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Markus Reuber - One of the best experts on this subject based on the ideXlab platform.
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Non-Epileptic Attack Disorder: Metaphysics, Epistemology and Ontology
2020Co-Authors: Jon M Dickson, Markus Reuber, Marian Peacock, Richard A. Grünewald, Paul Bissell, Cordelia Gray, Patrick Bracken, Annamaria CarusiAbstract:The proceedings of a workshop held at the Humanities Research Institute, The University of Sheffield, on Friday 18th October 2019.
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Non-Epileptic Seizures in Our Experience - Neuropsychologist, 20 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter describes the experience of a Neuropsychologist who was working in the Neurosciences Directorate of a large teaching hospital at about the time that Non-Epileptic Attack Disorder (NEAD) was starting to be widely recognized. At the time, 10% to 28% of outpatient referrals to neurology with “intractable epilepsy” were cases of NEAD. People who had been treated for epilepsy, some for many years, and had just been given a diagnosis of NEAD were referred to the Neuropsychologist. Their reactions varied: some were relieved that they would no longer have to take antiepileptic medication, some were angry that they had been misdiagnosed and had been given inappropriate medication, and some refused to believe that they did not have epilepsy. Among this last group, there were people who had secondary gains from the diagnosis of epilepsy, such as special protection and status or exemption from household tasks. Obviously, explaining the cause of NEAD is central to establishing a relationship of trust, and to accept that the client has a definite condition is central in treatment. The Neuropsychologist would then explore the idea that their Attacks were a response to stress. If the client accepts this, treatment can move on to identifying areas of stress and addressing them. The chapter then identifies the different precipitants of NEAD.
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Non-Epileptic Seizures in Our Experience - Clinical Psychologist in Neuropsychology, 9 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter discusses the experience of a Clinical Psychologist who has provided psychological therapy for around one hundred people with Non-Epileptic Attack Disorder (NEAD) over the past five years. The first couple of sessions usually involve the Clinical Psychologist explaining her general understanding of NEAD and tailoring it to the person’s individual experience so that he or she has a personal understanding of what is happening. For some people, an explanation of NEAD being due to trauma and dissociation makes a lot of sense. They can recognize how they learned to automatically dissociate as a way of coping with trauma, and that their Attacks are episodes of dissociation. Indeed, their NEAD may be part of wider mental health difficulties, with dissociation happening in response to overwhelming emotional distress. However, many people with NEAD do not find that this explanation makes sense for them. They are often the strong one in their family. They may have had a life with lots of hardship, trauma, and objective “stress,” but they have never felt particularly stressed or overwhelmed; they just got on with it.
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Non-Epileptic Seizures in Our Experience - Epilepsy Specialist Nurse, 30 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter details the experience of an epilepsy specialist nurse with regard to episodes of Non-Epileptic Attack Disorder (NEAD), which are typically characterized by nonrhythmic jerking and the ability of the individual to respond during the episode. In particular, the nurse worked with a man who had been known to have NEAD for a number of years. During the Non-Epileptic Attacks, the man’s awareness was not impaired as he seemed to be able to focus on what was happening around him. Sometimes, the man would be admitted to the hospital with these episodes and treatment would be administered, which led to many theories such as attention seeking, the body reacting to withdrawal medication, and avoidance techniques at particular times and activities. On one occasion, when the man was admitted to the hospital, a new doctor saw him. The doctor stated that the episodes were not NEAD but, in fact, focal seizures. This event made the nurse question all NEAD in terms of underlying causes and truly believe that something is happening to the person experiencing these episodes, whether it is neurological or psychological. Ultimately, the terminology of NEAD can be misleading and can have consequences in terms of treatment.
