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Markus Reuber - One of the best experts on this subject based on the ideXlab platform.
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The aetiology of Psychogenic Non-Epileptic Seizures: risk factors and comorbidities.
Epileptic disorders : international epilepsy journal with videotape, 2019Co-Authors: Stoyan Popkirov, Roderick Duncan, Ali A. Asadi-pooya, Coraline Hingray, W. Curt Lafrance, David Gigineishvili, Chrisma Pretorius, Andres M. Kanner, Markus ReuberAbstract:Psychogenic Non-Epileptic Seizures (PNES), also known as dissociative Seizures, are paroxysms of altered subjective experience, involuntary movements and reduced self-control that can resemble epileptic Seizures, but have distinct clinical characteristics and a complex neuropsychiatric aetiology. They are common, accounting for over 10% of seizure emergencies and around 30% of cases in tertiary epilepsy units, but the diagnosis is often missed or delayed. The recently proposed "integrative cognitive model" accommodates current research on experiential, psychological and biological risk factors for the development of PNES, but in view of the considerable heterogeneity of presentations and medical context, it is not certain that a universal model can capture the full range of PNES manifestations. This narrative review addresses key learning objectives of the ILAE curriculum by describing the demographic profile, common risk factors (such as trauma or acute stress) and comorbid disorders (such as other dissociative and functional disorders, post-traumatic stress disorder, depressive and anxiety disorders, personality disorders, comorbid epilepsy, head injury, cognitive and sleep problems, migraine, pain, and asthma). The clinical implications of demographic and aetiological factors for diagnosis and treatment planning are addressed.
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Neuroimaging studies in patients with Psychogenic Non-Epileptic Seizures: A systematic meta-review
NeuroImage. Clinical, 2017Co-Authors: Marco Mcsweeney, Markus Reuber, Liat LevitaAbstract:Psychogenic Non-Epileptic Seizures (PNES) are 'medically unexplained' seizure-like episodes which superficially resemble epileptic Seizures but which are not caused by epileptiform discharges in the brain. While many experts see PNES disorder as a multifactorial biopsychosocial condition, little is known about the neurobiological processes which may predispose, precipitate and/or perpetuate PNES symptomology. This systematic meta-review advances our knowledge and understanding of the neurobiological correlates of PNES by providing an up-to-date assessment of neuroimaging studies performed on individuals with PNES. Although the results presented appear inconclusive, they are consistent with an association between structural and functional brain abnormalities and PNES. These findings have implications for the way in which we think about this "medically unexplained" disorder and how we communicate the diagnosis to patients. However, it is also evident that neuroimaging studies in this area suffer from a number of significant limitations and future larger studies will need to better address these if we are to improve our understanding of the neurobiological correlates of predisposition to and/or manifestation of PNES.
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psychological and psychiatric aspects of Psychogenic non epileptic Seizures pnes a systematic review
Clinical Psychology Review, 2016Co-Authors: Richard J. Brown, Markus ReuberAbstract:Psychogenic Non-Epileptic Seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
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Psychogenic Non-Epileptic Seizures: How Doctors Use Medical Labels when They Communicate and Explain the Diagnosis
The Palgrave Handbook of Adult Mental Health, 2016Co-Authors: Chiara M. Monzoni, Markus ReuberAbstract:Psychogenic Non-Epileptic Seizures (PNES) superficially resemble epileptic Seizures, but are not associated with ictal electrical discharges in the brain. PNES are episodes of paroxysmal impairment of self-control, which represent an experiential or behavioural response to distress. The most effective treatment of PNES involves psychotherapy (LaFrance, Reuber, & Goldstein, 2013).
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Psychogenic Non-Epileptic Seizures: aetiology, diagnosis and management
Advances in Psychiatric Treatment, 2014Co-Authors: Maria Oto, Markus ReuberAbstract:SUMMARY Psychogenic Non-Epileptic Seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient’s history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical Seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.
Richard J. Brown - One of the best experts on this subject based on the ideXlab platform.
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psychological and psychiatric aspects of Psychogenic non epileptic Seizures pnes a systematic review
Clinical Psychology Review, 2016Co-Authors: Richard J. Brown, Markus ReuberAbstract:Psychogenic Non-Epileptic Seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
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Short-term outcome of Psychogenic Non-Epileptic Seizures after communication of the diagnosis.
