Characteristics of patients with nonepileptic seizures

doi:10.1016/0896-6974(91)90080-3

Journal of Epilepsy

Volume 4, Issue 4, 1991, Pages 225-229

Journal of Epilepsy

https://doi.org/10.1016/0896-6974(91)90080-3 Get rights and content

Abstract

The personality features, neuropsychological data, and ictal characteristics of 23 patients with nonepileptic seizures (NES) were compared to 25 patients with EEG-confirmed epileptic seizure (ES) disorders. A distinctive pattern of seizure, behavior, and personality features was evident in NES patients. NES was characterized by later disease onset and shorter disease duration. NES tends to last significantly longer than ES and rarely results in tongue-biting or self-injury. Patients who develop NES frequently have witnessed seizures prior to developing the disorder and have greater somatic concerns than patients with ES. Neuropsychological group data failed to differentiate NES from ES. However, the absence of group differences may reflect heterogeneity within the NES population. Although many NES patients performed well within normal limits on all neuropsychological measures, most were mildly to severely impaired. Qualitative analysis of neuropsychological data also revealed inconsistencies within the NES group. These findings suggest that a more global neurobehavioral profile may be useful in the diagnosis of NES. Future studies of NES must also recognize that important individual differences may be masked within group data.

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Cited by (52)

