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• Functional seizure semiology shared many similarities across socioeconomic contexts. • Generalised motor seizures were the most reported FS type in both hospitals, at 62%. • Emotional situations were the most commonly reported seizure trigger, at 18%. • Headaches were the most common type of aura, reported by 17% of participants. • Confusion/fatigue was the most reported post-ictal sign, at 58%. Our understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. The study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital. A total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (N = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients. While the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Functional/dissociative seizures (FDS), also known as psychogenic non-epileptic seizures (PNES), are sudden, transient, and involuntary events that include motor, sensory, cognitive or autonomic function alterations. In this work we analyzed the psychopathological characteristics of a subgroup of women who suffer from FDS with the aim to analyze the role of psychological trauma, with special emphasis on trauma due to sexual abuse (SA). Methods: Forty-five women diagnosed with FDS were included in the study (age range 18 to 64 years, mean = 34.7, standard deviation (SD) = 13.1). Clinical and psychopathological characteristics were reviewed. All patients have completed the clinical interviews, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID II) and the Global Assessment of Functioning (GAF) according to a special protocol for mental health assessment. Also, the history of sexual abuse trauma, the history of other non-sexual traumas and absence of history of trauma were reviewed. Results: Eighty percent of the cases reported a history of trauma, and 40% reported a history of SA. Patients with a history of SA presented a significantly lower average age of seizure onset than patients with a history of other non-sexual traumas (p = 0.021). Significant associations were found between SA and post-traumatic stress disorder (PTSD) (p = 0.031), and SA and history of suicide attempts (p = 0.037). Conclusions: SA carries serious implications for the mental health of women suffering from FDS. Mental health professionals must consider the history of this type of trauma to provide the necessary care for this patient population. [ABSTRACT FROM AUTHOR]

• Components and modalities of psychoeducation interventions vary widely. • Methods and quality of evaluation vary between studies. • There are indications that psychoeducation has benefits as an intervention in its own right. • Psychoeducation likely best placed as part of a stepped care model. Cognitive behavioural therapy (CBT) and other psychological approaches have a growing evidence base for treating Non-Epileptic Seizures (NES). However, communication about the diagnosis can be difficult for clinicians and is not always well received. It is thought that Psychoeducation about NES may improve engagement with treatment such as CBT and may contribute to reductions in the frequency of seizures and improvements in health related quality of life. However, psychoeducational components of treatment are often not evaluated in isolation meaning the specific benefit to patients is not currently well understood. The researchers aimed to examine the outcomes associated with psychoeducational interventions and the content of these programmes for NES. A scoping review was undertaken across four databases with seventeen eligible studies identified which were charted to analyse the data. Findings revealed that components and modalities of interventions varied as did methods of evaluating the interventions. A number of different outcome measures were used and not all studies reported the significance of findings. Results across studies were inconsistent; however, there was a general trend across the studies of symptom reduction and improvement in mental health. Findings illustrate that psychoeducation has potential benefits as an intervention in its own right. However, it may be best placed as a second step in a stepped care model, between initial diagnosis and further psychological treatment. The present literature needs replication and more robust studies for more certain conclusions to be drawn. [ABSTRACT FROM AUTHOR]

• 81% of patients with FS reported having a comorbidity. • 72% of patients with FS reported having a medical comorbidity. • 41% of patients with FS reported having a psychiatric comorbidity. • 41% of patients with FS reported somatic and cognitive symptoms. • 47% of patients with FS reported undergoing a medical procedure. Patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds may differ, however, this remains a gap in current literature. Comorbidities can play both a precipitating and a perpetuating role in FS and are important in the planning of individual treatment for this condition. With this study, we aimed to describe and compare the reported medical and psychiatric comorbidities, injuries, somatic and cognitive symptoms, and medical procedures among patients with FS from a private and a public epilepsy monitoring unit (EMU) in Cape Town, South Africa. This is a retrospective case-control study. We collected data on the comorbidity and medical procedure histories, as well as symptoms and clinical signs reported by patients with video-electroencephalographically (video-EEG) confirmed FS without comorbid epilepsy. We used digital patient records starting with the earliest available digital record for each hospital until the year 2022. A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Public hospital patients had higher odds of reporting intellectual disability (aOR=15.58, 95% CI [1.80, 134.95]), circulatory system disease (aOR=2.63, 95% CI [1.02, 6.78]) and gait disturbance (aOR=8.52, 95% CI [1.96, 37.08]) compared to patients with FS attending the private hospital. They did, however, have fewer odds of reporting a history of an infectious or parasitic disease (aOR=0.31, 95% CI [0.11, 0.87]), respiratory system disease (aOR=0.23, 95% CI [0.06, 0.82]), or medical procedures in the past (aOR=0.32, 95% CI [0.16, 0.63]). The study presents prevalence and comparative data on the medical profiles of patients with FS from different socioeconomic backgrounds which may inform future considerations in FS diagnosis and treatment. [ABSTRACT FROM AUTHOR]

• The study estimates the proportion of newly diagnosed nonepileptic seizures. • A causal pathway could exist between brain resections and functional seizures. • The proportion of de novo functional seizures following intracranial surgery is 3 %. • We expect brain resections to impact functional seizure epidemiology. The epidemiology of psychogenic non-epileptic seizures (PNES) is still unclear. Although approximately 14 million people need neurosurgical care annually, there is a dearth of thorough analysis on PNES occurrence following surgery. This study seeks to estimate the proportion of newly diagnosed PNES. We conducted a literature search of the PubMed, Ovid, CINAHL, and Cochrane Library databases up to December 2023. We identified studies using an observational design on the occurrence of PNES in patients who underwent intracranial surgery, and confirmed diagnosis using video-EEG. Estimates are reported as proportions using random effects models. We reported both 95 % CIs and prediction intervals (PI). We assessed the risk of bias and identified the pooled odds ratio (OR) for mutually exclusive groups. The heterogeneity was investigated using the I² statistic and significance determined using Cochran's Q-test. Post-hoc Egger's regression test, and several sensitivity analyses were performed. This study was registered in PROSPERO (CRD42023488611). Of the 1766 unique studies identified, 86 were selected for full-text review. Eight studies (n = 3,699) were eligible for inclusion. Studies, spanning from 1995 to 2017, primarily focused on epilepsy surgeries. The pooled proportion was 3 % (95 % CI 2 %-5 %; 95 % PI 0 %-11 %). Temporal resections indicated twofold increase of PNES comparing to either resections (OR 2.05, 95 %CI 0.81–5.19). The risk of bias assessment indicated satisfactory quality for included studies, and heterogeneity in estimates was mainly explained by publication year of studies and their rounded sample size. Given the estimations, there is expected impact of intracranial procedures on functional seizures epidemiology. Further efforts need to understand the contribution of brain resections to PNES incidence. [ABSTRACT FROM AUTHOR]