Epilepsy & behavior : E&B, 2012Co-Authors: Rebecca Mayor, Allan House, Richard J. Brown, Hannah R. Cock, Stephanie Howlett, Phil Smith, S. Singhal, Markus ReuberAbstract:Abstract We previously described a communication strategy for the delivery of the diagnosis of Psychogenic Non-Epileptic Seizures (PNES) that was acceptable and effective at communicating the psychological cause of PNES. This prospective multicenter study describes the short-term seizure and psychosocial outcomes after the communication of the diagnosis and with no additional treatment. Participants completed self-report measures at baseline, two and six months after the diagnosis (seizure frequency, HRQoL, health care utilization, activity levels, symptom attributions and levels of functioning). Thirty-six participants completed the self-report questionnaires. A further eight provided seizure frequency data. After six months, the median seizure frequency had dropped from 10 to 7.5 per month (p = 0.9), 7/44 participants (16%) were seizure-free, and an additional 10/44 (23%) showed greater than 50% improvement in seizure frequency. Baseline questionnaire measures demonstrated high levels of impairment, which had not improved at follow-up. The lack of change in self-report measures illustrates the need for further interventions in this patient group.
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Understanding patient perceptions following a psycho-educational intervention for Psychogenic Non-Epileptic Seizures
Epilepsy & behavior : E&B, 2012Co-Authors: Susan Baxter, Allan House, Rebecca Mayor, Wendy Baird, Richard J. Brown, Hannah R. Cock, Stephanie Howlett, Josie Messina, Phil Smith, Markus ReuberAbstract:This study formed part of an evaluation of a brief educational intervention for patients with Psychogenic Non-Epileptic Seizures (PNES). The sessions provide information, seizure control techniques and management planning. The qualitative component of the research reported here aimed to provide insight into the participants' perceptions following the intervention. Semi-structured interviews were conducted with twelve patients. Interviews were tape-recorded, transcribed and analyzed, using principles of thematic analysis. Six key themes were identified: getting answers; understanding the link with emotions; seeking a physiological explanation; doubting the diagnosis; the role of medication; and finding a way forward. The findings highlight considerable individual variation in response, with evidence of changed perceptions or enhanced understanding in some patients while others continued to seek answers or explanations about the cause of their Seizures. There were no clear links between reported improved understanding or acceptance of the diagnosis and a perceived improvement in the condition.
Martin Lancman - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of alexithymia in patients with Psychogenic Non-Epileptic Seizures and epileptic Seizures and predictors in Psychogenic Non-Epileptic Seizures.
Epilepsy & behavior : E&B, 2013Co-Authors: Lorna Myers, Barbara Matzner, Martin Lancman, Kenneth PerrineAbstract:Abstract Objective The first objective of this study was to determine the prevalence rate of alexithymia (dysregulation and unawareness of emotion) in patients with Psychogenic Non-Epileptic Seizures (PNESs) and epileptic Seizures (ESs). The second objective was to identify the predictors of alexithymia in patients with PNESs. Methods We studied 66 consecutive patients with PNESs and 35 patients with ESs with the Toronto Alexithymia Scale-20. The prevalence of alexithymia was determined in both groups. In order to identify the risk factors of alexithymia in PNES, the Trauma Symptom Inventory-II (TSI-II), the MMPI 2-RF, a clinical history, and demographic variables were studied. Results Our study revealed a prevalence of alexithymia in PNES and ES of 36.9% and 28.6%, respectively (not a significant difference). Upon examining the group with PNES, we found a significant correlation between alexithymia and Anxious Arousal (r = .497, p Conclusion Symptoms of psychological trauma and cynicism in patients diagnosed with PNESs were associated with alexithymia. These findings are encouraging, as they assist in better understanding the condition and in treatment design for this subset of patients.