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Neuropsychologist, 7 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter demonstrates the rise and fall of a Non-Epileptic Attack Disorder (NEAD) service. The first recorded NEAD referral to the Neuropsychology Service arrived in 2004. The patient was referred to Neuropsychology by a Consultant Neurologist, who wrote that having captured some of the Attacks on telemetry, it was clear that these were “Non-Epileptic.” The patient was also under the care of mental health services for depression and other psychiatric difficulties. She was sent a waiting list letter, but the referral was not followed up and she was never seen. Even at this early stage in the provision of NEAD services, it was evident that the remit of mental health and physical health services was unclear and that patients could fall through the gap. In the following three years, referrals remained low at one or two per year. However, in 2012, NEAD made up 7% of all referrals. Recognizing that this group of people needed specialist intervention, a Neuropsychologist undertook an extensive literature review. Some facts stood out: the extreme delay in obtaining a diagnosis, the importance of receiving a clear and compassionately delivered diagnosis in reducing or stopping seizures, the sense of being left in limbo following diagnosis, and the need for clients to have a safe place to process painful emotions.
Andrea E. Cavanna - One of the best experts on this subject based on the ideXlab platform.
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PO217 Diagnostic, investigation and management strategies for non epileptic Attack Disorder
Journal of Neurology Neurosurgery & Psychiatry, 2017Co-Authors: F Ali, Andrea E. CavannaAbstract:Purpose Recommendations by International League Against Epilepsy (ILAE) Non-Epileptic Seizures Task Force propose a four-level hierarchical approach (using history, witnessed event, electroencephalographic (EEG)) to establish Non-Epileptic Attack Disorder (NEAD) diagnosis. We describe clinical characteristics, diagnostic certainty level, investigation pathways and management strategies of patients at a specialist neuropsychiatry clinic. Method Medical notes of 148 patients with NEAD attending between September 2012 – 2015 were reviewed. Results Patient categorisation (Females: n=108, 73.0%; Disease duration: 7.9 years (SD 10.4)) was mainly based on clinical features and EEG findings; only 7 (4.7%) patients had Attacks witnessed by a specialist. Largest diagnostic categories were ‘possible’ (less robust) (n=54; 36.5%), ‘clinically-established’ (moderately robust) (n=40; 27.0%), then ‘documented’ (most robust) (n=12; 8.1%), ‘probable’ (n=5; 3.4%) (moderately robust). EEG was most commonly performed (n=125; 84.4%), then neuro-imaging (MRI: n=100, 67.6%). 48 (32.4%) had further neurological/cardiac/vestibular/sleep testing. There were no differences in pharmacological/behavioural management across categories. Conclusion Difficulty in witnessing clinical events in person/on video recording/EEG limits clinical application of diagnostic recommendations, and thereby more robust diagnostic categorisation. Displaying video-footage in clinic could improve diagnostic certainty. Adherence to recommendations may help streamline investigation paths, reducing diagnostic delays. Irrespective of categorisation, pharmacological and behavioural interventions are implemented.
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Neurophysiological investigations for the diagnosis of Non-Epileptic Attack Disorder in neuropsychiatry services: from safety standards to improved effectiveness
Acta neuropsychiatrica, 2016Co-Authors: Andrea E. Cavanna, Stefano SeriAbstract:OBJECTIVE: The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including Non-Epileptic Attack Disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and Non-Epileptic Attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry. METHODS: We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or Non-Epileptic Attacks. RESULTS: Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of Non-Epileptic Attack Disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly. CONCLUSION: The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.
