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Abstract Objective We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case–control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. Methods Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. Results Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05–0.24, and −2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60–12.40 and −2loglikelihood = 245.99). Significance Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs.

Epilepsy is a heterogeneous disorder of recurrent seizures which often is comorbid with anxiety, depression, attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), and other psychiatric manifestations. Treating both epilepsy and behavioral symptoms from psychiatric disorders can result in polypharmacy with interactions of medications leading to both worsened efficacy of antiseizure medications due to psychotropic effects and worsening of psychiatric symptoms due to antiseizure medication side effects. We aim to suggest pragmatic strategies for the neurologist in the diagnosis and management of comorbid ADHD in patients with epilepsy based on the International League Against Epilepsy (ILAE) Pediatric Commission guidelines and additional literature review. The screening tool of choice for the symptoms of ADHD is validated in the country of practice and written in the language of the family, though various screening tools and advantages and disadvantages of each will be discussed. Once ADHD is diagnosed, recent safety data suggest that Methylphenidate, Amphetamine, and Atomoxetine are generally safe for patients with epilepsy. We present a case of a child with epilepsy and ADHD and discuss the clinical signs, symptoms, and strategies for treatment as well as when to refer to child psychiatry.

Objective: We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case–control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. Methods: Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. Results: Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05–0.24, and −2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60–12.40 and −2loglikelihood = 245.99). Significance: Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs. [ABSTRACT FROM AUTHOR]

Abstract Objective We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group.

Objective: We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods: Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results: Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance: Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group. [ABSTRACT FROM AUTHOR]

• This clinical practice guideline identified standards with recommendations summarized in Table S1. • Limited high-level evidence addressing standards for LTVEM exist, and further research is needed. • Selected topics for utility of LTVEM exist, although comprehensive criteria addressing minimum standards for performance are needed. • Clinicians, hospital administrators, and insurers benefit from establishing standards for inpatient video-EEG monitoring applied to patient management. The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events (see Table S1). For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and establish its clinical utility. [ABSTRACT FROM AUTHOR]

Abstract Objectives This International League Against Epilepsy (ILAE) Report: (a) summarizes the literature about “driving and psychogenic nonepileptic seizures (PNES)”; (b) presents the views of international experts; and (c) proposes an approach to assessing the ability of persons with PNES (PwPNES) to drive. Methods Phase 1: Systematic literature review. Phase 2: Collection of international expert opinion using SurveyMonkey®. Experts included the members of the ILAE PNES Task Force and individuals with relevant publications since 2000. Phase 3: Joint analysis of the findings and refinement of conclusions by all participants using email. As an ILAE Report, the resulting text was reviewed by the Psychiatry Commission, the ILAE Task Force on Driving Guidelines, and Executive Committee. Results Eight studies identified by the systematic review process failed to provide a firm evidence base for PNES‐related driving regulations, but suggest that most health professionals think restrictions are appropriate. Twenty‐six experts responded to the survey. Most held the view that decisions about driving privileges should consider individual patient and PNES characteristics and take account of whether permits are sought for private or commercial driving. Most felt that those with active PNES should not be allowed to drive unless certain criteria were met and that PNES should be thought of as “active” if the last psychogenic seizure had occurred within 6 months. Significance Recommendations on whether PwPNES can drive should be made at the individual patient level. Until future research has determined the risk of accidents in PwPNES a proposed algorithm may guide decisions about driving advice.

Objective: To determine the utility of suggestive seizure induction for inpatient work‐up of suspected psychogenic nonepileptic seizures (PNES). Methods: Prospective study of epilepsy center inpatient admissions with suspected PNES. Patients were randomized to undergo suggestive induction first (group A) and then, if necessary, long‐term video–electroencephalography (EEG) monitoring, or vice versa (group B). Diagnostic pathways were compared. Potential clinical predictors for diagnostic success were evaluated. Results: Length of in‐hospital stay did not significantly differ between groups. Suspicion of PNES was confirmed in 43 of 77 (56%) patients, evenly distributed between group A (22 of 39) and group B (21 of 38). In nine patients, recorded habitual seizures were epileptic and in 25 cases, no diagnostic event could be recorded. Diagnosis of PNES was ascertained primarily by recording a typical seizure through suggestive induction in 24 patients and through long‐term monitoring in 19 patients. In group A (induction first), monitoring was not deemed necessary in 21% of cases. In group B (monitoring first), 13% would have remained inconclusive without suggestive induction. Patients who reported triggers to their habitual seizures were not more likely to have spontaneous or provoked PNES during monitoring or suggestive inducion, respectively. Patients with subjective seizure prodromes (auras) were significantly more likely to have a PNES during suggestive induction than those without (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.1‐10.4). There was no significant difference in seizure frequency between patients with spontaneous PNES during long‐term monitoring and those with nondiagnostic monitoring sessions. Significance: Our results support the notion that suggestive seizure induction can reduce the number of inconclusive inpatient workups, and can obviate resource‐intensive long‐term monitoring in one fifth of cases. Patients who are aware of prodromes might have a higher chance of having seizures induced through suggestion. [ABSTRACT FROM AUTHOR]

Objectives: This International League Against Epilepsy (ILAE) Report: (a) summarizes the literature about "driving and psychogenic nonepileptic seizures (PNES)"; (b) presents the views of international experts; and (c) proposes an approach to assessing the ability of persons with PNES (PwPNES) to drive. Methods: Phase 1: Systematic literature review. Phase 2: Collection of international expert opinion using SurveyMonkey®. Experts included the members of the ILAE PNES Task Force and individuals with relevant publications since 2000. Phase 3: Joint analysis of the findings and refinement of conclusions by all participants using email. As an ILAE Report, the resulting text was reviewed by the Psychiatry Commission, the ILAE Task Force on Driving Guidelines, and Executive Committee. Results: Eight studies identified by the systematic review process failed to provide a firm evidence base for PNES‐related driving regulations, but suggest that most health professionals think restrictions are appropriate. Twenty‐six experts responded to the survey. Most held the view that decisions about driving privileges should consider individual patient and PNES characteristics and take account of whether permits are sought for private or commercial driving. Most felt that those with active PNES should not be allowed to drive unless certain criteria were met and that PNES should be thought of as "active" if the last psychogenic seizure had occurred within 6 months. Significance: Recommendations on whether PwPNES can drive should be made at the individual patient level. Until future research has determined the risk of accidents in PwPNES a proposed algorithm may guide decisions about driving advice. [ABSTRACT FROM AUTHOR]