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Psychogenic Non-Epileptic Seizures: Predisposing factors to diminished quality of life
Epilepsy & behavior : E&B, 2012Co-Authors: Lorna Myers, Barbara Matzner, Martin Lancman, Olgica Laban-grant, Martin LancmanAbstract:Abstract Objective The objective of this study was to examine the factors that contribute to the reports of diminished quality of life (QOL) in patients with Psychogenic Non-Epileptic Seizures (PNES). Methods We assessed 62 patients with PNES for quality of life, anger expression and personality, and psychiatric, social and medical histories. Results Diagnosis of depression, pain syndromes, older age of onset and shorter duration of PNES correlated with poorer quality of life. Elevated anger state, trait and total anger scores correlated with worse quality of life and with Quality of Life in Epilepsy 31 subscales of emotional well-being, medication, cognitive and social effects, seizure worry, and fatigue. Conclusion Our study verifies reported correlations between depression and somatic symptoms and quality of life. A novel finding is that of a relationship between quality of life in PNES and anger expression. This result has important implications for psychotherapeutic treatment of PNES in that it provides a potentially modifiable target.
Gaston Baslet - One of the best experts on this subject based on the ideXlab platform.
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Psychogenic Non-Epileptic Seizures: An Updated Primer
Psychosomatics, 2015Co-Authors: Gaston Baslet, Ashok Seshadri, Adriana Bermeo-ovalle, Kim Willment, Lorna MyersAbstract:Background Psychogenic Non-Epileptic Seizures are the most common paroxysmal event misdiagnosed as epilepsy. They significantly affect quality of life, functional status, and use of medical resources. Objective The goal of this review is to provide guidance to psychiatrists and other mental health professionals in the understanding and practical management of this condition. Results An abundance of new reports on the pathogenesis and effective treatments have become available over the last decade, yet specific barriers impede the fluid transition to treatment and remain an important challenge in the management of patients with Psychogenic Non-Epileptic Seizures. In the context of these difficulties, we initially present background information on Psychogenic Non-Epileptic Seizures covering their historic context, epidemiology, etiologic factors (including psychiatric, neuromedical, and neuropsychological factors), and current neurobiological models. Updated evidence-based treatments are discussed along with data on long-term outcomes. We also provide practical tools to help clinicians navigate differential diagnoses, establish their interdisciplinary roles, communicate the diagnosis, deliver treatment, and sort out commonly encountered challenges in the management of this condition.
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Initial treatment retention in Psychogenic Non-Epileptic Seizures.
The Journal of neuropsychiatry and clinical neurosciences, 2013Co-Authors: Gaston Baslet, Eric PrenskyAbstract:The authors investigated factors relevant to treatment retention and initial adherence in patients with Psychogenic Non-Epileptic Seizures. The factors studies were 1) treatment modality, that is, whether psychotherapy and neuropsychiatric management were provided in the same institution or at a different location, and 2) subject characteristics. Modes of treatment provided at the same location yielded greater compliance than “divided intervention,” where subjects attended different settings for each approach. Subjects with cognitive complaints and those on anti-epileptic drugs showed lower compliance rates, whereas married subjects showed greater compliance.
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Emotion regulation profiles in Psychogenic Non-Epileptic Seizures.
Epilepsy & behavior : E&B, 2012Co-Authors: Amanda A. Uliaszek, Eric Prensky, Gaston BasletAbstract:Abstract Background Psychogenic Non-Epileptic Seizures (PNES) are frequently encountered in epilepsy referral centers, yet there is limited understanding of the emotion processing style in this psychiatrically heterogeneous population. Understanding profiles of emotion regulation in PNES will provide further evidence of the Psychogenic nature of the disorder and will potentially inform psychotherapeutic interventions. Methods Fifty-five patients with PNES underwent a neuropsychiatric evaluation and completed self-report questionnaires that measured difficulties in emotion regulation, psychopathology severity and quality of life. Results Through the use of cluster analysis, two groups were identified; Cluster 1 represented a highly emotion dysregulated group while Cluster 2 represented a low emotion dysregulated group. Additional analyses revealed that each group significantly differed from normative data. Finally, Cluster 1 was significantly associated with several measures of psychiatric symptoms, higher rates of comorbid psychiatric diagnoses and impairment in quality of life. Conclusions These findings suggest that patients with PNES may be subject to high levels of emotion dysregulation, severe psychiatric symptomatology and impaired quality of life, or to low emotion dysregulation characterized by emotional unawareness or avoidance. These profiles clearly differ from normative data regarding emotion regulation and their identification may help tailor psychotherapeutic interventions.
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Psychogenic Non-Epileptic Seizures: a model of their pathogenic mechanism.