Post-Traumatic Epilepsy (PTE) is a neurological disorder characterized by recurrent seizures that occur as a result of traumatic brain injury (TBI). It represents a significant medical challenge due to its complex pathophysiology, diverse clinical manifestations, and the long latency period between the initial injury and the onset of epilepsy. It typically manifests weeks, months, or even years after the initial trauma, complicating the prognosis and management of head injury patients. The incidence of PTE varies widely, influenced by the severity and nature of the brain trauma, with higher risks associated with penetrating injuries, severe brain contusions, and hemorrhagic lesions. Pathogenetic mechanisms involve a cascade of molecular and cellular events, including neuroinflammation, blood-brain barrier disruption, and neuronal hyperexcitability, which contribute to the formation of epileptic networks. Diagnosis relies on a detailed patient history, neuroimaging, and electroencephalography (EEG) to confirm seizure activity and exclude other causes. It is often delayed and complicates early intervention strategies. Current management primarily focuses on seizure control through antiepileptic drugs (AEDs), but response rates are variable, and many patients suffer from drug-resistant epilepsy. Advances in neuroimaging and biomarker research hold promise for earlier detection and targeted therapies. This review synthesizes recent findings on the epidemiology, pathophysiology, diagnosis, and management of PTE, highlighting the need for a multidisciplinary approach to improve outcomes for individuals affected by this condition.

Functional seizures (FS), the most common subtype of functional neurological disorder (FND), cause serious neurological disability and significantly impact quality of life. Characterized by episodic disturbances of functioning that resemble epileptic seizures, FS coincide with multiple comorbidities and are treated poorly by existing approaches. Novel treatment approaches are sorely needed. Notably, mounting evidence supports the safety and efficacy of psychedelic-assisted therapy (PAT) for several psychiatric conditions, motivating investigations into whether this efficacy also extends to neurological disorders. Here, we synthesize past empirical findings and frameworks to construct a biopsychosocial mechanistic argument for the potential of PAT as a treatment for FS. In doing so, we highlight FS as a well-defined cohort to further understand the large-scale neural mechanisms underpinning PAT. Our synthesis is guided by a complexity science perspective which we contend can afford unique mechanistic insight into both FS and PAT, as well as help bridge these two domains. We also leverage this perspective to propose a novel analytic roadmap to identify markers of FS diagnostic specificity and treatment success. This endeavor continues the effort to bridge clinical neurology with psychedelic medicine and helps pave the way for a new field of psychedelic neurology. [ABSTRACT FROM AUTHOR]

• Government hospital patients were more likely to be discharged with ASMs. • Private hospital patients were more likely to present with current ASMs. • Government hospital patients were less likely to use psychiatric medications. • Government hospital patients reported more cardiovascular medications. Currently, we have limited knowledge of any potential differences among patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds. Investigating medication use among these patients may provide insight into the quality and intensity of medical care they receive. Thus, we aimed to assess and compare the frequency and quantity of antiseizure medications (ASMs), and psychiatric and other medications used among patients with FS from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. Only video-electroencephalographically (video-EEG) confirmed patients with FS with no comorbid epilepsy were eligible for the study. For this retrospective case-control study we collected data on patients' medication-taking histories using digital patient records, starting with the earliest available digital patient record for each hospital. A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Patients with FS attending the public hospital had lower odds of taking any ASMs at presentation (aOR=0.39, 95% CI [0.20, 0.75]) and ever taking psychiatric medications (aOR=0.41, 95% CI [0.22, 0.78]) compared to FS patients from the private hospital. They did, however, have higher odds of being discharged with an ASM (aOR=6.60, 95% CI [3.27, 13.35]) and ever taking cardiovascular medication (aOR=2.69, 95% CI [1.22, 5.90]) when compared to the private hospital patients. With every additional presenting ASM (aOR=0.63, 95% CI [0.45, 0.89]) and psychiatric medication (aOR=0.58, 95% CI [0.40, 0.84]) the odds of being from the public hospital decreased. However, they increased with every additional discharge ASM (aOR=3.63, 95% CI [2.30, 5.72]) and cardiovascular medication (aOR=1.26, 95% CI [1.02, 1.55]). Standard approaches to pharmacological treatment for patients with FS differed between the public and private hospitals and may indicate a gap in quality of care. [ABSTRACT FROM AUTHOR]

• Many patients with psychogenic non epileptic seizures (PNES) receive anti-seizure medications (ASM) and sometimes even life-threatening treatments such as intubation. • The literature regarding risk factors for the use of ASM in PNES patients is sparse. • Study result shows that PNES patients with abnormal EEG patterns and pathological brain imaging findings are more likely to be treated with ASM. • The pure dialeptic nature of seizures is less likely to be misdiagnosed as ES. • PNES patients with dialeptic seizures are less likely to be treated with multiple treatment lines. The average time for psychogenic nonepileptic seizures (PNES) diagnosis is about 7.5 years. Many patients receive inadequate treatment and sometimes even life-threatening treatments such as tracheal intubation during this time. To determine the risk factors for misdiagnosis of PNES as Epilepsy. The medical records of patients who underwent video-electroencephalogram (EEG) monitoring were reviewed retrospectively. Patients who had PNES without epileptic seizures (ES) were included in this study. Baseline personal and monitoring characteristics were collected. The patients were then divided into two groups based on their therapeutic status. Patients in the treatment group were again divided into two groups based on the number of anti-seizure medications (ASM) they were treated with. Fifty-seven patients diagnosed with PNES were included in this study. Thirty-seven patients were under treatment, and 20 patients were not under treatment at the time of monitoring. Motor seizures, abnormal interictal EEG patterns, and pathological brain imaging findings were more frequent among patients in the treatment group (p <0.05). Patients with motor seizures were more likely to be treated with multiple ASM than patients with only dialeptic nonmotor seizures (p <0.05). Lastly, patients in the treatment group were monitored longer and had fewer seizures during monitoring (p <0.05). PNES patients with abnormal EEG patterns and pathological brain imaging findings are more likely to be treated with ASM. The pure dialeptic nature of seizures is less likely to be misdiagnosed as ES. In addition, patients with such seizures are less likely to be treated with multiple treatment lines. [ABSTRACT FROM AUTHOR]

• Psychogenic non-epileptic seizures (PNES) in people with epilepsy (PWE) are associated with personality disfunction. • Higher levels of anxiety and higher scores on trait domains of psychoticism and disinhibition are associated with PNES in PWE. • Further studies are needed to examine the maladaptive personality profiles of patients with different "types" of PNES. We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective. The cohort study included 77 consecutive inpatients with active epilepsy aged 36–55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables. Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism. The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES) are such class of pseudo-neurological disorder which finds home nowhere whether its psychology, neurology or psychiatry and thus always a state of confusion continues among PNES patients that where to seek for assistance, though patients with PNES are first reported in neurology department because it mimics epileptic seizures. The main reason behind PNES is psychological turmoil but recent studies have come up with biological and social aspects also. Therefore, till today debate behind PNES's etiology persist. Thus, in this report we done an educational review of etiology of PNES briefly considering all three aspects i.e. psychological, biological and social ensuring an eclectic professional help to devise any diagnostic and management plan for PNES patients.

