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 none...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.展开更多
Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the g...Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be completed.The issue is further complicated in cases of combined PNES with ES.In emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging investigations.Outside of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.Early recognition is thus desirable to initiate adequate treatment and improve prognosis.Considering experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and neuropsychiatrists.In such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be inaccurate.Thorough analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence level.Indeed,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of PNES.Moreover,induction and/or inhibition tests of PNES have a good diagnostic value when positive.Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic seizures.Finally,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.展开更多
Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencepha...Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.展开更多
文摘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.
文摘Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be completed.The issue is further complicated in cases of combined PNES with ES.In emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging investigations.Outside of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.Early recognition is thus desirable to initiate adequate treatment and improve prognosis.Considering experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and neuropsychiatrists.In such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be inaccurate.Thorough analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence level.Indeed,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of PNES.Moreover,induction and/or inhibition tests of PNES have a good diagnostic value when positive.Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic seizures.Finally,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.
文摘Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.