The diagnosis of atypical paroxysmal events represents a significant challenge for clinicians when differentiating epileptic from nonepileptic events. The ictal manifestations of pharyngeal dysesthesias are often misdiagnosed and difficult to distinguish clinically, given their subtle features such as pharyngeal discomfort with and without autonomic symptomology. We report a rare case of isolated ictal pharyngeal dysesthesias localizing to the non-dominant frontal operculum lobe misdiagnosed as psychogenic and later confirmed by continuous video-EEG monitoring. [ABSTRACT FROM AUTHOR]

مقدمه: تشنج‌هاي غير صرعي، يك اختلال عصب‌شناختي با تركيبي از علایم نورولوژي و تعارض روان‌شناختي می‌باشد. هدف از انجام پژوهش حاضر، تعيين ميزان اثربخشي مداخله‌ی تنظيم هيجان بر كيفيت زندگي، تنظیم شناختی هیجان و تعداد حملات تشنجی بيماران مبتلا به تشنج‌هاي غير صرعي در شهر اصفهان در سال 1394 بود. روش‌ها: اين پژوهش، مطالعه‌ي نيمه‌تجربي به همراه پيش‌آزمون، پس‌آزمون و پي‌گيري است. از ميان بيماران مراجعه كننده به بيمارستان‌هاي نور و آيت‌ا‌له كاشاني اصفهان، تعداد 16 بيمار مبتلا به تشنج‌هاي غير صرعي انتخاب و به طور تصادفي به دو گروه 8 نفری مورد و شاهد با میانگین سنی به ترتیب 71/29 و 14/31 سال تقسیم شدند. 12 جلسه‌ی 90 دقيقه‌اي مداخله‌ی درماني تنظيم هيجان به شیوه‌ی گروهی برای گروه مورد اجرا شد. داده‌های پژوهش با پرسش‌نامه‌های جمعیت‌شناختی محقق ساخته، كيفيت زندگي سازمان بهداشت جهانی و تنظیم هیجان شناختی Garnfsky جمع‌آوري و با استفاده از آزمون Repeated measures ANOVA و نرم‌افزار SPSS تحليل شد. یافته‌ها: مداخله‌ی تنظيم هيجان، تفاوت معنی‌داري در كيفيت زندگي، تنظیم هیجان شناختی و تعداد حملات تشنجی بين دو گروه مورد مطالعه در مراحل پس‌آزمون و پي‌گيري يك ماهه ایجاد نمود (050/0 > P). نتیجه‌گیری: مداخله‌ی تنظیم هیجانی در بهبود ابعاد کیفیت زندگی، افزایش استفاده از راهبردهای مثبت، کاهش استفاده از راهبردهای منفی تنظیم شناختی هیجان و کاهش تعداد حملات تشنجی بیماران مبتلا به تشنج‌هاي غير صرعي اثرگذار بود.

Epilepsy is a heterogeneous disorder of recurrent seizures which often is comorbid with anxiety, depression, attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), and other psychiatric manifestations. Treating both epilepsy and behavioral symptoms from psychiatric disorders can result in polypharmacy with interactions of medications leading to both worsened efficacy of antiseizure medications due to psychotropic effects and worsening of psychiatric symptoms due to antiseizure medication side effects. We aim to suggest pragmatic strategies for the neurologist in the diagnosis and management of comorbid ADHD in patients with epilepsy based on the International League Against Epilepsy (ILAE) Pediatric Commission guidelines and additional literature review. The screening tool of choice for the symptoms of ADHD is validated in the country of practice and written in the language of the family, though various screening tools and advantages and disadvantages of each will be discussed. Once ADHD is diagnosed, recent safety data suggest that Methylphenidate, Amphetamine, and Atomoxetine are generally safe for patients with epilepsy. We present a case of a child with epilepsy and ADHD and discuss the clinical signs, symptoms, and strategies for treatment as well as when to refer to child psychiatry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Purpose: The aim of the current study was to depict a comprehensive geographical picture of the existing literature on psychogenic nonepileptic seizures (PNES) and to highlight the needs for future works.Methods: We searched the electronic database PubMed on June 8, 2019 for articles that included any of the related key words to analyze all the relevant literature. We applied the advance search; field was adjusted to the title and dates were adjusted to 01/01/2000 until 06/08/2019. We selected the relevant articles. Location of the study was determined according to the affiliation(s) of the authors.Results: 1017 papers were included. Interest in research and publication on PNES has risen over the past two decades. Six hundred and nine full length research original papers and 199 review articles were published on PubMed from 2000 until 2019. Continent-wise, most articles were from North America and Europe (41.1% of the whole publications from Europe and 40.8% from North America; 833 papers totally), followed by Asia (92 papers), Oceania (36 papers) and South America (31 publications), while only 0.9% of the papers (9 papers) were from Africa.Conclusion: A global campaign is necessary to inform and educate the world on the issue of PNES and its significance. While PNES merit further epidemiological investigations, there is a significant disparity with regard to the location of the studies. There is a huge need to invest more on studies on various aspects of PNES in many places in the world, including African nations, India, and China. [ABSTRACT FROM AUTHOR]

