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David L. Perez - One of the best experts on this subject based on the ideXlab platform.

  • a clinically oriented perspective on psychogenic Nonepileptic Seizure related emergencies
    Clinical Eeg and Neuroscience, 2015
    Co-Authors: Barbara A Dworetzky, David L. Perez, Daniel Weisholtz, Gaston Baslet
    Abstract:

    Psychogenic Nonepileptic Seizures (PNES) can present emergently and are often mistaken for epileptic Seizures. PNES emergencies have not been well studied, and yet there are associated serious morbidities, particularly when patients are seen in an emergency setting and are misdiagnosed. PNES may be prolonged, mimicking status epilepticus, a condition we refer to as Nonepileptic psychogenic status (NEPS), and patients may receive aggressive and unnecessary medical treatments that can lead to serious iatrogenic complications, including death. NEPS is also associated with an increased risk of self-harm, including suicide attempts, and may indicate a serious comorbid psychiatric illness. In addition to iatrogenic complications of PNES, accidents and injuries are an underrecognized source of morbidity. PNES may also present during medical procedures, which may not only interfere with their completion, but may alarm practitioners who, fearing liability, may initiate further medical evaluations and treatments. When PNES occur during pregnancy, patients may be misdiagnosed with eclampsia and their offspring delivered prematurely. They also risk being placed on medications that are harmful to the fetus. Increased awareness of PNES is necessary to prevent iatrogenic harm and to identify underlying psychiatric illnesses that carry their own risks. As yet, data available to guide treatment are scant, and further study is needed.

  • an integrative neurocircuit perspective on psychogenic Nonepileptic Seizures and functional movement disorders neural functional unawareness
    Clinical Eeg and Neuroscience, 2015
    Co-Authors: David L. Perez, Barbara A Dworetzky, Gaston Baslet, Bradford C Dickerson, Lorene Leung, Rachel Cohn, David Silbersweig
    Abstract:

    Functional neurological disorder (conversion disorder) is a neurobehavioral condition frequently encountered by neurologists. Psychogenic Nonepileptic Seizure (PNES) and functional movement disorder (FMD) patients present to epileptologists and movement disorder specialists respectively, yet neurologists lack a neurobiological perspective through which to understand these enigmatic groups. Observational research studies suggest that PNES and FMD may represent variants of similar (or the same) conditions given that both groups exhibit a female predominance, have increased prevalence of mood-anxiety disorders, frequently endorse prior abuse, and share phenotypic characteristics. In this perspective article, neuroimaging studies in PNES and FMD are reviewed, and discussed using studies of emotional dysregulation, dissociation and psychological trauma in the context of motor control. Convergent neuroimaging findings implicate alterations in brain circuits mediating emotional expression, regulation and awareness (anterior cingulate and ventromedial prefrontal cortices, insula, amygdala, vermis), cognitive control and motor inhibition (dorsal anterior cingulate, dorsolateral prefrontal, inferior frontal cortices), self-referential processing and perceptual awareness (posterior parietal cortex, temporoparietal junction), and motor planning and coordination (supplementary motor area, cerebellum). Striatal-thalamic components of prefrontal-parietal networks may also play a role in pathophysiology. Aberrant medial prefrontal and amygdalar neuroplastic changes mediated by chronic stress may facilitate the development of functional neurological symptoms in a subset of patients. Improved biological understanding of PNES and FMD will likely reduce stigma and aid the identification of neuroimaging biomarkers guiding treatment development, selection, and prognosis. Additional research should investigate neurocircuit abnormalities within and across functional neurological disorder subtypes, as well as compare PNES and FMD with mood-anxiety-dissociative disorders.

  • teaching video neuroimages complex partial Seizure evolving into a psychogenic Nonepileptic Seizure
    Neurology, 2010
    Co-Authors: David L. Perez, Amit Haldar, Alexander Rotenberg, Sanjeev V Kothare
    Abstract:

    An 11-year-old, right-handed girl was admitted for video-EEG monitoring of nocturnal paroxysms consisting of eye opening, groans, right arm shaking, and altered consciousness (see video on the Neurology ® Web site …

  • teaching video neuroimages complex partial Seizure evolving into a psychogenic Nonepileptic Seizure
    Neurology, 2010
    Co-Authors: David L. Perez, Amit Haldar, Alexander Rotenberg, Sanjeev V Kothare
    Abstract:

    An 11-year-old, right-handed girl was admitted for video-EEG monitoring of nocturnal paroxysms consisting of eye opening, groans, right arm shaking, and altered consciousness (see video on the Neurology ® Web site …

Sanjeev V Kothare - One of the best experts on this subject based on the ideXlab platform.

Amit Haldar - One of the best experts on this subject based on the ideXlab platform.

Alexander Rotenberg - One of the best experts on this subject based on the ideXlab platform.

Barbara A Dworetzky - One of the best experts on this subject based on the ideXlab platform.