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Diagnosing a non-epileptic seizure is difficult in the absence of a video electroencephalogram. The expert commission of the international league against epilepsy proposes a diagnostic approach allowing the diagnosis to be made according to a degree of certainty with or in the absence of a video electroencephalogram. Our objective was to determine the hospital frequency of psychogenic non-epileptic seizures in the absence of videoelectroencephalogram. Using the outpatient registry, we identified patients followed for epilepsy with two normal interictal electroencephalographies, between January 2020 and October 2021. A review of the patients' medical records and an assessment of the validity of the diagnosis were carried out. Out of 64 patients evaluated with normal interictal electroencephalogram, 19 were included as suffering from psychogenic non-epileptic seizures, i.e. 26.68%. The average age was 23.94 +/- 9.4 years. Women represented 68.4%. Patients followed in neurology represented 84%. A history of childhood trauma was found in (47.4%). The first crisis was preceded by stressful events in 47.36%. Post-traumatic stress disorder was the most represented with 73.7% of cases. The average age was 20.95 +/- 9.8 years for the first crisis and the average duration of evolution of the crises was 3 years +/- 2 years. This study illustrates the possibility of making a presumptive diagnosis of psychogenic non-epileptic seizure in the absence of video-electroencephalogram. [ABSTRACT FROM AUTHOR]

Patients diagnosed with functional (psychogenic nonepileptic) seizures have similar or greater levels of disability, morbidity and mortality than people with epilepsy, but there are far fewer treatment services. In contrast to epilepsy, the current understanding of pathophysiological mechanisms and the development of evidence-based treatments for functional seizures is rudimentary. This leads to high direct healthcare costs and high indirect costs to the patient, family and wider society. There are many patient, clinician and system-level barriers to improving outcomes for functional seizures. At a patient level, these include the heterogeneity of symptoms, diagnostic uncertainty, family factors and difficulty in perceiving psychological aspects of illness and potential benefits of treatment. Clinician-level barriers include sub-specialism, poor knowledge, skills and attitudes and stigma. System-level barriers include the siloed nature of healthcare, the high prevalence of functional seizures and funding models relying on individual medical practitioners. Through the examination of international examples and expert recommendations, several themes emerge that may address some of these barriers. These include (1) stepped care with low-level, brief generalised interventions, proceeding to higher level, extended and individualised treatments; (2) active triage of complexity, acuity and treatment readiness; (3) integrated interdisciplinary teams that individualise formulation, triage, and treatment planning and (4) shared care with primary, emergency and community providers and secondary consultation. Consideration of the application of these principles to the Australian and New Zealand context is proposed as a significant opportunity to meet an urgent need. [ABSTRACT FROM AUTHOR]

This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10–0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = −0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10–0.13, rs-values = −0.46–0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = −0.74) and working memory tests (p < 0.001, rs = −0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67–0.85). These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary. [ABSTRACT FROM AUTHOR]

Abstract Background/aim As the clinical differentiation between epileptic seizures, psychogenic non-epileptic seizures (PNES), and syncope depends mainly on a detailed report of the event, which may not be available, an objective assessment of a potential biochemical analysis is needed. We aimed to investigate whether serum creatine kinase (CK) could be used to differentiate epileptic seizure from PNES and syncope and to assess the strength of evidence present. Methods We directed a retrospective cohort study coupled with a systematic review and meta-analysis of studies that measured CK in patients with epilepsy, PNES, syncope, and healthy controls. Results The cohort study, which traced 202 patients, showed that the CK level was significantly higher 48 h after the event in the epilepsy group versus patients with syncope (p

Daichi Sone Department of Psychiatry, Jikei University School of Medicine, Tokyo, JapanCorrespondence: Daichi Sone, Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, Japan, Tel +81-3-3433-1111, Fax +81-3-5401-1879, Email d-sone@jikei.ac.jpAbstract: Psychiatric non-epileptic seizure (PNES), also known as a form of functional neurological disorders (FND), is a common but still underrecognized disorder presenting seizure-like symptoms and no electrophysiological abnormality. Despite the significant burden of this disorder, the neurobiological mechanisms are not clearly understood, which hinders the development of better diagnosis and treatment. In the recent neuroimaging research on PNES, brain network analysis has become a relevant topic beyond conventional methodologies. The human brain is a highly intricate system of interconnected regions that collaborate to facilitate a wide range of cognitive and behavioral functions. White matter tracts, which are comprised of bundles of axonal fibers, are the primary means by which information is transmitted between different brain regions. As such, comprehending the organization and structure of the brain’s white matter network is critical for gaining insight into its functional architecture. This review article aims to provide an overview of the brain mechanisms underlying PNES, with a special focus on analyzing brain networks.Keywords: psychogenic non-epileptic seizures, functional neurological disorders, neuroimaging, brain network, diffusion tensor imaging

• Patient sociodemographic and trauma profiles were similar between hospitals. • Public hospital patients reported higher odds of intimate partner violence. • Public hospital patients reported higher odds of death/sickness in the family. • Private hospital patients reported higher odds of coming from an abusive home. To date not much is known about the differences, if any, between patients with functional seizures (FS) from different socioeconomic backgrounds. We sought to compare the psychological stress and trauma profiles of patients with FS from a private and public hospital in Cape Town, South Africa. Only video-electroencephalography-confirmed patients with FS were eligible for the study. In this retrospective case-control study we collected data on self-reported demographic and psychological stressor/trauma variables using digital patient records starting with the earliest available digital patient record for each hospital. A total of 321 patients from a private hospital and 68 patients from a public hospital were included in the study. Most factors showed no significant differences. However, public hospital patients had higher odds of being older (p = 0.002), almost nine times the odds of reporting physical violence by an intimate partner (aOR = 8.65, 95% CI [1.70, 44.08]), more than eight times the odds of reporting psychological stress in the form of death and/or sickness in the family (aOR = 8.56, 95% CI [1.81, 40.41]) and almost three times the odds for other general psychosocial stressors (aOR = 2.82, 95% CI [1.08, 7.42]) compared to those attending the private hospital. They also had half the odds of being female compared to the private hospital patients (aOR = 0.47, 95% CI [0.23, 0.95]) and 93% fewer odds of reporting coming from an abusive home (aOR = 0.07, 95% CI [0.01, 0.52]). History and psychological trauma and stressor profiles showed many similarities between the public and private hospital groups; however, some differences were noted and could benefit further exploration and consideration in therapeutic and diagnostic contexts. [ABSTRACT FROM AUTHOR]