Objectives Epidemiologic evidence supporting antiseizure properties of cannabis is limited and controversial. We determined the prevalence of marijuana use and its perceived effects in patients with and without epilepsy. Methods Information was collected over 14 months from consecutive adult patients admitted to an epilepsy monitoring unit using a 27-item anonymous questionnaire. Patients with cognitive impairment unable to understand the questions or give informed consent and readmissions were not recruited. Subjects were divided into 4 groups, those with epileptic seizures, those with psychogenic nonepileptic seizures (PNES), those with both epileptic and PNES, and those with other nonepileptic events. Patients with exclusively epileptic seizures were compared with those with exclusively PNES. Results From 310 patients, 18 undiagnosed cases were excluded leaving a cohort of 292 patients with median age 35 (range: 27–49) years; 57.2% female. Epilepsy was documented in 190 (65.1%), PNES in 64 (21.9%), and both types of seizures in 26 (8.9%). Median duration of seizure disorder was longer (2 [1–9] vs. 13 [5.7–25] years; p < 0.001) and seizure frequency lower (daily or weekly in 62.3% vs. 44.9%; p = 0.03) in patients with epilepsy compared with those in patients with PNES. Overall, 166 (57%) had tried marijuana, and 36.2% used it over the past year. Utilization was 57.1% in sole epilepsy and 64.1% in sole PNES, but daily use was more likely in epilepsy (59% vs. 33.3%). Estimated mean dose was 1 g/day. Marijuana use was associated with tobacco smoking (p < 0.001) but not alcohol use. Eight patients used other street drugs. Improvement in seizures was perceived by 84% in those with epilepsy and 72.7% in those with PNES. In the 2 groups, stress was decreased in 84.9% and 88%, sleep improved in 77.3% and 88%, and memory/concentration was better in 32% and 28%, respectively. Antiepileptic drug side effects were decreased in 53.2% of marijuana users. Perceived effect on epileptic seizures correlated with effect on stress (r = 0.35, p = 0.004). Adverse effects of marijuana were mild and reported in 30.7% but included possible seizure precipitation in 5 patients with epilepsy. Significance Patients with uncontrolled epilepsy or nonepileptic events had a high rate of marijuana use with associated perceived improvements in seizure control, stress, sleep, and drug side effects. Stress reduction may contribute to the perceived impact of marijuana on seizures and nonepileptic events in adults. [ABSTRACT FROM AUTHOR]

Purpose: To assess and compare peak, multimodal ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES).Methods: Between 4/1/2010 and 4/1/2011, 183 adults had video-EEG monitoring, with 96 consecutive patients meeting inclusion criteria. Heart rate (HR), oxygen saturation (SaO2), and blood pressure (BP) were obtained at baseline and during an ictus. The motor semiology of each ES and PNES was also assessed. Student t-test, Fischer's Test, Wilcoxon Test (p=<0.05), and linear regression provided statistical correlation.Results: The 46 patients with ES and 50 patients with PNES had similar baseline VS. Generalized tonic-clonic ES had the highest absolute iVS. ES yielded a higher absolute ictal HR (p=0.0004) and lower SaO2 nadir (p=0.003) than PNES. Systolic and diastolic BP did not differ between groups (p=NS). The upper ranges of iS-BP attained a maximum value of 195/135mm Hg in ES and 208/128mmHg in PNES. For ES, the change in ictal HR was inversely correlated with a reduction in ictal SaO2 (CC= -0.4; p=0.003). In PNES, ictal HR correlated with systolic BP (CC=0.6; p=<0.0001), but not ictal SaO2.Conclusion: The inverse relationship between ictal HR and ictal SaO2 in ES suggests a neurobiological difference, and the concept of intrinsic cardio-respiratory dysfunction in patients with epilepsy. The significantly raised peak elevations in ictal HR and ictal systolic BP during PNES demonstrates the potential for serious adverse outcomes if attacks are prolonged. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to describe social behaviors and preferences in adults with psychogenic nonepileptic seizures (PNES) including self-reported use of various socialization mediums (face-to-face and indirect communication) as well as perceived social barriers. Methods One hundred forty-one consecutive patients with a diagnosis of PNES that was later confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first outpatient appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program. Results Contrary to prevalent assumptions that patients with PNES tend to be socially isolated, our responders reported that they were in fact quite socially connected (72.2% reported daily communication with friends and family via telephone, 68.54% saw relatives in person weekly, 65.28% saw friends weekly, and 51.2% reported using the computer daily to socialize). Facebook was the preferred online social media. Indoor/solitary activities were most common with 57.44% stating that they watch TV/read/use the computer. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side effects. Respondents expressed the greatest interest in online support groups or educational programs (29.46%), office-based support groups (28.57%), and volunteering (23.21%). Conclusion Although it has been speculated that social isolation is a significant problem for patients with PNES, considerable participation in social activities was reported. Characteristics of socialization practices may be more nuanced than first believed. When addressing therapeutic interventions with this group of patients in the future, it might be beneficial to offer both distance-based options as well as face-to-face options for treatment and support depending on age and personal preference. [ABSTRACT FROM AUTHOR]

Breath-holding spells are common nonepileptic paroxysmal events in early childhood. They consist of brief apneic episodes provoked by some acute emotional stimulus. Breath-holding spells usually begin at the age of 6-18 months. Breath-holding spells are classified into cyanotic and pallid types. The pathogenetic mechanisms of the two types are different. While there is intense respiratory inhibition with slight cardiac effect in the cyanotic type, there is powerful cardiac inhibition with slight respiratory effect in the pallid type. The diagnosis of breath-holding spells is largely based on the characteristic history and clinical events. Epilepsy and cardiac disease should be considered in the differential diagnosis. A few patients may require ECG recording and video EEG monitoring in the differential diagnosis. Antiepileptic treatment is not required in children with Breath-holding spells, and the prognosis is excellent. [ABSTRACT FROM AUTHOR]

