Translating Phenomenology of Psychogenic Nonepileptic Seizures Into Nosology: Insights From Patients' and Caregivers' Profiles.
Journal
The neurologist
ISSN: 2331-2637
Titre abrégé: Neurologist
Pays: United States
ID NLM: 9503763
Informations de publication
Date de publication:
01 May 2022
01 May 2022
Historique:
pubmed:
3
12
2021
medline:
10
5
2022
entrez:
2
12
2021
Statut:
epublish
Résumé
Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology. Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables. Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures. Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology.
METHODS
METHODS
Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables.
RESULTS
RESULTS
Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures.
CONCLUSIONS
CONCLUSIONS
Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.
Identifiants
pubmed: 34855664
doi: 10.1097/NRL.0000000000000378
pii: 00127893-202205000-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100-105Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
LaFrance WC Jr, Barry JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav. 2005;7:364–374.
LaFrance WC Jr, Alosco ML, Davis JD, et al. Impact of family functioning on quality of life in patients with psychogenic nonepileptic seizures versus epilepsy. Epilepsia. 2011;52:292–300.
Karakis I, Morton ML, Janocko NJ, et al. Caregiver burden in psychogenic non-epileptic seizures. Seizure. 2020;81:13–17.
Karakis I, Janocko NJ, Morton ML, et al. Stigma in psychogenic nonepileptic seizures. Epilepsy Behav. 2020;111:107269.
Dhiman V, Sinha S, Rawat VS, et al. Children with psychogenic non-epileptic seizures (PNES): a detailed semiologic analysis and modified new classification. Brain Dev. 2014;36:287–293.
Dikmen PY, Unlusoy Acar Z, Gurses C. Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification. Neurol Res. 2013;35:1070–1075.
Groppel G, Kapitany T, Baumgartner C. Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia. 2000;41:610–614.
Hubsch C, Baumann C, Hingray C, et al. Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J Neurol Neurosurg Psychiatry. 2011;82:955–960.
Magaudda A, Lagana A, Calamuneri A, et al. Validation of a novel classification model of psychogenic nonepileptic seizures by video-EEG analysis and a machine learning approach. Epilepsy Behav. 2016;60:197–201.
Szabo L, Siegler Z, Zubek L, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012;53:565–570.
Wadwekar V, Nair PP, Murgai A, et al. Semiologic classification of psychogenic non epileptic seizures (PNES) based on video EEG analysis: do we need new classification systems? Seizure. 2014;23:222–226.
Abubakr A, Kablinger A, Caldito G. Psychogenic seizures: clinical features and psychological analysis. Epilepsy Behav. 2003;4:241–245.
Hill SW, Gale SD. Neuropsychological characteristics of nonepileptic seizure semiological subgroups. Epilepsy Behav. 2011;22:255–260.
Griffith NM, Szaflarski JP, Schefft BK, et al. Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile. Epilepsy Behav. 2007;11:105–111.
Griffith NM, Smith KM, Schefft BK, et al. Optimism, pessimism, and neuropsychological performance across semiology-based subtypes of psychogenic nonepileptic seizures. Epilepsy Behav. 2008;13:478–484.
Baslet G, Tolchin B, Dworetzky BA. Altered responsiveness in psychogenic nonepileptic seizures and its implication to underlying psychopathology. Seizure. 2017;52:162–168.
Jawad SS, Jamil N, Clarke EJ, et al. Psychiatric morbidity and psychodynamics of patients with convulsive pseudoseizures. Seizure. 1995;4:201–206.
Wilkus RJ, Dodrill CB. Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients. Epilepsia. 1989;30:339–347.
Vanderzant CW, Giordani B, Berent S, et al. Personality of patients with pseudoseizures. Neurology. 1986;36:664–668.
Meierkord H, Will B, Fish D, et al. The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology. 1991;41:1643–1646.
Selwa LM, Geyer J, Nikakhtar N, et al. Nonepileptic seizure outcome varies by type of spell and duration of illness. Epilepsia. 2000;41:1330–1334.
Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–897.
Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation; 1993.
Cramer JA, Perrine K, Devinsky O, et al. Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory. Epilepsia. 1998;39:81–88.
Karakis I, Cole AJ, Montouris GD, et al. Caregiver burden in epilepsy: determinants and impact. Epilepsy Res Treat. 2014;2014:808421.
Groover O, Morton ML, Janocko NJ, et al. Mind the gap: health disparities in families living with epilepsy are significant and linked to socioeconomic status. Epileptic Disord. 2020;22:782–789.
Karakis I, Montouris GD, Piperidou C, et al. Patient and caregiver quality of life in psychogenic non-epileptic seizures compared to epileptic seizures. Seizure. 2014;23:47–54.
Teagarden DL, Morton ML, Janocko NJ, et al. Socioeconomic disparities in patients with psychogenic nonepileptic seizures and their caregivers. Epilepsy Behav. 2020:107160.
Baker GA, Smith DF, Dewey M, et al. The initial development of a health-related quality of life model as an outcome measure in epilepsy. Epilepsy Res. 1993;16:65–81.
Jarvie S, Espie CA, Brodie MJ. The development of a questionnaire to assess knowledge of epilepsy: 2--Knowledge of own condition. Seizure. 1993;2:187–193.
Jacoby A. Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med. 1994;38:269–274.
Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980;20:649–655.
Hoerth MT, Wellik KE, Demaerschalk BM, et al. Clinical predictors of psychogenic nonepileptic seizures. Neurologist. 2008;14:266–270.
Drane DL, Coady E, Williamson DJ, et al. Schoenberg MR, Scott J. Little black book of neuropsychlogy. Neuropsychological Assessment of Patients With Psychogenic Nonepileptic Seizures. New York, NY: Springer; 2011.
Asadi-Pooya AA, Brigo F, Mesraoua B, et al. Clinical characteristics of functional (psychogenic nonepileptic) seizures: an international retrospective study. Epilepsy Behav. 2020;111:107197.
Asadi-Pooya AA, Alsaadi T, Gigineishvili D, et al. Social aspects of life in patients with functional (psychogenic nonepileptic) seizures: an international study. Epilepsy Behav. 2020;113:107534.
Asadi-Pooya AA, Mesraoua B, Hingray C, et al. Marital status in patients with functional (psychogenic nonepileptic) seizures: an international study. Epilepsy Behav. 2020;112:107461.
Asadi-Pooya AA. Semiological classification of psychogenic nonepileptic seizures: a systematic review and a new proposal. Epilepsy Behav. 2019;100(pt A):106412.
Gale SD, Hill SW, Pearson C. Seizure semiology in males with psychogenic nonepileptic seizures is associated with somatic complaints. Epilepsy Res. 2015;115:153–157.
Betts T, Boden S. Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part II. Previous childhood sexual abuse in the aetiology of these disorders. Seizure. 1992;1:27–32.
Chen DK, Izadyar S. Characteristics of psychogenic nonepileptic events among veterans with posttraumatic stress disorder: an association of semiology with the nature of trauma. Epilepsy Behav. 2010;17:188–192.
Krawetz P, Fleisher W, Pillay N, et al. Family functioning in subjects with pseudoseizures and epilepsy. J Nerv Ment Dis. 2001;189:38–43.
Wood BL, McDaniel S, Burchfiel K, et al. Factors distinguishing families of patients with psychogenic seizures from families of patients with epilepsy. Epilepsia. 1998;39:432–437.
Moore PM, Baker GA, McDade G, et al. Epilepsy, pseudoseizures and perceived family characteristics: a controlled study. Epilepsy Res. 1994;18:75–83.
Duwicquet C, de Toffol B, Corcia P, et al. Are the clinical classifications for psychogenic nonepileptic seizures reliable? Epilepsy Behav. 2017;77:53–57.
Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures-Phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2017;44:199–205.
Baker GA, Brooks J, Buck D, et al. The stigma of epilepsy: a European perspective. Epilepsia. 2000;41:98–104.