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BEHAVIOURAL PROFILE OF ZONISAMIDE IN ADULT PATIENTS WITH EPILEPSY AND NEUROPSYCHIATRIC COMORBIDITY
Journal of Neurology Neurosurgery & Psychiatry, 2013Co-Authors: Andrea E. Cavanna, Stefano SeriAbstract:Objective Zonisamide is a newer antiepileptic drug indicated as adjunctive therapy in the treatment of adult patients with partial-onset seizures, with or without secondary generalization. Following isolated reports of zonisamide-induced mania, other behavioural adverse effects, including psychosis and suicidal ideation have been associated with its use, and it was suggested that past psychiatric history is among the factors associated with discontinuation of zonisamide therapy in patients with epilepsy. We therefore set out to assess the tolerability profile of zonisamide in this particular group of patients with epilepsy, who are at risk of developing adverse reactions to zonisamide. Method This study investigated the prevalence and characteristics of adverse effects resulting from the use of zonisamide in a retrospective chart review of patients with epilepsy and co-morbid cognitive and/or behavioural problems, recruited from the specialist neuropsychiatry clinic at the National Centre for Mental Health, BSMHFT and University of Birmingham. Results We identified 12 eligible patients (3 males, mean age 36 years, range 16-59 years). All patients had a clinical diagnosis of treatment-refractory epilepsy (9=temporal lobe epilepsy), supported by neurophysiological and neuroimaging findings, and had concomitant and/or previous antiepileptic medications (11=levetiracetam, 8=carbamazepine, 6=lamotrigine, 6=valproate). In our neuropsychiatric sample, 6 patients had a previous diagnosis of depression, 2 anxiety Disorders, 2 learning disability, 2 neurodevelopmental Disorders (Tourette syndrome and autism) and 1 psychosis. Co-morbid Non-Epileptic Attack Disorder was documented in 4 patients. In the majority of cases, zonisamide (mean maintenance dose=212.5mg daily, range 50-500 mg daily) was well tolerated and behavioural adverse effects were not severe. Three patients (25.0%) discontinued zonisamide over the observation period (mean duration 15 months, range 1-48 months). The main reasons for discontinuation were lack of efficacy on seizure control (two cases) and emerging depression as an adverse effect (one case). Conclusion This preliminary observation of relatively low discontinuation rate of zonisamide in a selected population of patients with epilepsy and neuropsychiatric comorbidity prompts further research to establish whether this medication is a safe treatment option for vulnerable patients with treatment-refractory epilepsy.
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Dissociative experiences and quality of life in patients with Non-Epileptic Attack Disorder
Epilepsy & behavior : E&B, 2012Co-Authors: James W. Mitchell, Fizzah Ali, Andrea E. CavannaAbstract:Dissociative experiences are commonly reported by patients with Non-Epileptic Attack Disorder (NEAD). This cross-sectional study examined the prevalence and characteristics of dissociative experiences in patients with NEAD and assessed their association with health-related quality of life (HRQoL). Fifty-three patients diagnosed with NEAD were consecutively recruited (70.0% female, mean age=42 years, 22.0% with comorbid epilepsy) from a specialist neuropsychiatric clinic. Our sample reported high levels of dissociative experiences, with 36.7% of patients scoring ≥30 on the Dissociative Experiences Scale (DES). Significant negative correlations were found between total DES scores and HRQoL, as measured by the QOLIE-31 questionnaire (r=-0.64, p
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Resting state networks in paroxysmal Disorders of consciousness
Epilepsy & behavior : E&B, 2012Co-Authors: Andrew P. Bagshaw, Andrea E. CavannaAbstract:Abstract Functional MRI (fMRI) has transformed academic neuroscience in the last decade and is now the most widely used non-invasive functional brain imaging technique. However, it has had much less of an impact in clinical neuroscience. While a majority of fMRI applications examine brain function in response to an externally driven task, an alternative approach characterizes the brain's intrinsic functional architecture. This involves fMRI scanning in the absence of an explicit task (i.e., in the resting state) and is, therefore, much more easily performed and tolerated by neurological and neuropsychiatric patient groups. The data are easily acquired, and the functional networks extracted are reproducible and reliable. However, quantifying networks of distributed brain activity and identifying the most informative features in a particular Disorder remain a challenge. Progress has been made in this direction in recent years, with the adoption of mathematical tools from communications engineering. Specific alterations to the brain's functional connectivity at rest have been observed in generalized and focal epilepsies, as well as in Non-Epileptic Attack Disorder. The challenge for the future is to exploit knowledge of how the brain works as a complex system in order to develop more accurate and sensitive diagnostic tests for neurological and neuropsychiatric Disorders. This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.
J Singh - One of the best experts on this subject based on the ideXlab platform.