Objectives Paroxysmal nonepileptic events (PNEs) are frequently encountered phenomena in children. Although frequencies and types of PNEs have been extensively studied in adult populations, the data available for children and adolescents are limited, especially in patients without underlying neurologic disorders. In this study, we evaluated and compared the characteristics of PNEs between age groups and according to the presence of neurologic deficits to improve early detection and diagnosis of PNEs. Methods We retrospectively reviewed 887 pediatric patients who were admitted to the epilepsy monitoring unit at the Samsung Medical Center between December 2001 and July 2014. One hundred and forty-one patients (15.9%) were diagnosed as having PNEs on the basis of their clinical history and long-term video-electroencephalography (EEG) monitoring (VEM). Results Children with PNEs were divided into three groups by age: 1) the infant, toddler, and preschool group (< 6 years, N = 50, 35.5%); 2) the school-age group (6–< 12 years, N = 30, 21.3%); and 3) the adolescent group (12–< 18 years, N = 61, 43.3%). Physiologic disorders, such as normal infant behavior, sleep movement, and staring, were more common in patients younger than 6 years of age, whereas psychogenic nonepileptic seizures were predominant in patients older than 6 years. Vasogenic syncope was also frequently observed in the adolescent group and was confirmed by the head-up tilt test. There was no significant difference in specific PNE types between the groups of patients with or without neurologic deficits. Conclusions Physiologic symptoms were predominant in the younger age group, whereas psychogenic nonepileptic seizures were observed in older age groups more often. Clinical pattern recognition by age plays an important role in clinical practice, because pediatric patients present various types of PNEs with age-specific patterns. Considering various and inconsistent presentations and the importance of correct diagnosis, long-term VEM can be helpful in diagnosing normal infant behavior and psychogenic nonepileptic seizures. [ABSTRACT FROM AUTHOR]

Background Paroxysmal nonepileptic events are common in children. Events with a psychological basis, historically referred to as pseudoseizures, are a large subset of paroxysmal nonepileptic events. Methods A review of the relevant pediatric and adult literature was performed. Results It was found that these events have many semioloigc features similar to epileptic events and can be challenging to correctly identify. The use of a detailed history in combination with video encephalography and knowledge of psychogenic paroxysmal nonepileptic events will facilitate making the correct diagnosis. Paroxysmal nonepileptic events are important to identify as comorbid disorders such as depression, anxiety disorder, family discord, and school issues are frequent. In addition, prior sexual, emotional, and/or physical abuse may be present. Conclusions Pediatric patients with paroxysmal nonepileptic events need to be recognized in order to avoid unnecessary antiepileptic drugs and emergency department or hospital visits and to facilitate appropriate psychological intervention to address the underlying etiologies. This review will focus on evaluation and identification of paroxysmal nonepileptic events, in addition to reviewing the various comorbidities, effective treatments, and outcomes for pediatric patients. The key differences between pediatric and adult patients with paroxysmal nonepileptic events are addressed. [ABSTRACT FROM AUTHOR]

Purpose Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. Methods Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State–Trait Anxiety Inventory and Patient Health Questionnaire—15 (a somatic symptom inventory) were also administered. Results We found significant group differences in explicit (p < 0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit–explicit SE discrepancies were larger in the group with PNESs than in the other groups (p < 0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (r s = − .83, p < 0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; r s = .65, p < 0.01). These relationships remained significant when controlling for anxiety and somatization. Conclusion Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit–implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE. [ABSTRACT FROM AUTHOR]

Background Despite the long history of psychogenic nonepileptic seizures (PNES), relatively little is known about the mechanisms that cause and maintain this condition. Emerging research evidence suggests that patients with PNES might have difficulties in regulating their emotions. However, much remains to be learned about the nature of these difficulties and the emotional responses of individuals with PNES. This study aimed to gain a detailed understanding of emotion regulation processes in patients with PNES by examining differences between patients with PNES and a healthy control group with regard to intensity of emotional reactions, understanding of one's emotional experience, beliefs about emotions, and managing emotions by controlling emotional expression. Method A cross-sectional design was used to compare the group with PNES (n = 56) and the healthy control group (n = 88) on a range of self-report measures. Results Participants with a diagnosis of PNES reported significantly poorer understanding of their emotions, more negative beliefs about emotions, and a greater tendency to control emotional expression compared to the control group. While intensity of emotions did not discriminate between the groups, poor understanding and negative beliefs about emotions were found to be significant predictors of PNES, even after controlling for age, education level, and emotional distress. Furthermore, the presence of some emotion regulation difficulties was associated with self-reported seizure severity. Conclusions The results of this study are largely consistent with previous literature and provide evidence for difficulties in emotion regulation in patients with PNES. However, this research goes further in bringing together different aspects of emotion regulation, including beliefs about emotions, which have not been examined before. As far as it is known, this is the first study to suggest that levels of alexithymia in a population with PNES are positively associated with self-reported seizure severity. The findings suggest a need for tailored psychological therapies addressing specific emotion regulation difficulties in individuals with PNES. [ABSTRACT FROM AUTHOR]

Abstract: This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit–explicit anxiety discrepancies were only identified in patients with PNESs (p <.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r =.63, p <.01) and frequency of seizures (r =.67, p <.01); implicit anxiety correlated with frequency of seizures only (r =.56, p <.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder. [Copyright &y& Elsevier]