Background/aim: As the clinical differentiation between epileptic seizures, psychogenic non-epileptic seizures (PNES), and syncope depends mainly on a detailed report of the event, which may not be available, an objective assessment of a potential biochemical analysis is needed. We aimed to investigate whether serum creatine kinase (CK) could be used to differentiate epileptic seizure from PNES and syncope and to assess the strength of evidence present. Methods: We directed a retrospective cohort study coupled with a systematic review and meta-analysis of studies that measured CK in patients with epilepsy, PNES, syncope, and healthy controls. Results: The cohort study, which traced 202 patients, showed that the CK level was significantly higher 48 h after the event in the epilepsy group versus patients with syncope (p < 0.01) Along with 1086 patients obtained through a database search for meta-analysis, CK level compared to different types of seizures from PNES was higher in epileptic seizure patients with a mean difference of 568.966 mIU/ml (95% CI 166.864, 971.067). The subgroup analysis of CK showed that it was higher in GTCS compared to syncope with a mean difference of 125.39 mIU/ml (95% CI 45.25, 205.52). Discussion: Increased serum levels of CK have been associated mainly with epileptic seizures in relation to non-epileptic events. However, further studies would try to explore the variation in measurements and any other potential diagnostic marker. Conclusion: The cohort study shows that the CK level in epilepsy seizures is higher after 48 h from the event compared to syncope. Moreover, the meta-analysis results show the present diagnostic utility of CK and its importance to be used in accordance with a detailed report of the event. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the clinical features of psychogenic non-epileptic seizures (PNES) and to enhance the accuracy of the differential diagnosis of epilepsy. Methods: This retrospective case series included patients diagnosed with PNES between December 2003 and February 2019 at Taipei Veterans General Hospital. We used International Classification of Diseases (10th revision) codes for screening, and relevant medical records were reviewed. Experienced pediatric neurologists diagnosed PNES based on clinical manifestations, and occasionally on confirmatory video-electroencephalography (EEG) or simultaneous scalp-EEG during the paroxysmal attack. General information, clinical manifestations, psychological conditions, and relevant laboratory or imaging test results were collected and analyzed. Results: Twenty-six patients (mean age, 13 years 8 months) were evaluated, 9 male and 17 female. Ten patients with PNES had a previously established diagnosis of epilepsy. The duration between symptom onset and diagnosis ranged from 1 to 120 (mean, 21; median, 12) days. Sixteen patients showed possible causative psychosocial stressors. Multiple characteristic features or specific clinical manifestations of PNES—that usually differ from epileptic seizures—were observed in all patients with PNES. Conclusion: A detailed evaluation of clinical manifestations and medical history is important for the accurate diagnosis of PNES.

Several patients are referred to the epilepsy monitoring unit (EMU) to evaluate episodic events that can be challenging to differentiate from epileptic events. The current study aimed to determine the prevalence of non-epileptic events (NEEs) among children and adolescents admitted to the EMU, and the clinical and demographic features of such events. Methods: We retrospectively evaluated all patients aged 18 years and below who were admitted to the EMU of King Fahad Medical City, Riyadh, KSA, from January 2014 to March 2020. Results: The prevalence of NEEs in children & adolescents admitted to the EMU was 25%. Psychogenic events (PNESs, 30%) were the most common type. Movement disorders occurred more often in younger age group, while migraine was seen more often in school-aged children. Conclusion: The prevalence of NEEs was 25%, and this result is similar to that reported in the literature. The distribution of events is mainly based on age. Clinical and video-based assessments are essential in identifying such events to prevent unnecessary treatment with anti-seizure medications.

Background: In medical practice, it is common to see patients who present with physical symptoms for which no disease pathology can be found. The presence of neurological symptoms that are shown to be incompatible with neurological pathophysiology is classically known as "conversion disorder" or "Functional Neurological Symptom Disorder" (FND). While FND is common in Egypt as in the rest of the world, few scientific studies systematically evaluate the degree of knowledge, attitude, and care provided by health care professionals to FND patients. We aimed to assess Egyptian physicians' perspectives on FND. Results: A cross-sectional study has been conducted on 152 physicians dealing with FND practicing in Egypt from specialties of psychiatry, neurology, and other specialties. We found that for 45% of the participants, disordered functioning of the nervous system plus psychogenesis was the accepted etiology behind FND. Most participants were significantly not satisfied with their education about FND (p-value 0.01). Psychiatrists and neurologists significantly preferred to use the term "conversion disorder" while other specialties mainly used "psychic" and "Somatization/Somatoform Disorder" (p-value 0.001). Forty-four percent of the participants think they have a good knowledge of functional neurological disorders (FND), while the majority (86.8%) were worried about missing an organic disorder. Psychiatrists were the most confident in diagnosing FND and the most comfortable discussing it with patients (p-values 0.055 and 0.007, respectively). Conclusion: Here we highlight the common theme of worry about FND patients prevailing among healthcare professionals who are mostly perplexed about the mechanisms behind FND, and how to communicate these symptoms to other professionals and patients themselves. Future directions need to be devoted to minimizing the gap between the research finding and the currently applied care. Better education and teaching about FND may improve patient care. [ABSTRACT FROM AUTHOR]

This is a retrospective case series of pediatric patients referred to the psychogenic nonepileptic events clinic (PNEE) who had comorbid diagnoses of autism spectrum disorder (ASD) or intellectual disability (ID). We describe 15 patients, nine with ASD and six with ID who had a telephone visit follow-up at 12 months. There were higher rates of male gender (40%) and comorbid epilepsy (53%) compared to the larger PNEE cohort. Eleven patients were available for follow-up and ten patients had improvement in events or were event-free. We report that patients with ASD or ID can develop PNEE and experience improvement from events. [ABSTRACT FROM AUTHOR]

Introduction: Functional dissociative seizures (FDS) are episodes that resemble epileptic seizures, but are caused by different biopsychosocial factors. The way in which these patients cope with the challenges of their condition has been considered an important maintaining factor. The aim of this systematic review is to identify the coping strategies used by adult patients with FDS, and the measures used to assess them. Methods: The review was conducted following the PRISMA guidelines. A search was conducted in Pubmed, Cochrane Library, Scielo, Science Direct and Lilacs databases. Results: Eleven articles met the inclusion criteria and were integrated into a narrative synthesis. FDS patients use more avoidance and emotion-focused strategies than the general population. Their excessive use has been related to greater psychopathology, poorer quality of life and greater distress in the face of stress. On the other hand, the diversity of coping assessment instruments reflects the heterogeneity of the field. Conclusions: More research is needed to understand the coping strategies of FDS patients and to offer more personalized and effective treatment. [ABSTRACT FROM AUTHOR]

Psychological therapies are considered the treatment of choice for functional/dissociative seizures (FDSs). Although most previous studies have focused on seizure persistence or frequency, it has been argued that well‐being or health‐related quality of life outcomes may actually be more meaningful. This study contributes by summarizing and meta‐analyzing non‐seizure outcomes to quantify the effectiveness of psychological treatment in this patient group. A pre‐registered systematic search identified treatment studies (e.g., cohort studies, controlled trials) in FDSs. Data from these studies were synthesized using multi‐variate random‐effects meta‐analysis. Moderators of treatment effect were examined using treatment characteristics, sample characteristics, and risk of bias. A total of 171 non‐seizure outcomes across 32 studies with a pooled sample size of N = 898 yielded a pooled effect‐size of d =.51 (moderate effect size). The outcome domain assessed and the type of psychological treatment were significant moderators of reported outcomes. Greater rates of improvement were demonstrated for outcomes assessing general functioning. Behavioral treatments emerged as particularly effective interventions. Psychological interventions are associated with clinical improvements across a broad array of non‐seizure outcomes, over and above seizure frequency, in adults with FDSs. [ABSTRACT FROM AUTHOR]