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Non-Epileptic Attack Disorder AND TODD'S PARESIS: A CASE SERIES AND LITERATURE REVIEW
Journal of Neurology Neurosurgery & Psychiatry, 2012Co-Authors: J SinghAbstract:Background Todd9s paresis is a transient focal weakness of the hand, arm or leg which follows partial seizure activity within that limb. This was first described by Robert Bentley Todd in 1849. The weakness can range in severity from mild to complete paralysis and usually occurs on just one side of the body. The paralysis can last from minutes to hours. It may occur in up to 13% of seizure cases. Todd9s paresis may affect speech, eye gaze or vision. It most commonly occurs after generalised tonic clonic seizures. Treatment of Todd9s paralysis is symptomatic and supportive because it resolves quickly. Three of our patients with a diagnosis of Non-Epileptic Attack Disorder (NEAD) complained of motor weakness after the seizure. This led us to reinvestigate their cases to rule out epilepsy. The above three patients have a diagnosis of NEAD. Todd9s Paresis has an association with true seizures rather than with NEAD. The subjective complaint of post seizure weakness made us interested in finding out if there is any association of motor weakness with NEAD We did an electronic literature search using PubMed, Medline and Trip Database. Discussion Our three patients above had a diagnosis of NEAD and they all complained of motor weakness or Todd9s paresis, which is more characteristic of Epilepsy. We wanted to establish if there is any association between Todd9s paresis and NEAD. We tried to find the answer by doing a literature search but unfortunately this was not helpful.
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P18 Non epileptic seizures and Todd's paresis: case series and literature review
Journal of Neurology Neurosurgery & Psychiatry, 2012Co-Authors: J Singh, M LambertAbstract:Objective Todd9s paresis is a transient focal weakness of a hand, arm or leg which follows a partial seizure activity within that limb. This was first described by Robert Bentley Todd in 1849. The weakness can range from severity from mild to complete paralysis and usually occurs on just one side of the body. The paralysis can last from minutes to hours. There have been case reports of longer duration of paresis, ranging to as long as days. It may occur in up to 13% of seizure cases. Todd9s paresis may affect speech, eye gaze or vision. It most commonly occurs after generalised tonic clonic seizures. There is literature on Todd9s paresis and its association with epilepsy since it was first described in 1849. There is dearth of literature on its association with Non-Epileptic seizures. Its presentation in patients with NEAD whether represents a true epileptic event or it represents a pseudo paralysis was something we were interested in. The interest was primarily driven by the three patients we had of Non-Epileptic Attack Disorder who presented with focal weakness. Method We did an electronic literature search using PubMed, Medline and Trip database. The key words used were—epilepsy, Todd9s paresis, Non-Epileptic Attack Disorder, post ictal paresis, pseudo Todd9s paresis and pseudoneurological symptoms. The case series is as follows: Case 1 : A 48-year-old gentleman with history of Non-Epileptic Attack Disorder (NEAD) was admitted to hospital following another episode of NEAD. He reported having an Attack of cluster of absent seizures following which he complained of being paralysed down one side. He complained of loss of function of left arm and leg. He was admitted to hospital where he had a full neurological screen done. Objectively, there was no evidence of any focal deficits. He reported being unable to feel anything on left side but was able to respond appropriately to lateralised tactile stimulation with eyes closed. Gate was antalgic with a reduced support phase on left. He had video telemetry done with no evidence of seizures and CT exam was unremarkable. Patient was discharged with the diagnosis of NEAD. Case 2 : 37-year-old, female with history of Non-Epileptic Attack Disorder was admitted to hospital following an episode of Non-Epileptic seizure. Patient reported right sided paresis; difficulty lifting her right arm and leg. The weakness lasted 2–3 h, settled on its own. No evidence of any focal deficits on neurological examination. EEG was unremarkable. MRI showed slight asymmetry of left pre central gyrus. No convincing signal abnormality and the appearances were constitutional. Case 3 : A 33-year-old lady with history of Non-Epileptic Attack Disorder was seen in the outpatient clinics. She had an NEAD Attack which was generalised and following that she complained of left sided facial weakness. No dysphasia or problems with vision reported. The weakness lasted for only few minutes and subsided on its own. She had further episodes of seizures but never had a weakness afterwards. On assessment there was no evidence of any change in the nature or degree of her seizure pattern. Results Our three patients above had diagnosis of NEAD and they all complained of motor weakness or Todd9s paresis which is more characteristic of Epilepsy. This raised doubts in our minds that whether these patients actually had a seizure and that resulted in Todd9s paresis. The first two patients had investigations re done to establish that but no cause was found. The third patient was seen well after the episode of facial weakness. We did not notice any change in her seizure episodes from the past so further investigations were not carried out. We wanted to establish if there is any association between Todd9s paresis and NEAD .We tried to find the answer by doing a literature search but unfortunately it did not help much as we could find only one case report and nothing else useful. Conclusion There will always be ethical dilemma that whether patients with NEAD should be re investigated or not if they complained of neurological symptoms. We believe that each case should be dealt on its merit and the patients to be managed accordingly. It is not uncommon for patients with NEAD to have epilepsy and as a result Todd9s paresis. The literature search was not very useful in finding the right answer.