Patients with psychogenic nonepileptic seizures (PNES) represent a distinct, challenging group among those with functional neurologic symptom (conversion) disorders and involve a complex set of symptoms and comorbidities, best evaluated and treated by a multidisciplinary team of clinicians. Multidisciplinary, collaborative care is becoming more common, using evidence-based treatment. Outpatient neurology clinics at sites not currently treating these patients hold potential for providing such a model of care, with coordination of services. Best practice care should encourage the integration of neurology and mental health professionals to improve communication among clinicians and with patients, allowing for better patient care and symptomatic outcomes., Competing Interests: Disclosure N.J. Beimer has served as an ad hoc reviewer for Epilepsy & Behavior; has received honoraria from MedLink LLC and Decker Intellectual Properties; has received research support from the Health Resources and Services Administration (HRSA H98MC30374, co-I), NIH (R01 NS094399-10, co-I), the University of Michigan Department of Neurology, and the Pediatric Epilepsy Research Foundation; serves on the Epilepsy Foundation of Michigan Professional Advisory Board, and has provided medicolegal expert testimony. W.C. LaFrance, Jr. has served on the editorial boards of Epilepsia, Epilepsy & Behavior; Journal of Neurology, Neurosurgery and Psychiatry, and Journal of Neuropsychiatry and Clinical Neurosciences; receives editor's royalties from the publication of Gates and Rowan's Nonepileptic Seizures, 3rd edition (Cambridge University Press, 2010) and 4th ed (2018); author's royalties for Taking Control of Your Seizures: Workbook and Therapist Guide (Oxford University Press, 2015); has received research support from the Department of Defense (DoD WSlXWH-17-0169), NIH (NINDS 5K23NS45902 [PI]), Providence VAMC, Center for Neurorestoration and Neurotechnology, Rhode Island Hospital, the American Epilepsy Society (AES), the Epilepsy Foundation (EF), Brown University, and the Siravo Foundation; serves on the Epilepsy Foundation New England Professional Advisory Board, the Functional Neurological Disorder Society Board of Directors, the American Neuropsychiatric Association Advisory Council; has received honoraria for the American Academy of Neurology and AES Annual Meetings; has served as a clinic development consultant at University of Colorado Denver, Cleveland Clinic, Spectrum Health, Emory University, Oregon Health Sciences University, and Vanderbilt University; and has provided medicolegal expert testimony., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study was carried out to analyze the semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs) and to propose a modified new classification of PNESs. This retrospective analysis included 82 patients (M:F=38:44; mean age: 33.4±12.0years) diagnosed to have PNESs based on video-EEG recording. Detailed semiological characteristics including pattern of limb movements, body movements, psychological/emotional manifestations, “aura”, level of consciousness, age at onset of PNESs, age at diagnosis, and history of AED intake were recorded. We classified our cohort of patients as per available classifications and proposed a modified new classification. Age at onset of PNESs was 21.8±14.1years (range: 2–64; median: 18.5years), age at diagnosis was 29.3±12.7years (range: 2–67; median: 26.0years), and delay in diagnosis was 7.4±7.3years (range: 0–28; median: 5.0years). There were 369 recorded attacks (range: 1–10; median: 4). Prior to VEEG, 47 (57.3%) patients were incorrectly diagnosed as having true epileptic seizures initially and were on antiepileptic drugs (AEDs), 15 (18.3%) patients had an initial diagnosis of PNESs which remained unchanged after VEEG analysis, and 20 (24.4%) patients had both PNESs and epileptic seizures. We could not classify 40–66% of our patients into any of the available classification proposed by previous authors. We categorized all our patients into the following categories of a modified new classification: abnormal hypermotor response: 23 (28%), abnormal partial motor response: 18 (22%), affective/emotional behavior phenomena: 4 (4.9%), dialeptic type: 5 (6.1%), nonepileptic aura: 5 (6.1%), and mixed pattern: 27 (32.9%). Incorrect diagnosis of PNESs leads to unnecessary prescription of AEDs, with side effects and cost implications. A modified systematic classification of PNESs is proposed which would help in the better characterization of PNESs. [ABSTRACT FROM AUTHOR]

Abstract: Though posttraumatic epilepsy (PTE) is a prominent sequela of traumatic brain injury (TBI), other nonepileptic phenomena also warrant consideration. Within two UCLA pediatric TBI cohorts, we categorized five spell types: 1) PTE; 2) Epilepsy with other potential etiologies (cortical dysplasia, primary generalized); 3) Psychopathology; 4) Behavior misinterpreted as seizures; and 5) Other neurologic events. The two cohort subsets differed slightly in injury severity, but they were otherwise similar. Overall, PTE occurred in 40%, other epilepsy etiologies in 14%, and nonepileptic spells collectively in 46%. Among children with spells, PTE was associated with severe TBI (p=0.001), whereas psychopathology (p=0.014) and epilepsy with other etiologies (p=0.006) were associated with milder TBI severity. Posttraumatic epilepsy (p=0.002) and misinterpreted behavior (p=0.049) occurred with younger injury age. Psychopathology (p=0.020) and other neurologic events (p=0.002) occurred with older injury age. In evaluating possible PTE, clinicians should maintain a broad differential diagnosis to prevent misdiagnosis and inappropriate treatment. [Copyright &y& Elsevier]

Abstract: The purpose of the study was to evaluate the clinical characteristics of paroxysmal nonepileptic events (PNEs) in pediatric patients. Reports of 1108 patients who underwent long-term video-EEG monitoring at Seoul National University Children''s Hospital were reviewed retrospectively. One hundred forty-three (12.9%) patients were diagnosed as having PNEs. The most common type of PNE was staring. Staring, tonic posturing, sleep myoclonus, and sleep-related disorders were more common in patients younger than 6years old. Psychogenic nonepileptic seizure was the most common PNE in patients older than 6years. Patients who were younger than 6years old showed shorter disease duration and more varied types of PNEs when compared to older patients (6years old or older). Presence of epilepsy was not significantly related to clinical difference in PNEs. In patients with developmental delay, staring and tonic posture were significantly more frequent than patients without developmental delay. Thirty-two patients without concurrent epilepsy were misdiagnosed with epilepsy, and AEDs were discontinued after the correct diagnosis of PNEs. Whenever the diagnosis of paroxysmal abnormal behavior is uncertain, correct diagnosis should be made using long-term video-EEG monitoring, especially in younger pediatric patients and patients with developmental delay. [Copyright &y& Elsevier]

Abstract: Information obtained during psychological evaluations of 93 patients with epileptic events (EEs) and 63 with nonepileptic events (NEEs) was used to test the relative contributions of multiple risk factors to prediction of NEEs during video/EEG monitoring. The best group of independent predictors of NEEs comprised: (1) age at first spell, (2) symptoms of a psychiatric diagnosis other than anxiety or depression, (3) marital instability, (4) symptoms of an anxiety disorder other than panic disorder, and (5) years of education. Report of childhood abuse or neglect and taking psychotropic medication correlated with most of the other risk factors for NEEs. It may not be necessary to gather data on all of the variables shown to be associated with NEEs. Although there is a high prevalence of risk factors for psychopathology in patients with EEs, it is lower compared with that of patients with NEEs, and patients with EEs are less likely to report multiple risk factors. [ABSTRACT FROM AUTHOR]