The impact of the collaboration between photographer Eadweard Muybridge and neurologist Francis Dercum is detailed within the context of a photographic study of an artificially induced psychogenic non-epileptic seizure. Their contribution served as inspiration to other contemporary European neurologists and photographers to use motion photography to further understand psychogenic neurological disorders, such as seizures. [ABSTRACT FROM AUTHOR]

This study aimed to determine the clinical features of psychogenic non-epileptic seizures (PNES) and to enhance the accuracy of the differential diagnosis of epilepsy. This retrospective case series included patients diagnosed with PNES between December 2003 and February 2019 at Taipei Veterans General Hospital. We used International Classification of Diseases (10th revision) codes for screening, and relevant medical records were reviewed. Experienced pediatric neurologists diagnosed PNES based on clinical manifestations, and occasionally on confirmatory video-electroencephalography (EEG) or simultaneous scalp-EEG during the paroxysmal attack. General information, clinical manifestations, psychological conditions, and relevant laboratory or imaging test results were collected and analyzed. Twenty-six patients (mean age, 13 years 8 months) were evaluated, 9 male and 17 female. Ten patients with PNES had a previously established diagnosis of epilepsy. The duration between symptom onset and diagnosis ranged from 1 to 120 (mean, 21; median, 12) days. Sixteen patients showed possible causative psychosocial stressors. Multiple characteristic features or specific clinical manifestations of PNES—that usually differ from epileptic seizures—were observed in all patients with PNES. A detailed evaluation of clinical manifestations and medical history is important for the accurate diagnosis of PNES. [ABSTRACT FROM AUTHOR]

Objectives: There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine. Materials and Methods: This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively. Results: Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease. Conclusion: Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger. [ABSTRACT FROM AUTHOR]

Objective: Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic–pituitary–adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children. Methods: Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3−16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6–17.7 years). Saliva samples were collected using a Salivette sampling device at two time points – upon awakening and 30 minutes after awakening. Results: Patients with functional neurological disorder showed a decrease in cortisol awakening response (–4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t (55) = –.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r (58) = –0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r (58) = –0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r (56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses. Discussion: The results suggest dysregulation of the hypothalamic–pituitary–adrenal axis in children with functional neurological disorder. Hypothalamic–pituitary–adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic–pituitary–adrenal dysregulation – and changes in glucocorticoid (cortisol) signalling at the molecular level – may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder. [ABSTRACT FROM AUTHOR]

Purpose: Functional seizures (FS) cause significant long-term disability and clinicians offer differing views on proper work restrictions and qualifications for disability benefits in this population. We assess the views and perspectives of experienced disability and work limitations in people living with functional seizures. Methods: Between (4/29/2020–1/13/2021) an open-access 21-item internet survey was conducted via FNDHope.org; allowing for people living with self-reported functional seizures to remark on topics of work difficulties, work restrictions, qualifications for disability benefits, and driving. Demographic information was collected, and univariate and multivariate logistic regressions were used to evaluate potential predictors of current employment status. Results: One hundred eighteen (118) responses were received, of which 92 (84.4%) completed > 50% of the survey; they were predominantly (92%) female. Most respondents (88%) reported some personal difficulty at work and nearly all (99%) believed that others with FS would experience difficulties in the workplace. A majority (71%) felt that work restrictions should apply to people living with active FS, at least in certain lines of work. Most (64%) felt people with FS should qualify for disability benefits; however, 35% stated work accommodations or a new job compatible with FS was more appropriate. Of those who felt people with FS should qualify for disability, 60% thought recipients should remain eligible for disability while symptomatic and 38% felt benefits should be lifelong. In univariate and multivariate logistic regressions, older age was predictive of unemployment (univariate OR 0.95 ± 0.02, 95% CI 0.92–0.98, p-value 0.002). Conclusion: Our results suggest that work difficulties are common in people with FS, with older age being a predictor of unemployment. A majority of people with FS support work restrictions for those with their disorder, at least in some lines of work. In comparison to a prior study of clinicians, a higher percentage of people with FS supported work restrictions. These results may help facilitate productive discussions between people with FS, providers, and policymakers regarding appropriate work and disability limitations.

Background Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking. Aims To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations. Method We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle–Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263). Results Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case–control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66–1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19–0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65–1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI −0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25–2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations. Conclusions Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.

IntroductionYouth with psychogenic non-epileptic seizures (PNES) are an understudied group associated with significant medical and psychiatric morbidity. Several studies have examined characteristics associated with youth's development of this disorder, though the exploration of family factors including psychiatric illness, has been lacking. This study sought to establish the need for a more comprehensive future study.MethodsA retrospective chart review was conducted on patients who had been admitted and diagnosed with PNES at the epilepsy monitoring unit at Children's Hospitals and Clinics of Minnesota. A total of 62 patients were included. All patients were evaluated by an epileptologist and psychologist during their diagnostic admission. “Spells” in question were captured via video EEG monitoring. PNES youth and family risk factors were assessed.ResultsMean age of PNES symptom onset was 13.9 years. Patients (73%) were diagnosed within 6 months of onset of symptoms. Histories of other impairing somatic complaints were present in the youth (54%), with 67% having prior psychiatric diagnoses. Experiencing suicidal ideation or thoughts of self-harm occurred in 47% of this sample. Family members were unaware of the history of these symptoms with 12% of the parent's reporting awareness. Family history of psychiatric disorders (first-degree relatives of patient) was present in 54% of the sample, with anxiety, depression and conversion disorder being the most commonly endorsed diagnoses.ConclusionsYouth with PNES present with comorbid psychiatric disorders, though prior assessment and treatment for these disorders was not common. Youth with PNES have history of suicidal ideation and thoughts of self-harm, though parental awareness of these co-occurring symptoms is limited. Family risk factors, such as history of psychiatric disorder in first degree relatives, was high. The impact of these family risk factors is understudied and should be further evaluated to better understand the impact on development and maintenance of this disorder in youth.

