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Psychogenic Nonepileptic Attacks

  • Andrea E. Cavanna
Chapter

Abstract

Psychogenic nonepileptic attacks are paroxysmal behavioural manifestations characterised by altered physical and/or mental function and considered to be of psychological aetiology. Unlike epileptic seizures, psychogenic nonepileptic attacks are not a manifestation of abnormal electrical activity of cortical brain areas (epileptiform discharges). Although the clinical manifestations can resemble the ones observed in epileptic seizures, it has been argued that referring to psychogenic nonepileptic attacks as ‘psychogenic nonepileptic seizures’ could be misleading. Both post-traumatic and developmental aetiological models have been proposed for psychogenic nonepileptic attacks. A previous history of trauma, including physical and/or sexual abuse, is reported in up to 80% of patients. Overall, psychogenic nonepileptic attacks are likely to result from the complex interaction between psychiatric disorders, psychosocial stressors, dysfunctional coping styles, and central nervous system vulnerability. There is increasing evidence that the process of communicating the diagnosis is important as a potentially effective therapeutic step. Management strategies for patients with psychogenic nonepileptic attacks may require psychoeducation, psychotherapy, and pharmacotherapy, as well as reduction of iatrogenic harm, achieved by discontinuing ineffective antiepileptic drugs.

Keywords

Diagnosis communication Nonepileptic attacks Paroxysms Psychological aetiology Trauma 

Suggested Reading

Books

  1. Schachter SC, LaFrance WC Jr. Gates and Rowan’s nonepileptic seizures. 4th ed. Cambridge: Cambridge University Press; 2018.Google Scholar