Abstract: Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults. We determined the types of nonepileptic events that are most prominent in the pediatric population, and stratified those events by age group. Ninety-four of 416 pediatric patients monitored during a 3-year period (23%) were found to have had nonepileptic events. Thirty-eight percent of these children were diagnosed with psychogenic nonepileptic seizures, and 72% of those were adolescents. In children younger than 5 years of age, behavioral events and parasomnias were the most common mimickers of epilepsy. Other events, including stereotyped movements and myoclonus, were also diagnosed. We suggest that children with refractory paroxysmal events should be considered for early inpatient monitoring. [Copyright &y& Elsevier]

Abstract: Subjective and objective assessments of cognitive and affective functioning of patients admitted to the EMU with epileptic (ES, n =22) and psychogenic nonepileptic (NES, n =23) seizures were compared. It was hypothesized that the patients with NES would overestimate their cognitive impairments and underestimate their affective disturbances relative to those with ES. Results revealed that the patients with NES reported greater word-finding difficulty than those with ES (P =0.02), but performed better than the patients with ES on the Boston Naming Test (BNT, P =0.03), suggesting a tendency to overestimate word-finding difficulty. Patients with NES and ES did not otherwise differ in subjective ratings of cognitive functions or emotional state; however, patients with NES performed worse on a test of affect expression/perception compared with those with ES (P =0.02). For patients with NES, only performance on memory tests was significantly correlated with their anxiety level. Obtaining both subjective ratings and objective test findings of cognitive and affective functioning may help further differentiate between patients with NES and those with ES. [Copyright &y& Elsevier]

Abstract: We examined the usefulness of video versus EEG in isolation for the differentiation of epileptic seizures (ES) from psychogenic nonepileptic events (PNEE). Video-EEG recordings of 43 events in 43 patients (27 with ES and 16 with PNEE) were analyzed by experienced clinical epileptologists/electroencephalographers blinded to the patients’ clinical histories. Both the video and EEG were scored independently by the same reader for each event. Relying on video recordings alone, the readers correctly identified ES with a sensitivity of 93% and specificity of 94%. Based on EEG data alone, the readers correctly identified ES with a sensitivity of 89% and specificity of 94%. Semiologically, a gradual evolving buildup of visible symptoms, reaching maximal behavioral intensity within 70 seconds of event onset, was a reliable indicator of ES. No patient with ES demonstrated eye closure at the time of peak behavioral manifestations. Although several additional semiologic features were statistically associated with either ES or PNEE, they were less reliably present and, hence, less clinically useful. Correct categorization of some neurobehavioral events can be made by experienced epileptologists on the basis of video or EEG recordings during an event, without simultaneous review of both provided that the full event is recorded. Home video recordings may represent a useful screening tool for a subset of patients with neurobehavioral events of unclear etiology. [Copyright &y& Elsevier]

Abstract: Minnesota Multiphasic Inventory 2 (MMPI-2) scale 3, duration of illness, and routine EEGs have been used to predict nonepileptic events (NEEs) with a high degree of accuracy in patients referred for video/EEG (vEEG) monitoring. This study tested the Storzbach logistic regression equation in our patients with definitive epileptic seizures (n =57) or NEEs without evidence of epileptiform activity (n =51) during vEEG monitoring, yielding an overall classification accuracy of 81%, sensitivity of 80%, and specificity of 81%. This study also replicated previous findings of significant group differences in duration (years) of spells, number of elevations on the MMPI-2, MMPI-2 elevations on scales 1, 2, 3, and 8, and incidence of the conversion valley on the MMPI-2. Our findings indicated that combined use of the MMPI-2 and clinical variables was most predictive of patients with NEEs. [Copyright &y& Elsevier]

In this study, the investigators show the diagnostic value of video smartphone technology with regard to a seizure diagnosis as well as the ability of smartphone video to help distinguish epileptic seizures from nonepileptic events. [ABSTRACT FROM AUTHOR]

Abstract: Psychogenic nonepileptic seizures (PNES) remain a poorly understood phenomenon for both patients and their physicians. Recent work has begun to focus on the possible psychological underpinnings of this diagnosis, but few studies have focused on specific emotional pathologies. This study sought to investigate the impact of a specific emotional measure: self-reported fear sensitivity. Three patient groups (patients with PNES, patients with epilepsy, and healthy volunteers) were administered the Modified Fear Survey Schedule, along with other neuropsychological batteries. As expected, the PNES and epilepsy cohorts demonstrated elevated levels of depression, anxiety, and comorbid psychiatric conditions. The PNES group independently exhibited a statistically significant higher level of fear sensitivity compared with both patients with epilepsy and healthy volunteers. This fear-specific trait was independent of other comorbid psychological factors or psychiatric conditions. These results suggest that patients with PNES exhibit disproportionately elevated fear sensitivity on self-report measures when compared with patients with epilepsy. This finding may reflect an elevated internal “setpoint” for appraising the intensity of emotional settings. [Copyright &y& Elsevier]

Abstract: There is evidence that psychogenic nonepileptic seizures (PNES) remain underdiagnosed, especially in children and adolescents. Diagnosis of such events is even more difficult in patients that do have epilepsy, leading to delayed diagnosis and treatment and, consequently, iatrogenic complications. This study aimed to evaluate possible risk factors in children with epilepsy who had PNES. Seizures and epileptic syndromes were classified according to International League Against Epilepsy guidelines. Patients were evaluated with a structured psychiatric anamnesis and classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research; and Schedule for Affective Disorders and Schizophrenia for School-Age Children—Epidemiological Version. Risk factors such as head trauma, physical, sexual and psychological abuse, and psychiatric diagnoses, among others, were investigated. Family history of epilepsy and psychiatric illness were detected by review of medical records and/or follow-up interviews. Gender was not a predictive factor, and although older children had a higher risk for PNES, younger children also presented truly psychogenic events mimicking epileptic seizures. The most common associated psychiatric diagnosis was depression. Family histories for epilepsy and psychiatric illness were a frequent finding. An inadequate family environment was more common than sexual or physical abuse. Current knowledge obtained from adults with PNES has been used to understand children with PNES. However, this study of children with epilepsy revealed some similarities and many differences. These features may help to identify predictive factors in a population in need of adequate diagnosis of and therapy for this long-lasting pathology. [Copyright &y& Elsevier]