Paul Cooper - One of the best experts on this subject based on the ideXlab platform.
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099 A retrospective study of mortality rates in a video-EEG telemetry patient cohort
Journal of Neurology Neurosurgery and Psychiatry, 2019Co-Authors: Farhat Mirza, Paul Cooper, Varduhi Cahill, Rajiv MohanrajAbstract:Rationale Despite emerging evidence of altered brain connectivity patterns in patients with Non-Epileptic Attack Disorder (NEAD), studies on the mortality rates in these patients remain scarce. Methods Mortality data was studied retrospectively in a cohort of patients admitted for video-telemetry evaluation at the Manchester Centre for Clinical Neurosciences from 2009 to 2019. The diagnosis of NEAD, epilepsy or both was confirmed by the consensus opinion of experienced epileptologists. Mortality and cause of death were identified from the death alert system linked to the Electronic Patient Record and from coroners’ reports, where available. Results Out of 693 patients 662 were included in the study analyses. Death was registered in 23 patients, 82.6% of whom suffered with epilepsy and 17.4% with NEAD. In epilepsy patients, sudden unexpected death was recorded in 42.1%, death from other medical conditions in 52.6% and death from external causes - in 5.3%. In the NEAD group, the causes of death included iatrogenic and other medical conditions. Conclusions Mortality rates in the NEAD group of patients are not negligible. With NEAD patients being at risk of unnecessary iatrogenic interventions, increased awareness of the heightened mortality rates in this patient cohort could avert preventable deaths.
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Transient loss of consciousness (excluding epilepsy)
Medicine, 2008Co-Authors: Sanjiv Petkar, Adam Fitzpatrick, Paul CooperAbstract:Abstract Patients are often referred suffering from a ‘Collapse ?cause'. In some of these patients, the ‘collapse' would have been caused by or associated with loss of consciousness. The three main and common causes of transient loss of consciousness (T-LOC) are syncope, epilepsy and Non-Epileptic Attack Disorder (NEAD). The term T-LOC excludes patients in whom the loss of consciousness is induced by trauma or is prolonged (e.g. metabolic Disorders like hypoglycaemia and hyponatremia). Among the causes of T-LOC, syncope, which is a symptom with many underlying causes, is much more prevalent than either epilepsy or NEAD. This article will deal predominantly with syncope and how it can be differentiated from epilepsy and NEAD.
Steven C. Schachter - One of the best experts on this subject based on the ideXlab platform.
