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Old 08-15-2007, 07:41 PM
linniec linniec is offline
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Default Psychogenic Pseudo seizure Nonepileptic Seizures PNES

First, pseudoseizures, also called psychogenic nonepileptic seizures (PNES) , are real. They are the brain's way of handling stress. An earlier name for psychogenic nonepileptic seizure was pseudoseizure or pseudo seizure, a less accepted (though accurate) term.
More people get this type of seizure if they have incest or a very traumatic event in their lives than those who have not had incest or a very traumatic event in their lives. Psychogenic nonepileptic seizures (PNES) are different in that epileptic seizures are caused by uncontrolled firing of electricity in the brain, a neurological disorder that usually, but of course not always, responds in some way, not always totally, to antiseizure medications. Psychogenic nonepileptic seizures do not. Psychogenic nonepileptic seizures (PNES) or Pseudoseizures are not excess firings of electrical impulses in the brain.
Instead, they are the brain's way of handling stress. The person having psychogenic nonepileptic seizures is not faking.

Indeed, a person can have both epilepsy caused by uncontrolled firing of electricity and also have PNES.

Psychogenic nonepileptic seizures (PNES) or pseudoseizures are not treated by anti Epilepsy Drugs (AEDs) as these not helpful.

Instead, psychogenic nonepileptic seizures are treated by neuropsychiatrist or a good psychiatrist who teachs the patient to 'teach' their brain to handle stress.

The majority of pseudoseizures are grand mal (Tonic-Clonic) seizures. Again, it is very important to understand that the person who has these seizures is not faking them or causing them.

It is the way their brain has decided to handle unacceptable or stressful situations. Some people have a mixture of epilepsy and psychogenic seizures, and others might be misdiagnosed with pseudo seizures. But in some situations, what is thought of as epilepsy might indeed be psychogenic nonepileptic seizures . As said before, some people have both.

What follows is a good article from Applied Neurology :


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Old 08-15-2007, 07:45 PM
linniec linniec is offline
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November 01, 2005 Applied Neurology
The Challenge of Psychogenic Nonepileptic Seizures
by Dee Rapposelli

Is it epilepsy or conversion disorder? An estimated 5% to 10% of outpatients receiving treatment for epilepsy and about 20% to 40% of patients hospitalized for intractable epilepsy may be suffering from psychogenic nonepileptic seizures (PNES).1,2 a conversion disorder. Both neurologists and psychiatrists emphasize that it is a real and debilitating condition but that it is a somatoform disorder, not epilepsy.
As recognition of the disorder grows and more research emerges, guides for distinguishing PNES from epilepsy, as well as management strategies are becoming available. Video-electroencephalographic (V-EEG) monitoring and observation of seizure activity specific to PNES are important in arriving at a differential diagnosis--considering that the health care burden associated with misdiagnosis of PNES, although unstudied as yet, is thought to be quite high. In their introduction to a report on a health care utilization study, a team led by Roy C. Martin, PhD, director of neuropsychology services for the University of Alabama at Birmingham Comprehensive Epilepsy Program, estimated the figure to be $110 million to $920 million per year, assuming that 300,000 to 400,000 people are affected and are being treated for intractable epilepsy at a lifetime cost of $100,000 per patient.3
Affected patients are treated, often for years, with antiepileptic drugs (AEDs) and other interventions that can promote further morbidity (Incidence of the disease),4-6 One study demonstrated that morbidity persists years after an appropriate diagnosis is made.6 Seventy-one percent of 164 patients who responded to a series of outcome, personality, and psychosymptomatic questionnaires about 4 years after PNES was diagnosed reported that they continued to have seizures. Fifty-six percent of respondents reported that they were unemployed or had retired because of their disability. Furthermore, 40.7% of respondents continued to receive AEDs after a PNES diagnosis was made--and 82% were readmitted to neurology wards.
"What accounts for the breakdown between diagnosis and implementation of treatment?" questioned Andres M. Kanner, MD, associate professor of neurological sciences and psychiatry at Rush Medical College in Chicago, in a commentary on the study.7 In his outline of possible explanations, Kanner cited a lack of communication between neurologists and psychiatrists and referred to a study he coauthored, showing that fewer than 20% of psychiatrists believed V-EEG findings were reliable in diagnosing PNES.8
Kanner concluded that a collaboration must be forged between the treating neurologist, mental health practitioner, patient, and patient's family so that the psychogenic features of the disability are addressed and the neurologic features are monitored. "Such collaboration may help patients achieve a safer and complete discontinuation of AEDs," he wrote.
Among neurologists, V-EEG findings are considered to be diagnostically definitive for PNES. Martin and colleagues also found that routine V-EEG monitoring for the differential diagnosis of epilepsy can significantly reduce health care utilization and its attendant costs.3 The study, published in Seizure in 1998, compared health care utilization for 20 patients 6 months before and 6 months after a V-EEG-confirmed diagnosis of PNES. At 6 months postdiagnosis, total seizure-related medical charges were reduced by an average of 84%. A 97% reduction in emergency room visits and an 80% reduction in outpatient visits were achieved. Furthermore, an average 76% reduction in diagnostic testing charges and a 69% reduction in medication charges were seen.
The study authors pointed out that patients diagnosed with PNES had received consultations about their diagnosis from the attending physician and the epilepsy care team and from a clinical psychologist. The patients also received assistance in obtaining referrals for outpatient mental health care.