Abstract: Video electroencephalographic monitoring (VEEG) is considered the “gold standard” for making the differential diagnosis between epileptic seizures (ES) and nonepileptic seizures (NES), but is a costly, time-consuming procedure and not readily available in all communities. Of the various diagnostic techniques and measures that have been used, the Personality Assessment Inventory (PAI) has shown promise as an effective psychological screening tool to aid in the differential diagnosis of ES/NES. Using VEEG results as the outcome measure, this study examined the diagnostic effectiveness of the PAI in a group of adults with treatment-refractory seizures. Results indicated that, on psychological screening, patients with NES endorse significantly greater functional consequences of their seizure-like episodes than participants with ES. A “NES Indicator” score, calculated from the PAI Somatization subscales, provided a sensitivity of 84% and specificity of 73% for the diagnosis of NES versus ES. The PAI appears to be a useful screening tool prior to hospital admission for VEEG. [Copyright &y& Elsevier]

The aim of this study was to determine the degree to which subjective ratings of neurocognitive ability accurately reflect objectively measured neuropsychological functioning in patients diagnosed with epileptic (ES, n=45) or psychogenic nonepileptic (PNES; n=37) seizures. Patients received a battery of neuropsychological tests, measures of current mood state, and the Quality of Life In Epilepsy—89 questionnaire. Results indicated that subjective ratings of neuropsychological functioning were only partially accurate within each group. Patients with ES accurately rated their memory function, but overestimated language and attention abilities. Patients with PNES accurately rated attention, but underestimated memory and overestimated language. In both groups, poorer self-reported neurocognitive functioning was strongly related to poorer mood state; however, mood state did not predict objectively measured neurocognitive abilities. Given the inaccuracies that exist in patient self-report, results highlight the importance of a comprehensive neuropsychological assessment when evaluating the neurocognitive status of individuals with seizures. [Copyright &y& Elsevier]

The objective of this clinical practice guideline is to provide recommendations on the indications and minimum standards for inpatient long-term video-electroencephalographic monitoring (LTVEM). The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology develop guidelines aligned with the Epilepsy Guidelines Task Force. We reviewed published evidence using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. We found limited high-level evidence aimed at specific aspects of diagnosis for LTVEM performed to evaluate patients with seizures and nonepileptic events. For classification of evidence, we used the Clinical Practice Guideline Process Manual of the American Academy of Neurology. We formulated recommendations for the indications, technical requirements, and essential practice elements of LTVEM to derive minimum standards used in the evaluation of patients with suspected epilepsy using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Further research is needed to obtain evidence about long-term outcome effects of LTVEM and to establish its clinical utility., (© 2021 International Federation of Clinical Neurophysiology, Inc. and International League Against Epilepsy.)