Objective: Quality and type of early relationships with primary caregivers is considered one of the key factors in the etiopathogenesis of many mental disorders including depression, anxiety, and conversion disorders. This study focused on the type and quality of attachment style in adult patients with psychogenic non-epileptic seizures (PNES). Materials and methods: We evaluated the demographic data and profiles of PNES patients (n = 262) and group of healthy volunteers (n = 51) measured by the Parental Bonding Inventory (PBI) and Experiences in Close Relationships (ECR) and Experiences in Close Relationships-Relationship Structure (ECRRS). Results: Significant differences in measured values between the two groups were identified; specifically, differences in the caregiver style-father and mother overprotection (PBI) was higher in the PNES group. The most frequent type of attachment in PNES was type 2 (preoccupied). Correlations between the PBI and ECR results were also found. Conclusion: This study highlighted certain attachment styles in patients with PNES and statistically significant differences between patients with PNES and a healthy sample. Some correlations between the results of the questionnaires with socio-demographic factors were found. The identification of specific patterns in attachment may be useful for further use in reaching a differential diagnosis and administering tailored psychotherapy of patients with PNES. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES) may resemble epileptic seizures but are not caused by epileptic activity. However, the analysis of electroencephalogram (EEG) signals with entropy algorithms could help identify patterns that differentiate PNES and epilepsy. Furthermore, the use of machine learning could reduce the current diagnosis costs by automating classification. The current study extracted the approximate sample, spectral, singular value decomposition, and Renyi entropies from interictal EEGs and electrocardiograms (ECG)s of 48 PNES and 29 epilepsy subjects in the broad, delta, theta, alpha, beta, and gamma frequency bands. Each feature-band pair was classified by a support vector machine (SVM), k-nearest neighbour (kNN), random forest (RF), and gradient boosting machine (GBM). In most cases, the broad band returned higher accuracy, gamma returned the lowest, and combining the six bands together improved classifier performance. The Renyi entropy was the best feature and returned high accuracy in every band. The highest balanced accuracy, 95.03%, was obtained by the kNN with Renyi entropy and combining all bands except broad. This analysis showed that entropy measures can differentiate between interictal PNES and epilepsy with high accuracy, and improved performances indicate that combining bands is an effective improvement for diagnosing PNES from EEGs and ECGs. [ABSTRACT FROM AUTHOR]

Psychogenic non-epileptic seizures (PNES), which closely resemble epileptic seizures (ES), are typically triggered by psychological distress and represent the most prevalent form of conversion disorder encountered in clinical practice. Multiple physical conditions can both precipitate and sustain PNES episodes. Epilepsy, a common neurological disorder, imposes significant emotional and physical burdens, frequently resulting in elevated levels of anxiety and depression. This case report details the clinical course of a 19-year-old female whose PNES was exacerbated by the diagnosis and disease burden of epilepsy. The patient's background of childhood trauma, bullying, and sexual abuse likely predisposed her to the development of PNES. Upon receiving a diagnosis of epilepsy, characterized by focal seizures originating from the left parietal region, the patient experienced increased anxiety and required frequent hospitalizations. Despite adjustments to her treatment regimen, including the administration of levetiracetam (LEV) and lacosamide (LCM), her seizures persisted. Comprehensive evaluations, comprising electroencephalography (EEG) and single-photon emission computed tomography (SPECT), indicated the coexistence of epilepsy and PNES. Although surgical intervention was initially considered, it was ultimately deemed unnecessary, which subsequently alleviated the patient's anxiety. Psychoeducation highlighting the manageability of her epilepsy with ongoing pharmacotherapy significantly reduced her PNES episodes. This case emphasizes the critical role of addressing the psychosocial burden associated with an epilepsy diagnosis, as these factors may exacerbate PNES. It also underscores the importance of a holistic treatment approach that integrates psychological support with medical management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kimura et al.)

ObjectiveQuality and type of early relationships with primary caregivers is considered one of the key factors in the etiopathogenesis of many mental disorders including depression, anxiety, and conversion disorders. This study focused on the type and quality of attachment style in adult patients with psychogenic non-epileptic seizures (PNES).Materials and methodsWe evaluated the demographic data and profiles of PNES patients (n = 262) and group of healthy volunteers (n = 51) measured by the Parental Bonding Inventory (PBI) and Experiences in Close Relationships (ECR) and Experiences in Close Relationships–Relationship Structure (ECR-RS).ResultsSignificant differences in measured values between the two groups were identified; specifically, differences in the caregiver style–father and mother overprotection (PBI) was higher in the PNES group. The most frequent type of attachment in PNES was type 2 (preoccupied). Correlations between the PBI and ECR results were also found.ConclusionThis study highlighted certain attachment styles in patients with PNES and statistically significant differences between patients with PNES and a healthy sample. Some correlations between the results of the questionnaires with socio-demographic factors were found. The identification of specific patterns in attachment may be useful for further use in reaching a differential diagnosis and administering tailored psychotherapy of patients with PNES.

Background: Anxiety disorders are the most frequent mental disorders. Among the different subtypes, specific phobias are the commonest. Due to the ongoing SARSCoV-19 pandemic, blood-injury-injection phobia (BII) has gained wider attention in the context of large-scale vaccination campaigns and public health. In this BII phobia minireview and case report, we describe the successful treatment of a severe BII phobia case with combined fainting and psychogenic non-epileptic seizures (PNES) and demonstrate the role of specialized outpatient care. Case Report: The patient was a 28-year-old woman. She suffered from intense fear and recurrent fainting with regard to needles, injections, injuries, and at the sight of blood since early childhood. Medical history revealed infrequent events suggestive of PNES following panic attacks after sustained exposure to phobic stimuli. Family history was positive for circulation problems and BII fears. Psychopathological evaluation confirmed BII phobia symptoms and diagnosis was made according to the DSM-5. The Multidimensional Blood/Injury Phobia Inventory short version (MBPI-K) revealed severe manifestation of the disease. Neurological examination was ordinary. Repeated electroencephalography detected no epileptic pattern. Cranial magnetic resonance imaging showed normal morphology. Treatment was carried out by a seasoned, multidisciplinary team. Cognitive behavior therapy and exposure were performed. Modification of standard treatment protocol was necessary due to hurdles posed by recurrent fainting and a severe panic-triggered dissociative PNES during in vivo exposure. Modification was implemented by limiting in vivo exposure intensity to moderate anxiety levels. In addition to applied muscle tension and ventilation techniques, increased psychoeducation, cognitive restructuring, and distress tolerance skills (e.g., ice pack, verbal self-instructions) were used to strengthen the patient's situational control during in vivo exposure. A total of 15 sessions were performed. Therapy success was proven by 83% reduction in MBPI-K rating, SARS-CoV-19 vaccination, and a blood draw without psychological assistance, fainting, or seizure. Conclusion: Taken together, this case demonstrates the potential of and need for specialized outpatient care and individualized treatment for severe BII phobia patients in order to provide them the perspective to have necessary medical procedures done and get vaccinated. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this scoping review was to explore the extent, range and nature of knowledge on stigma in functional seizures (FS).Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis (JBIMES) guidelines and the five-step framework by Arksey and O'Malley. We searched for data sources written in English using MEDLINE, Scopus, EBSCOhost, Ovid, PubMed, Science Direct, Web of Science, Wiley Online Library, Microsoft Academic, Google Scholar, as well as grey literature sources, with no date limitations up to September 2021. The extracted data were analysed using basic frequency counts and thematic synthesis.Results: The systematic search yielded a set of 988 potentially relevant data sources, of which 70 met the inclusion criteria. The retrieved sources reflected data from 85 countries and 5949 study participants. The thematic synthesis highlighted the prevalence of FS stigma, as well as its potential origins, context and impact on patients and families. The majority of studies were conducted in healthcare settings with healthcare providers, with fewer data sources reporting on family, patient, and broader society perspectives relating to FS stigma.Conclusion: Our scoping review suggests that FS stigma is prevalent but remains understudied. We need more research with a specific focus on stigma in FS, and factors that contribute to FS stigma (e.g. culture and context, naming of the condition), as well as accessible interventions and guidelines addressing FS stigma through education and training. Supportive attitudes and knowledge appear to be protective factors against FS stigma. [ABSTRACT FROM AUTHOR]