  • a clinically oriented perspective on psychogenic Nonepileptic Seizure related emergencies
    Clinical Eeg and Neuroscience, 2015
    Co-Authors: Barbara A Dworetzky, David L. Perez, Daniel Weisholtz, Gaston Baslet
    Abstract:

    Psychogenic Nonepileptic Seizures (PNES) can present emergently and are often mistaken for epileptic Seizures. PNES emergencies have not been well studied, and yet there are associated serious morbidities, particularly when patients are seen in an emergency setting and are misdiagnosed. PNES may be prolonged, mimicking status epilepticus, a condition we refer to as Nonepileptic psychogenic status (NEPS), and patients may receive aggressive and unnecessary medical treatments that can lead to serious iatrogenic complications, including death. NEPS is also associated with an increased risk of self-harm, including suicide attempts, and may indicate a serious comorbid psychiatric illness. In addition to iatrogenic complications of PNES, accidents and injuries are an underrecognized source of morbidity. PNES may also present during medical procedures, which may not only interfere with their completion, but may alarm practitioners who, fearing liability, may initiate further medical evaluations and treatments. When PNES occur during pregnancy, patients may be misdiagnosed with eclampsia and their offspring delivered prematurely. They also risk being placed on medications that are harmful to the fetus. Increased awareness of PNES is necessary to prevent iatrogenic harm and to identify underlying psychiatric illnesses that carry their own risks. As yet, data available to guide treatment are scant, and further study is needed.

  • an integrative neurocircuit perspective on psychogenic Nonepileptic Seizures and functional movement disorders neural functional unawareness
    Clinical Eeg and Neuroscience, 2015
    Co-Authors: David L. Perez, Barbara A Dworetzky, Gaston Baslet, Bradford C Dickerson, Lorene Leung, Rachel Cohn, David Silbersweig
    Abstract:

    Functional neurological disorder (conversion disorder) is a neurobehavioral condition frequently encountered by neurologists. Psychogenic Nonepileptic Seizure (PNES) and functional movement disorder (FMD) patients present to epileptologists and movement disorder specialists respectively, yet neurologists lack a neurobiological perspective through which to understand these enigmatic groups. Observational research studies suggest that PNES and FMD may represent variants of similar (or the same) conditions given that both groups exhibit a female predominance, have increased prevalence of mood-anxiety disorders, frequently endorse prior abuse, and share phenotypic characteristics. In this perspective article, neuroimaging studies in PNES and FMD are reviewed, and discussed using studies of emotional dysregulation, dissociation and psychological trauma in the context of motor control. Convergent neuroimaging findings implicate alterations in brain circuits mediating emotional expression, regulation and awareness (anterior cingulate and ventromedial prefrontal cortices, insula, amygdala, vermis), cognitive control and motor inhibition (dorsal anterior cingulate, dorsolateral prefrontal, inferior frontal cortices), self-referential processing and perceptual awareness (posterior parietal cortex, temporoparietal junction), and motor planning and coordination (supplementary motor area, cerebellum). Striatal-thalamic components of prefrontal-parietal networks may also play a role in pathophysiology. Aberrant medial prefrontal and amygdalar neuroplastic changes mediated by chronic stress may facilitate the development of functional neurological symptoms in a subset of patients. Improved biological understanding of PNES and FMD will likely reduce stigma and aid the identification of neuroimaging biomarkers guiding treatment development, selection, and prognosis. Additional research should investigate neurocircuit abnormalities within and across functional neurological disorder subtypes, as well as compare PNES and FMD with mood-anxiety-dissociative disorders.

  • clinical characteristics of psychogenic Nonepileptic Seizure status in the long term monitoring unit
    Epilepsy & Behavior, 2006
    Co-Authors: Barbara A Dworetzky, Katherine Mortati, Andrea O Rossetti, Bernardino Vaccaro, Aaron Nelson, Edward B Bromfield
    Abstract:

    Patients with psychogenic Nonepileptic Seizures (PNES) mimicking status epilepticus (PNES-status) are at risk of iatrogenic complications. Our aim was to assess whether the population of patients with PNES who develop PNES-status are distinguishable. Retrospectively, we identified patients with PNES-status and compared them with patients with PNES without status and with patients with electroclinical status epilepticus (SE). Of 49 patients with PNES, 9 had PNES-status (18.2%) and 40 had PNES only. Compared with patients with PNES, subjects with PNES-status had taken fewer than three antiepileptic medications (P=0.016), had more than one event per week (P=0.026), were more likely to be admitted emergently to the monitoring unit (P=0.007), had shorter long-term monitoring (LTM) stays (P=0.003), and tended to be diagnosed sooner after initial presentation (P=0.058). Use of fewer than three antiepileptic drugs and emergent admission were independent predictors of PNES-status classification on logistic regression. Of 154 patients with epilepsy, 8 had SE during LTM (5.2%), significantly fewer than the proportion with PNES-status relative to PNES (P=0.008); the only clinical variable distinguishing these two groups was a baseline lower Seizure frequency among the patients with epileptic Seizures (P=0.045). Our results suggest that patients with PNES-status have features that differentiate them from patients with PNES without status and, to a lesser extent, from patients with epileptic Seizures.