Summary: The medical records of 27 children admitted to the MINCEP Epilepsy Program for evaluation of intractable epilepsy but later shown to have nonepileptic events by EEG with simultaneous video monitoring were reviewed. Four groups were identified: pure psychogenic events (5 patients), psychogenic events plus epileptic seizures (3 patients), pure nonepileptic physiologic events (5 patients), and nonepileptic physiologic events plus seizures (14 patients). Historical data, physical examinations, and neurodiagnostic evaluations (including previous EEGs, neuroradiologic evaluations, and neuropsychologic testing) were reviewed. Children in all groups, except for those with pure psychogenic seizures, had a history of multiple seizure types identified by parents or caretakers. A history of status epilepticus was obtained in 64% (of 22 patients), including 11 of 14 patients with physiologic events plus seizures. Abnormal findings on neurologic examination were common, especially in children with nonepileptic physiologic events. AH but two patients had a history of interictal epileptiform abnormalities on previous routine EEGs. Based on identification of nonepileptic events, antiepileptic drugs (AEDs) were discontinued completely in eight patients (30%) and the total number of AEDs was reduced in nine others (33%). A diagnosis of nonepileptic events should be considered in all children with refractory seizures or multiple seizure types. Abnormal findings on routine (interictal) EEG may actually confound the diagnosis. Intensive neurodiagnostic EEG‐video recording is the preferred method for distinguishing nonepileptic from epileptic seizures. RÉSUMÉ: Les dossiers de 27 enfants hospitalisés pour bilan ďune épilepsie intratable, mais diagnostiquée ultérieurement comme présentant des évènements non épileptiques par monitorage EEG‐vidéo, ont été ré‐examinés. Les auteurs ont identifé 4 groupes: évènements purement psychogéniques (5 patients); évènements psychogéniques associés à des crises épileptiques (3 patients), évènements physiologiques non épileptiques purs (5 patients); évènements physiologiques non épileptiques associés à des crises (14 patients). Les antécédents, ľexamen clinique et ľévaluation neuro‐diagnostique (incluant les EEG antérieurs, les examens neuroradiologiques et les tests neuropsychologiques) ont été ré‐évalués. Les enfants de tous les groupes, àľexception de ceux présentant des crises purement psychogéniques, avient des antécédents de crises épileptiques de plusieurs types, identifiés par les parents ou par le personnel qui les avait en charge. Les antécédents ďétat de mal épileptique ont été observés chez 64% des case (sur 22 patients), y compris chez 11 patients sur 14 présentant des évènements physiologiques associés à des crises. Les anomalies àľexamen neurologique étaient fréquentes, tout particulièrement chez des enfants présentant des évènements physiologiques non épileptiques. Tous les patients saut 2 avaient des antécédents ďanomalies intercritiques ďallure épileptique sur des EEG de routine antérieurs. Ľidentification des évènements non épileptiques a permis ďarrêter complètement le traitement antiépileptique chez 8 patients (30%), et le nombre total de médicaments antiépileptiques a été réduit chez 9 patients supplémentaires (3%). Le diagnostic ďévènements non épileptiques doit être considéré chez tous les enfants présentant des crises rebelles ou plusieurs types de crises associés. Des constatations anormales sur les EEG intercritiques de routine peuvent rendre ce diagnostic difficile. Une surveillance neurodiagnostique EEG at vidéo intensive représente la modalité de choix pour le diagnostic différentiel des évènements non épileptiques et des crises épileptiques. RESUMEN: Se han revisado las historias médicas de 27 niños ingresados en el MINCEP, programa de Epilepsia, para valoración de epilepsía incontrolable pero que, más tarde, se encontró que existían episodios no‐epilépticos según el EEG con monotorización simulténea con vídeo. Se identificaron cuatro grupos: acontecimientos psicongénicos puros (5 pacientes); acontecimientos psicogénicos más ataques epilépticos (3 pacientes); acontecimientos puros fisiológicos no‐epilépticos (5 pacientes) y acontecimientos fisiológicos no‐epilépticos más ataques (14 pacientes). Se revisaron los datos históricos, las exploraciones físicas y las evaluaciones neurodiagnósticas (incluyendo previos EEGs, evaluaciones neuroradiológicas y estudios neuropsicológicos). En todos los grupos, los niños, con la exceptión de los que tenían ataques psicogénicos puros, tenían una historia de mútiples tipos de ataques identificados por los padres. Se obtuvo una historia de “status epilepticus” en 64% de 22 enfermos incluyendo 11 de los 14 enfermos con acontecimientos fisiológicos más ataques. Los hallazgos anormales en la exploratión neurológica fueron comunes, especialmente en niños con acontecimientos fisiológicos no epilépticos. Todos los pacientes, menos 2, tenían una historia de anomalías epileptiformes interictalesei los EEG previos rutinarios. La medicatión antiepilética se interrumpió completamente en 8 enfermos (30%) al identifier los acontecimientos no epilépticos y el número total de mediociones antiepilépticas se redujo en 9 casos (33%). El diagnóstico de acontecimientos no epilépticos debe ser considerado en todos los niños con ataques refractarios o con ataques de múltiples tipos. Las anomalías en EEG interictales rutinarios pueden confundir el diagnóstico. El estudio intensivo neurodiagnóstico con EEG y registros con vídeo es la modalidad de electión para distinguir ataques epilépticos de los no‐epiléticos. ZUSAMMENFASSUNG: Von 27 Kindern wurden die Krankengeschichten nochmals gesichtet. Sie waren zur Behandlung einer therapieresistenten Epilepsie zugewiesen worden ‐durch EEG und simultane Videoaufnahmen konnte das Vorliegen nicht epileptischer Anfälle bewiesen werden. 4 Gruppen wurden identifiziert: 1. reinepsy‐chogene Anfälle (N = 5), psychogene Anfälle und epileptische Anfälle (N = 3); reine nicht‐epileptische physiologische Ereig‐nisse (N = 5) and nicht‐epileptische physiologische Ereignisse und Anfälle (N = 14). Vorgeschichte, körperliche Untersuchung and Neurodiagnostik (einschlieβlich vorangegangener EEG‐Untersuchungen, neuroradiologischer Abklärung und neuropsy‐chologischen Testen) wurden gesichtet. Die Kinder aller Gruppen ausgenommen mit reinen psychogenen Anfällen, boten eine Krankengeschichte mit zahlreichen Anfällen, die durch Eltern oder Betreuer identifiziert wurden. In 64% (22 Patienten) konnte ein Status epilepticus gefunden werden einschlieβ1ich 11 von 14 Patienten mit physiologischen Ereingnissen und Anfällen. Auffällige neurologische Befunde waren häufig, besonders bei Kindern mit nicht‐epileptischen physiologischen Ereignissen. In den vorangegangenen EEGs hatten alle, auβer 2 Patienten interiktal epileptische Entladungen. Aufgrund der Diagnose nicht‐epileptische Anfälle, konnten bei 8 Patienten (30%) die Antiepileptika vollstandig abgesetzt werden und die Gesamtmenge antiepileptischer Medikation bei 9 weiteren (33%) ebenfalls reduziert werden. Bei alien Kindern mit therapieresistenten oder unterschiedlichen Anfällen sollten nicht‐epileptische Anfälle differntialdiagnostisch in Betracht gezogen werden. Auffällige Befunde im interiktalen EEG können die Diagnose verschleiern. Intensive neurodiagnostische EEG‐Videoanalyse stellt das Mit‐tel der Wahl dar, um nicht‐epileptische von epileptischen Anfällen zu unterscheiden. [ABSTRACT FROM AUTHOR]

Abstract: Depression is a multidimensional condition encompassing affective, physiological, and cognitive symptoms. Although depression''s high comorbidity with both epileptic and psychogenic nonepileptic seizures (ES and PNES) has been established, few studies have addressed whether the types of depressive symptoms experienced differ by seizure type (ES and PNES). This study compared the self-reported depressive symptomatology of patients (n =60 ES and 59 PNES) who underwent video-EEG monitoring and completed self-reported objective measures of psychopathology (PAI and BDI-II). Differences in depressive symptoms were also compared by gender and among several subgroups with ES. Results revealed the PNES group, particularly PNES females, endorsed a significantly higher level of physiological symptoms of depression as measured by the PAI DEP-P subscale than the ES group; the BDI-II did not differ between groups. These findings have potential clinical implications for the identification and management of depressive symptoms among these patient groups. [Copyright &y& Elsevier]

The main aim of this study was to assess the effectiveness of cognitive behavior therapy (CBT) for comorbid dissociative seizures (DS) in patients with epilepsy. We conducted a retrospective case note review of 14 patients with epilepsy who underwent outpatient CBT for DS in a tertiary neuropsychiatry service. The diagnosis of DS was confirmed by neurologists clinically and/or following video-telemetry electroencephalogram (EEG). We evaluated the outcome of the CBT treatment with respect to frequency of DS, measures of depression, anxiety, and social functioning. Measures of depression and anxiety significantly reduced following CBT treatment. Overall, frequency of DS reduced following CBT treatment but did not reach statistical significance. This study provides evidence that CBT can be effective in reducing depression and anxiety in patients with both epilepsy and DS. Anxiety and depression are likely to be associated with DS. Further research in larger samples and longitudinal studies are recommended to evaluate the long-term efficacy of CBT in this patient group. [ABSTRACT FROM AUTHOR]