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Non-Epileptic Seizures in Our Experience - Clinical Hypnotherapist, 1 year’s experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter discusses how a clinical hypnotherapist treated a patient with Non-Epileptic Seizures. Upon carrying out a detailed fact finding procedure focusing on the patient’s medical and personal background, it became apparent that she had experienced a very traumatic, stressful event in the last few years, which was caused by a medical scare. This resulted in her “inner child” being awoken, who had also had a traumatic experience. Her unconscious mind only knew how to express stress or anxiety in a way that resulted in the body kicking, shaking, and having a panic Attack as per Non-Epileptic Attack Disorder. Through therapy, the hypnotherapist assisted in connecting and building the bond between the inner child and conscious mind to gain the trust and reassurance that the inner child would be looked after, safe, and loved. The hypnotherapist then focused on training the patient to communicate with her unconscious mind and learn how to control when the seizures could happen, and empowered her to control the seizures. After undergoing an eclectic mix of therapies, the patient is now free from Non-Epileptic Attack Disorder and engaging in high-intensity sports.
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Non-Epileptic Seizures in Our Experience - Epilepsy Nurse Specialist, 15 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter describes the experience of an epilepsy nurse with patients with Non-Epileptic Attack Disorder (NEAD). It specifically details a rare case where the patient was undoubtedly diagnosed with NEAD and the diagnosis was met with complete acceptance. The patient was able to move forward with her life, putting this period of living with NEAD behind her, a period of time that possibly spanned several years. Ultimately, carers have a duty to provide ongoing support throughout the trajectory of the journey of patients with NEAD despite it being a psychiatric and not a neurological Disorder. This condition if untreated or treated inappropriately can fundamentally affect quality of life on a daily basis, and health professionals all have a duty of care to address that.
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Non-Epileptic Seizures in Our Experience - Clinical Research as a Neuroscientist, 4 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter highlights the experience of a Neuroscientist who has done clinical research. When the Neuroscientist started researching Non-Epileptic Attack Disorder (NEAD) and Functional Neurological Symptom Disorder (FND), the Neuroscientist had no doubt about the legitimacy or “realness” of these conditions. It has been shown that FND is the second most commonly diagnosed Disorder in Neurology clinics, and that NEAD is the most common type of FND. FND has also been shown to be distressing and potentially more disabling than other neurological conditions. However, it was not long before the Neuroscientist realized that there were issues around awareness of and attitudes toward these symptoms. Unfortunately, there have been several instances where the Neuroscientist has met medical professionals who were not as familiar with NEAD or FND as they perhaps should be.
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Non-Epileptic Seizures in Our Experience - Consultant Nurse, 18 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter discusses the need for consistency in the diagnosis and support of people with Non-Epileptic Attack Disorder (NEAD). Even within neurology, this is not always the case. Often, a diagnosis of NEAD follows many years of treatment for presumed epilepsy. There is a reluctance by many neurologists completely to undo that diagnosis, whether originally made by themselves or a predecessor. A vague assertion that some episodes may be NEAD while others are due to epilepsy is of no use to anyone, particularly the patient. Estimates of the incidence of dual diagnoses vary, but the literature consistently suggests that either epileptic or Non-Epileptic seizures will predominate. Therefore, health professionals need to make every effort to identify clearly which seizures are due to epilepsy, remembering that they will be stereotyped, and which are not.
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Non-Epileptic Seizures in Our Experience - Specialist Cognitive Behavioral Therapist in NEAD, 6 years’ experience, UK
Non-Epileptic Seizures in Our Experience, 2020Co-Authors: Markus Reuber, Gregg H. Rawlings, Steven C. SchachterAbstract:This chapter describes the experience of a specialist cognitive behavioral therapist in Non-Epileptic Attack Disorder (NEAD). Offering therapy for people with NEAD can involve frustrations, difficulties, concerns, and, without a doubt, imposter syndrome. Nevertheless, knowing someone personally growing up with NEAD definitely inspired the therapist to work in this field. The therapist also had an understanding of what NEAD was as a layperson before the therapist became a professional. Moreover, the therapist had lived experience of how this condition affects the person and how it affects family members and friends, relationships, and careers. It creates worry and uncertainty in everyone around, in terms of what the problem is and how to help. Fortunately, the therapist learned quickly about the mind and body connection and how to explain this to patients, and it started to click with people and improve helpful engagement. The more the therapist became experienced, the more the therapist understood, and the less people had episodes in their assessments.