Seizure, 2010Co-Authors: Gaston BasletAbstract:Psychogenic Non-Epileptic Seizures (PNES) consist of paroxystic events facilitated by a dysfunction in emotion processing. Models explaining the pathogenic mechanisms leading to these seizure-like episodes are limited. In this article, evidence that supports dysfunction at the level of arousal tolerance, cognitive-emotional information processing and volitional control is reviewed. A hypothetical pathophysiological mechanism is discussed based on functional neuroimaging evidence from PNES-related conditions and traits. This pathophysiological model suggests an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes. Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system. During the episodes, sensorimotor and cognitive processes are modified or not properly integrated, allowing the deployment of autonomous prewired behavioral tendencies. Finally, I elaborate on how therapeutic applications could be modified based on the proposed hypothetical model, potentially improving clinical outcomes.
Christian E. Elger - One of the best experts on this subject based on the ideXlab platform.
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P83. Heart rate is differentially modulated in temporal lobe and Psychogenic, Non-Epileptic Seizures
Clinical Neurophysiology, 2015Co-Authors: T. Tsironis, K. Hampel, Christian E. Elger, Rainer SurgesAbstract:Purpose Epileptic Seizures are frequently accompanied by alterations of autonomic function. Previous studies have suggested that especially changes in heart rate (HR) may help to distinguish epileptic from Psychogenic, Non-Epileptic Seizures (PNES). Some of these studies may be confounded by various features such as age, gender, state of wakefulness and seizure semiology. Here, we re-assessed periictal HR modulation in temporal lobe Seizures (TLES) and PNES adjusted for a number of known confounders. Methods We retrospectively reviewed video-EEG data of people with refractory temporal lobe epilepsy undergoing presurgical assessment and of age- and gender matched patients without known epilepsy presenting with PNES. One seizure per patient was analyzed. HR was assessed with the help of a one-channel ECG lead at different time points (2 min before, during the seizure where HR was highest, immediately after seizure cessation, and 1, 2, 3, 5 and 10 min postictally). Data are given as mean ± SD. Results A total of 189 of patients and Seizures were included in the study. Sixty TLES arising from wakefulness (20 men, 34 ± 12 years) and 129 PNES were analyzed. In the PNES group, 60 of the Seizures had occurred spontaneously from wakefulness (PNES-S, 20 men, 37 ± 14 years), while 69 were induced by a provocation maneuver (verbal suggestion along with intravenous injection of vitamins; PNES-P, 23 men, 36 ± 14 years). In the PNES-P group, baseline HR was significantly higher as compared to the two other groups (p Conclusions TLES display higher relative HR changes during non-motor Seizures as well as shortly after major motor and non-motor Seizures, as compared to PNES-S. The setting of a provocation maneuver itself appears to enhance baseline HR. Taken together, our results support the notion that analysis of periictal HR is helpful in the differential diagnosis of epileptic versus Psychogenic, Non-Epileptic Seizures.
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Multidimensional assessment of personality in patients with Psychogenic Non-Epileptic Seizures
Journal of neurology neurosurgery and psychiatry, 2004Co-Authors: Markus Reuber, Ralf Pukrop, Jochen Bauer, R Derfuss, Christian E. ElgerAbstract:Objectives: To determine whether patients with Psychogenic Non-Epileptic Seizures (PNES) have evidence of maladaptive personality, and whether they have a single or several different typical pathological personality profiles. Methods: Patients were recruited from the department of epileptology, Bonn, Germany. In all, 85 patients with PNES and 63 with epilepsy completed a postal questionnaire including the dimensional assessment of personality pathology – basic questionnaire (DAPP-BQ). The DAPP-BQ was also completed by 100 healthy volunteers. The groups were compared and the PNES group was subjected to cluster analysis. Results: Patients with PNES had a greater degree of personality abnormality than clinical and non-clinical controls. There were several clusters of personality pathology. The profile of the largest cluster (n = 43) resembled that found in borderline personality disorder, that of the second largest (n = 37) was characterised by an overly controlled personality, that of the third (n = 4) was similar to the profile in avoidant personality disorder. Outcome differed between clusters. Conclusions: Maladaptive personality is common in patients with PNES. PNES are associated with several distinct profiles of pathological personality. This is relevant because outcome differed between profiles.