Articles

  1. Asadi-Pooya AA. Biological underpinnings of psychogenic nonepileptic seizures: directions for future research. Neurol Sci. 2016;37:1033–8.CrossRefPubMedGoogle Scholar
  2. Asadi-Pooya AA. Psychogenic nonepileptic seizures: a concise review. Neurol Sci. 2017;38:935–40.CrossRefPubMedGoogle Scholar
  3. Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav. 2015;46:60–5.CrossRefPubMedGoogle Scholar
  4. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81:719–25.CrossRefPubMedGoogle Scholar
  5. Baslet G. Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. Seizure. 2011;20:1–13.CrossRefPubMedGoogle Scholar
  6. Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L. Psychogenic non-epileptic seizures: an updated primer. Psychosomatics. 2016;57:1–17.CrossRefPubMedGoogle Scholar
  7. Benbadis SR. Psychogenic nonepileptic ‘seizures’ or ‘attacks’? It’s not just semantics: attacks. Neurology. 2010;75:84–6.CrossRefPubMedGoogle Scholar
  8. Bodde NM, Brooks JL, Baker GA, Boon PA, Hendriksen JG, Mulder OG, Aldenkamp AP. Psychogenic non-epileptic seizures—definition, etiology, treatment and prognostic issues: a critical review. Seizure. 2009;18:543–53.CrossRefPubMedGoogle Scholar
  9. Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG, Nardone R. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav. 2012;25:251–5.CrossRefPubMedGoogle Scholar
  10. Brigo F, Ausserer H, Nardone R, Tezzon F, Manganotti P, Bongiovanni LG. Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events. Epilepsy Res. 2013;104:1–10.CrossRefPubMedGoogle Scholar
  11. Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): a systematic review. Clin Psychol Rev. 2016a;45:157–82.CrossRefPubMedGoogle Scholar
  12. Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev. 2016b;47:55–70.CrossRefPubMedGoogle Scholar
  13. Brown RJ, Syed TU, Benbadis S, LaFrance WC, Reuber M. Psychogenic nonepileptic seizures. Epilepsy Behav. 2011;22:85–93.CrossRefPubMedGoogle Scholar
  14. Cavanna AE, Seri S. Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services: from safety standards to improved effectiveness. Acta Neuropsychiatr. 2016;28:185–94.CrossRefPubMedGoogle Scholar
  15. Dekkers W, van Domburg P. The role of doctor and patient in the construction of the pseudo-epileptic attack disorder. Med Health Care Philos. 2000;3:29–38.CrossRefPubMedGoogle Scholar
  16. Devinsky O, Gazzola D, LaFrance WC. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol. 2011;7:210–20.CrossRefPubMedGoogle Scholar
  17. Durrant J, Rickards H, Cavanna AE. Prognosis and outcome predictors in psychogenic non-epileptic seizures. Epilepsy Res Treat. 2011:274736.Google Scholar
  18. Goldstein LH, Mellers JD. Recent developments in our understanding of the semiology and treatment of psychogenic nonepileptic seizures. Curr Neurol Neurosci Rep. 2012;12:436–44.CrossRefPubMedGoogle Scholar
  19. Hoerth MT, Wellik KE, Demaerschalk BM, Drazkowski JF, Noe KH, Sirven JI, Wingerchuk DM. Clinical predictors of psychogenic nonepileptic seizures: a critically appraised topic. Neurologist. 2008;14:266–70.CrossRefPubMedGoogle Scholar
  20. Hustvedt S. Philosophy matters in brain matters. Seizure. 2013;22:169–73.CrossRefPubMedGoogle Scholar
  21. Kanaan RAA, Duncan R, Goldstein LH, Jankovic J, Cavanna AE. Are psychogenic non-epileptic seizures just another symptom of conversion disorder? J Neurol Neurosurg Psychiatry. 2017;88:425–9.CrossRefPubMedGoogle Scholar
  22. Lacey C, Cook M, Salzberg M. The neurologist, psychogenic nonepileptic seizures, and borderline personality disorder. Epilepsy Behav. 2007;11:492–8.CrossRefPubMedGoogle Scholar
  23. LaFrance WC. Psychogenic nonepileptic ‘seizures’ or ‘attacks’? It’s not just semantics: seizures. Neurology. 2010;75:87–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. LaFrance WC, Gates JR, Trimble MR. Psychogenic unresponsiveness and nonepileptic seizures. Handb Clin Neurol. 2008;90:317–28.CrossRefPubMedGoogle Scholar
  25. LaFrance WC, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013a;54:2005–18.CrossRefPubMedGoogle Scholar
  26. LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013b;54(Suppl1):53–67.CrossRefPubMedGoogle Scholar
  27. Lawley A, Evans S, Manfredonia F, Cavanna AE. The role of outpatient ambulatory electroencephalography in the diagnosis and management of adults with epilepsy or non-epileptic attack disorder: a systematic literature review. Epilepsy Behav. 2015;53:26–30.CrossRefPubMedGoogle Scholar
  28. Mellers JDC, Goldstein LH. Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. J Neurol Neurosurg Psychiatry. 2006;77:616–21.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Mitchell J, Ali F, Cavanna AE. Dissociative experiences and quality of life in patients with non-epileptic attack disorder. Epilepsy Behav. 2012;25:307–12.CrossRefPubMedGoogle Scholar
  30. Mostacci B, Bisulli F, Alvisi L, Mostacci B, Bisulli F, Alvisi L. Ictal characteristics of psychogenic nonepileptic seizures: what we have learned from video-EEG recordings. A literature review. Epilepsy Behav. 2011;22:144–53.CrossRefPubMedGoogle Scholar
  31. Panagos PD, Merchant RC, Alunday RL. Psychogenic seizures: a focused clinical review for the emergency medicine practitioner. Postgrad Med. 2010;122:34–8.CrossRefPubMedGoogle Scholar
  32. Perez DL, LaFrance WC Jr. Nonepileptic seizures: an updated review. CNS Spectr. 2016;21:239–46.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Plug L, Reuber M. Making the diagnosis in patients with blackouts: it’s all in the history. Pract Neurol. 2009;9:4–15.CrossRefPubMedGoogle Scholar
  34. Popkirov S, Grönheit W, Wellmer J. A systematic review of suggestive seizure induction for the diagnosis of psychogenic nonepileptic seizures. Seizure. 2015;31:124–32.CrossRefPubMedGoogle Scholar
  35. Reuber M. Psychogenic non-epileptic seizures: answers and questions. Epilepsy Behav. 2008;12:622–35.CrossRefPubMedGoogle Scholar
  36. Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures: phenomenology, semiology and the Integrative Cognitive Model. Seizure. 2017;44:199–205.CrossRefPubMedGoogle Scholar
  37. Schmutz M. Dissociative seizures: a critical review and perspective. Epilepsy Behav. 2013;29:449–56.CrossRefPubMedGoogle Scholar
  38. Stone J, Campbell K, Sharma N, Carson A, Warlow CP, Sharpe M. What should we call pseudoseizures? The patient’s perspective. Seizure. 2003;12:568–72.CrossRefPubMedGoogle Scholar
  39. Thompson R, Isaac CL, Rowse G, Tooth CL, Reuber M. What is it like to receive a diagnosis of nonepileptic seizures? Epilepsy Behav. 2009;14:508–15.CrossRefPubMedGoogle Scholar
  40. Widdess-Walsh P, Mostacci B, Tinuper P, Devinsky O. Psychogenic nonepileptic seizures. Handb Clin Neurol. 2012;107:277–95.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea E. Cavanna
    • 1
  1. 1.Dept of NeuropsychiatryUniversity of BirminghamBirminghamUnited Kingdom

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