abstract: Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.

Cited by 30 publications

References 24 publications

Functional neurological disorders in Parkinson disease

Functional neurological disorders in Parkinson disease

Low-to-High Cross-Frequency Coupling in the Electrical Rhythms as Biomarker for Hyperexcitable Neuroglial Networks of the Brain

Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal

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