Purpose: Functional seizures (FS) are heterogenous, with no agreed way to subdivide them. One FS subtype frequently observed during EEG is those whose seizures are provoked by hyperventilation. We wished to see whether this subtype might reflect a different seizure mechanism.Methods: We analysed the video-EEG/ECGs of all patients with FS from two hospitals in Melbourne from 2010-6.Results: We identified 120 patients during the study period, 107 of whom had usable recordings. Examining those 11 (10%) whose seizures had been induced by hyperventilation, we compared the heart rates of those where the seizure occurred during the hyperventilation, and those where they occurred afterwards. The during-hyperventilation group had a higher baseline heart rate which increased prior to their seizure; the after-hyperventilation group had a lower baseline heart rate and no pre-ictal increase. In those patients whose seizures were not hyperventilation-induced, the same two heart rate patterns could be found: those with a higher baseline heart rate showed increasing heart rate prior to seizure onset, while those with a lower baseline heart rate did not. Cluster analysis showed the sample was optimally divided into these two groups based on their pre-onset heart rate alone.Conclusion: Patients with FS show two distinct patterns of pre-ictal heart rate, which may reflect two distinct seizure mechanisms. [ABSTRACT FROM AUTHOR]

Objectives:It has been found that pain response is higher in patients with depression and anxiety and also found higher in the patients with psychogenic non-epileptic seizures (PNES). However, these studies are limited in number and they are mainly focused on the chronic pain perception. We aimed to investigate anxiety and depression levels and the perception of acute pain along with childhood traumas among the patients with PNES.Methods:In our study, a total of 100 gender- and age-matched patients with PNES and 50 healthy controls were included in the study. The beck depression inventory (BDI), the beck anxiety inventory (BAI), and the childhood trauma questionnaire-28 were applied to all the participants. Pain perception was also evaluated by applying gradually increasing pressure with tension cuff while the participants were in a seated position. While the tension was about 180 mmHg, the participants were asked to evaluate their pain using the visual analog scale (VAS).Results:The major findings of our study are as follows: (i) The BDI and BAI scores were significantly higher in the PNES group than in the control group; (ii) VAS scores were significantly higher in the PNES group than in the control group; and (iii) among the PNES group, BAI scores were correlated with VAS scores.Conclusion:PNES is experienced by a heterogeneous patient group, and its underlying factors are still not well described. Depression and anxiety are common accompanying factors, and the pain response is higher in patients with PNES with high anxiety levels.

A 19-year-old primigravida underwent caesarean section under spinal anaesthesia. She presented with seizures on 7th post-operative day. All the common etiological factors for seizures were ruled out. We found out that the seizures were due to a psychiatric condition called 'psychogenic non-epileptic seizure (PNES)'. There were previous case reports of PNES that were documented on known patients of seizures, followed by general anaesthesia. Here is a case of PNES without any previous history of functional or organic seizures followed by spinal anaesthesia.

BackgroundAnxiety disorders are the most frequent mental disorders. Among the different subtypes, specific phobias are the commonest. Due to the ongoing SARS-CoV-19 pandemic, blood-injury-injection phobia (BII) has gained wider attention in the context of large-scale vaccination campaigns and public health. In this BII phobia mini-review and case report, we describe the successful treatment of a severe BII phobia case with combined fainting and psychogenic non-epileptic seizures (PNES) and demonstrate the role of specialized outpatient care.Case ReportThe patient was a 28-year-old woman. She suffered from intense fear and recurrent fainting with regard to needles, injections, injuries, and at the sight of blood since early childhood. Medical history revealed infrequent events suggestive of PNES following panic attacks after sustained exposure to phobic stimuli. Family history was positive for circulation problems and BII fears. Psychopathological evaluation confirmed BII phobia symptoms and diagnosis was made according to the DSM-5. The Multidimensional Blood/Injury Phobia Inventory short version (MBPI-K) revealed severe manifestation of the disease. Neurological examination was ordinary. Repeated electroencephalography detected no epileptic pattern. Cranial magnetic resonance imaging showed normal morphology. Treatment was carried out by a seasoned, multidisciplinary team. Cognitive behavior therapy and exposure were performed. Modification of standard treatment protocol was necessary due to hurdles posed by recurrent fainting and a severe panic-triggered dissociative PNES during in vivo exposure. Modification was implemented by limiting in vivo exposure intensity to moderate anxiety levels. In addition to applied muscle tension and ventilation techniques, increased psychoeducation, cognitive restructuring, and distress tolerance skills (e.g., ice pack, verbal self-instructions) were used to strengthen the patient's situational control during in vivo exposure. A total of 15 sessions were performed. Therapy success was proven by 83% reduction in MBPI-K rating, SARS-CoV-19 vaccination, and a blood draw without psychological assistance, fainting, or seizure.ConclusionTaken together, this case demonstrates the potential of and need for specialized outpatient care and individualized treatment for severe BII phobia patients in order to provide them the perspective to have necessary medical procedures done and get vaccinated.

• Expressive movements are integral part of socially relevant human behaviors. • Expressive movements exhibit worldwide features across history and cultures. • They may also be part of functional disorders and neurological diseases semiology. • Expressive movements' interpretation hinges on historical, socio-cultural contexts • A shared anatomical-functional substrate involving CPGs may be hypothesized [ABSTRACT FROM AUTHOR]

Introduction: Electroencephalograms (EEG) can be helpful in evaluating patients presenting to the emergency department (ED).Methods: We reviewed the charts of patients who had an EEG done in the ED at Dayton Children's Hospital in Dayton, Ohio from 2010 to 2018. We divided the indication for EEG into 6 categories, 1) suspected new onset seizures, 2) recurrent seizures, 3) altered mental status, 4) death, 5) non-convulsive status epilepticus, and 6) psychogenic seizures. We collected data on age, gender, suspected diagnosis, EEG result, outcome of the visit in terms of discharge versus inpatient admission, follow up of the patient with respect to a) diagnosis, b) medication, c) recurrent visit to the ED, and d) clinical outcome over a two-year follow up. We also collected data on the results of the subsequent video EEG in patients who had an EEG in the ED and determined whether the video EEG had the same results and/or added any additional information.Results: We studied 162 patients (mean ± SD age 7.8 ± 5.8 years, 42.6% females) with routine EEG in the ED from 2010 to 2018. In 142 patients (87.7%), the EEG was helpful in confirming or ruling out the suspected diagnosis. For the indications of new onset seizures (n = 90), recurrent seizures (n = 48), acute mental status change (n = 22), and psychogenic seizures (n = 5), the EEG was useful in 91.1%, 81.3%, 81.8%, and 100% respectively. Of the 162 patients, 58 were discharged and 104 were admitted. For the 142 patients in whom the routine EEG was diagnostically useful, 59.9% were admitted, compared to 95.0% of the 20 patients in whom the EEG did not help in clarifying the diagnosis (p = 0.002). In 31 of the admitted patients, a video EEG was done. In the 31 patients who obtained video EEG, it did not add any additional information in 23 patients while in 8 patients (25.8%) the video EEG provided additional information that was useful for diagnosis and management.Conclusions: EEG done in the ED is a useful diagnostic tool that may prevent admission to the hospital. Video EEGs should be considered in patients where the diagnosis is uncertain despite obtaining a routine EEG in the ED. [ABSTRACT FROM AUTHOR]