Optimism and pessimism as predictors of seizure group among patients with intractable seizure disorders
2023, Epilepsy and Behavior
The purpose of this study was to investigate the validity of the Revised Optimism-Pessimism Scale (PSM-R) as a measure of attributional style, and the incremental utility of optimism and pessimism as predictors of seizure group, in an intractable seizure disorder sample. Participants included adult patients with epileptic seizures (ES; n = 151) and psychogenic nonepileptic seizures (PNES; n = 173) whose diagnoses were confirmed by prolonged video/EEG monitoring (PVEM). Optimism and pessimism scores were computed from abbreviated versions of the MMPI for all participants. Analyses were conducted to examine the relationships between optimism, pessimism, and MMPI clinical scale scores. Logistic regression analyses were conducted to generate a model for the prediction of seizure group. Results supported the validity of the PSM-R as a measure of attributional style in an intractable seizure disorder sample. Both optimism and pessimism provided significant incremental predictive utility over and above other predictors of seizure group. There are advantages of using the proposed prediction model over other alternative differential diagnostic procedures, including lower cost, greater availability, and increased standardization. Overall, results indicated that attributional style is a clinically relevant index of personality and cognitive response to stress among an intractable seizure disorder sample.
How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures?
2017, Epilepsy and Behavior
Citation Excerpt :
Being an objective measure, ictal (seizure) duration is a unique semiological sign. Several studies have found that ictal duration is significantly longer in PNES compared with ES (Table 1) [8–14]. However, only one study presents diagnostic accuracy at a single threshold [15], and none of the studies, as summarized in Table 1, provides information on the overall diagnostic accuracy of the ictal duration as a test.
We sought to investigate (1) differences in ictal duration between psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES), (2) the odds of being PNES when seizures last ≥ 5 min, and (3) the value of ictal duration as a diagnostic test to differentiate PNES from ES. We retrospectively reviewed video-EEG recordings and tabulated ictal durations of all PNES and ES. We estimated the mean ictal durations of PNES and ES using linear mixed models. The odds of being PNES when seizures last ≥ 5 min were estimated using logistic regression. We used receiver operating characteristics (ROC) curves to study the overall diagnostic accuracy of ictal duration in differentiating PNES from ES. We studied 441 ES and 341 PNES recorded from 138 patients. The mean ictal duration of PNES (148.7 s, 95% CI: 115.2–191.8) was significantly longer (p < 0.001) than that of ES (47.7 s, 95% CI: 37.6–60.6). The odds of being PNES was about 24 times higher (Odds ratio: 23.8, 95% CI: 7.9–71.3) when the ictal duration was ≥ 5 min. The ROC curve yielded an area under the curve of 0.80 (95% CI 0.73–0.88). Youden's index identified 123.5 s as the optimal threshold to diagnose PNES with 65% sensitivity and 93% specificity. Our results indicate that ictal duration is a useful test to raise suspicion of PNES. When a seizure lasts ≥ 5 min, it is 24 times more likely to be PNES with the potential risk of misdiagnosis as status epilepticus.
Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review
2016, Clinical Psychology Review
Psychogenic non-epileptic seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
Neurologic diagnostic criteria for functional neurologic disorders
2016, Handbook of Clinical Neurology
The diagnosis of functional neurologic disorders can be challenging. In this chapter we review the diagnostic criteria and rating scales reported for functional/psychogenic sensorimotor disturbances, psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD). A recently published scale for sensorimotor signs has some limitations, but may help in the diagnosis, and four motor and two sensory signs have been reported as highly reliable. There is good evidence using eight specific signs for the differentiation of PNES from seizures. Recently, diagnostic criteria were developed for PNES; their sensitivity and specificity need to be evaluated. The definitive diagnosis of PNES can be made by recording typical positive features during the spells, and in a low proportion of cases, where the distinction with an organic etiology cannot easily be done, a normal electroencephalogram suggests the diagnosis. FMD diagnosis relies on diagnostic criteria, which have been refined over time and may be supplemented by laboratory tests in some phenotypes. Rating scales for PNES and FMD could be useful for severity measures, but several limitations remain to be addressed.
Biopsychosocial predictors of psychogenic non-epileptic seizures
2014, Epilepsy Research
Previous studies have identified numerous biological, psychological and social characteristics of persons with psychogenic non-epileptic seizures (PNES) however the strength of many of these factors have not been evaluated to determine which are predictive of the diagnosis compared to those that may only be stereotypes with limited clinical utility.
A retrospective chart review of persons admitted to our epilepsy monitoring unit over a 6-year period was conducted to examine predictors of a video-EEG confirmed PNES diagnosis.
A total of 689 patients had events leading to a diagnosis, 47% (n = 324) with PNES only, 12% (n = 84) with PNES & Epilepsy and 41% (n = 281) with Epilepsy only. Five biological predictors of a PNES only diagnosis were found; number of years with events (OR = 1.10), history of head injury (OR = 1.91), asthma (OR = 2.94), gastro-esophageal reflux disease (OR = 1.72) and pain (OR = 2.25). One psychological predictor; anxiety (OR = 1.72) and two social predictors; being married (OR = 1.81) and history of physical/sexual abuse (OR = 3.35). Two significant biological predictors of a PNES & Epilepsy diagnosis were found; migraine (OR = 1.83) and gastro-esophageal reflux disease (OR = 2.17).
Our findings support the importance of considering the biopsychosocial model for the diagnosis and treatment of PNES or PNES with concomitant epilepsy.
Subgroup classification in patients with psychogenic non-epileptic seizures
2013, Epilepsy and Behavior
Citation Excerpt :
In a small group of PNES patients, the communication of the PNES diagnosis in a clear, empathic way will result in seizure reduction [7,17–19]. However, patients with PNES comprise a very heterogeneous patient group [20–24]. Several studies report that for many PNES patients, the long-term prognosis is not good.
In this open non-controlled clinical cohort study, the applicability of a theoretical model for the diagnosis of psychogenic non-epileptic seizures (PNES) was studied in order to define a general psychological profile and to specify possible subgroups.
Forty PNES patients were assessed with a PNES “test battery” consisting of eleven psychological instruments, e.g., a trauma checklist, the global cognitive level, mental flexibility, speed of information processing, personality factors, dissociation, daily hassles and stress and coping factors.
The total PNES group was characterized by multiple trauma, personality vulnerability (in a lesser extent, neuropsychological vulnerabilities), no increased dissociation, many complaints about daily hassles that may trigger seizures and negative coping strategies that may contribute to prolongation of the seizures. Using factor analysis, specific subgroups were revealed: a ‘psychotrauma subgroup’, a ‘high vulnerability somatizing subgroup’ (with high and low cognitive levels) and a ‘high vulnerability sensitive personality problem subgroup’.
Using a theoretical model in PNES diagnosis, PNES seem to be a symptom of distinct underlying etiological factors with different accents in the model. Hence, describing a general profile seems to conceal specific subgroups with subsequent treatment implications. This study identified three factors, representing two dimensions of the model, that are essential for subgroup classification: psychological etiology (psychotrauma or not), vulnerability, e.g., the somatization tendency, and sensitive personality problems/characteristics (‘novelty seeking’). For treatment, this means that interventions could be tailored to the main underlying etiological problem. Also, further research could focus on differentiating subgroups with subsequent treatment indications and possible different prognoses.
This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.

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Characteristics of patients with nonepileptic seizures

Abstract

Psychosomatics

Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures

Epilepsia

Personality of patients with pseudoseizures

Neurology

Pseudoseizures: a problem in the diagnosis and management of epileptic patients

Neurology

Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients

Epilepsia