Background & Aims: Sleep and epilepsy are complex interactions and are completely interdependent, so that some patients experience seizures while asleep or deprived of sleep or when waking up, and for some they occur during the day or night (1). The American Psychiatric Association defines sleepiness as symptoms of excessive quantity of sleep (e.g., extended nocturnal sleep or involuntary daytime sleep), deteriorated quality of wakefulness (i.e., sleep propensity during wakefulness as shown by difficulty awakening or inability to remain awake when required), and sleep inertia (i.e., a period of impaired performance and reduced vigilance following awakening from the regular sleep episode or from a nap) (2). Its prevalence is higher in seizures than in the control group (3, 4) and in different groups seizures have been reported between 31 to 60% (5-7). According to common clinical beliefs, sleep disruption can have a significant effect on memory, as REM sleep or slow-wave sleep is essential for optimal cognitive function (3), and excessive daily sleepiness can increase seizures (8, 9) and pain (10) in patients; However, the exact function of sleep remains unclear, and the findings have not always been consistent. These discrepancies require the conduct of research in which, through a comprehensive look, a large number of parameters related to sleepiness are present in seizures. In other words, the heterogeneity of the previous findings highlights the variability of the course of the disease as a result of the interaction of sleepiness and seizures, which makes it necessary to conduct more research to better understand the problems of patients. Therefore, the aim of the present study was to investigate the comorbidity effect of sleepiness and epilepsy on cognitive functions, quality and severity of pain and disease severity markers in patients with epilepsy. Methods: The present research was conducted as a case-control study in 2020 in Shiraz Namazi Hospital. The statistical population of this study included all patients with focal epileptic seizures (temporal lobe epilepsy) (n = 30) and generalized (idiopathic generalized epilepsy) (n = 21) and psychogenic non-epileptic seizures (n = 17) in Shiraz. Through their follow-up treatment process, they referred to the epilepsy and seizure ward of Shiraz Namazi Hospital, from which 68 patients with inclusion criteria were selected through purposive sampling method. According to the inclusion and exclusion criteria, each patient completed a comprehensive list of demographic and clinical variables, the Stanford Sleepiness Scale, the Montreal Cognitive Assessment, the McGill Pain Questionnaire, and the Visual Analogue Scale under the supervision of an on-site clinical psychology PhD student. After collecting research data, patients with seizures were divided into two groups with sleepiness (n = 45) and no sleepiness (n = 23) through a cut score equal to or greater than 3 on the Stanford Sleepiness Scale. Data were analyzed using parametric and non-parametric tests in version 24 of SPSS software. Results: Preliminary findings showed that there was a significant difference between the two groups of patients with epilepsy with and without sleepiness in terms of mean age and frequency of antiepileptic drugs (P <0.05); While there was no difference between the two groups in terms of type of seizure, education, gender, marital status and employment status. In order to investigate the effect of sleepiness on cognitive function and components related to pain quality, multivariate and univariate analysis of covariance was used to control age variables and use antiepileptic drugs. The results showed that patients with sleepiness in functions of language, Abstraction, delayed recall, as well as achieving the overall Montreal Cognitive Assessment score performed worse. These patients had higher sensory perception of pain experience, rated their pain higher, scored higher in pain quality, and chose more words to describe their pain (P<0.05). Evaluations of disease severity markers through nonparametric tests also showed that compared to patients without sleepiness, patients with epilepsy with sleepiness have experienced more pain, more seizures, a higher incidence of comorbid physical diseases, a longer history of psychiatric diagnoses, and they have more concomitant use of antiepileptic and psychiatric drugs (P<0.05). Conclusion: The results showed that patients with epilepsy with sleepiness had lower mean scores on some cognitive subscales than their counterparts without sleepiness; However, the two groups did not differ in terms of spatial visual function, naming, attention, and orientation. Using a methodology similar to this study, Vascouto et al. Found that there was no difference between the two groups of patients with seizures with and without sleepiness in most cognitive components such as attention and spatial visual skills; Only from the point of view of the total score of auditory verbal learning, there is a significant difference (11) that is relatively consistent with the present study. Although more research is needed to draw more detailed discussions, the discrepancies in some findings can be explained by differences in the type of patient samples in the two studies and the reduction in attention and performance resulting from sleepiness. The results also showed that patients with epilepsy with sleepiness compared to their counterparts, evaluated the qualitative dimensions of their pain higher and experienced more severe pain. Consistent with these findings, Gutter et al. Found that sleepiness comorbidity in epileptic seizures leads to increased chronic pain in patients (10) and Jaussent et al. Also reported that chronic pain is a significant predictor of sleepiness (12). In this regard, potential underlying mechanisms such as structural and functional changes in the prefrontal cortex (13), anterior cingulate cortex (14), hippocampus (15), amygdala (16), insula (17), subcortical regions (17) and shock spinal cord passages (18); Neural-glial interactions; Abnormalities in autonomic function and hypothalamic-pituitary-adrenal axis and other biological factors may contribute to the relationship between sleepiness and pain. Finally, the results showed that the frequency of seizures, the presence of comorbidities of physical disease, the history of psychiatric diagnoses and the simultaneous use of antiepileptic and psychiatric drugs in patients with epilepsy with sleepiness were higher than their counterparts. In this regard, Pizzatto et al. (19) and Xu et al. (20) evaluated patients with epileptic seizures and did not find a relationship between daily sleepiness scores and the frequency of seizures. But Lee et al. Showed that the presence of psychiatric symptoms is an independent predictor of sleepiness in patients (21). It seems that sleepiness reduces the ability to control seizures in patients (22) and contributes to their recurrence and worsening of the disease. Disruption of patients' circadian rhythms can also be involved as a consequence of sleepiness; Because circadian rhythms affect the frequency of seizures depending on the epileptogenic region (23,24). According to the findings, measuring sleep habits, sleep hygiene and comorbidity of sleepiness is an unavoidable necessity. In particular, early diagnosis and treatment of comorbid sleepiness and seizures can improve the prognosis and reduce the negative health consequences in patients (25). Lack of objective measurements of sleepiness and self-reported nature of the data are the limitations of the present study. Future studies can complement these findings by using objective measures of sleepiness. Patients with epilepsy with sleepiness have a poorer cognitive and clinical status than their counterparts. [ABSTRACT FROM AUTHOR]