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Old 08-15-2007, 08:01 PM
linniec linniec is offline
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Part 2

November 01, 2005 Applied Neurology
The Challenge of Psychogenic Nonepileptic Seizures
by Dee Rapposelli

Although V-EEG (Video Electro EncephloGram) monitoring has become the preferred diagnostic tool, clinical researchers also are recognizing symptomatic signs that distinguish PNES from epilepsy. Markus Reuber, MD, PhD, MRCP, consultant neurologist at the University of Sheffield in England, and Christian Elger, MD, FRCP, director of the Department of Epileptology at the University of Bonn Medical Center in Germany, compiled a list of distinguishing symptomatic features in a comprehensive literature review about PNES.4 They note that gradual onset, undulating and asynchronous movements, closed eyelids, resistance to lid opening, prolonged convulsive episodes (more than 2 minutes), lack of cyanosis, (a bluish coloration of the skin due to the presence of deoxygenated hemoglobin in the blood vessels near the skin surface) and rapid postictal reorientation are common in PNES but rare in epileptic seizures.
Patients with PNES also tend to have distinguishing historical features that epileptic patients rarely share. Features listed by Reuber and Elger include recurrent status seizures, multiple unexplained physical symptoms, multiple operations and invasive tests, psychiatric intervention, and sexual and physical abuse.4 A history of chronic pain or fibromyalgia also is common among patients with PNES, according to a recent study9
by Selim R. Benbadis, MD, director of the Comprehensive Epilepsy Program and associate professor of neurology in the departments of neurology and neurosurgery at the University of South Florida in Tampa.
In addition, commentators point out that patients with PNES are typically challenged with a host of mental health issues.3-5,10-13 Childhood abuse and stress-related disorders4,10-13 have often been noted to be associated with PNES. Early intervention and the ability of patients and their families to accept and seek appropriate care for PNES are crucial.4,13-17 Studies show that morbidity (Incidence of the disease) is high among patients who fail to accept the diagnosis.6,17
APPROPRIATE INTERVENTION
Once the diagnosis of PNES has been established, what's next for the patient? Taoufik Alsaadi, MD, assistant professor of clinical neurology, and Anna Vinter Marquez, MD, a resident in psychiatry at the University of California at Davis, instruct clinicians to identify and address the specific psychopathology. In a comprehensive literature review published this past September in American Family Physician,10 they outline psychotherapeutic protocols that have been recommended in the literature to treat the underlying causes of PNES.
The authors note that no randomized controlled studies have been conducted on the management of PNES but that evidence18,19 suggests that psychotherapeutic intervention is of value. The manner in which diagnosis is disclosed appears to be important as well. Benbadis writes in a review posted on eMedicine (www.emedicine.com/NEURO/topic403.htm), "[t]he main obstacle to effective treatment is effective delivery of the diagnosis."13
According to Benbadis, obstacles include the examining physician's uneasiness about a PNES diagnosis and lack of communication about the diagnosis with the referring physician, as well as physician awkwardness about discussing the diagnosis with the patient. Like Kanner, he asserted that psychotherapeutic intervention is imperative and that an ongoing team approach must be forged by the neurologist and the mental health provider.
In a recent study15 that evaluated outcomes related to a specific protocol for disclosing diagnosis of PNES, 86% of patients surveyed 2 years after PNES was diagnosed reported that the intensity and/or frequency of their seizures was reduced.
The aim of the protocol, adapted from a protocol by Shen and colleagues and published in Neurology in 1990,20 was to "reframe" the diagnosis in a sensitive, honest, and acceptable manner. The patient is reassured that her seizures are nonepileptic and not associated with brain damage. Terms such as "psychogenic" and "pseudoepileptic" are not used, and during the history taking, the patient is not asked directly whether she has experienced sexual abuse, but whether she has ever undergone "traumatic or stressful life events."
The patient is informed that the exact cause of the seizure is unknown but is probably due to too much "psychological energy" and emotional stress. It is explained that AEDs will not help her condition and that the staff will assist in helping the patient discontinue them. While emphasizing the good news that she does not have epilepsy or brain damage but that her condition is real and treatable, the staff informs the patient that others with her condition have been helped by psychotherapeutic intervention. She is given patient education literature about PNES and reassured that the seizures may improve over time as she accepts her diagnosis and seeks appropriate intervention for emotional stressors.
Finally, Benbadis in his eMedicine review13 noted that written patient education resources about PNES are important, although scarce. Fortunately, he has been particularly proactive in physician and patient education about PNES and has coauthored a guide for patients and families titled Psychogenic (Non-Epileptic) Seizures: A Guide for Patients & Families that is available on the Web at http://hsc.usf.edu/COM/epilepsy/ PNESbrochure.pdf. *


For references, please go to www.appneurology.com. REFERENCES
1. Gates JR. Epidemiology and classification of non-epileptic events. In: Gates JR, Rowan AJ, eds. Non-Epileptic Seizures. 2nd ed. Boston: Butterworth-Heinemann; 2000:3-14.
2. Benbadis SR, Agrawal V, Tatum WO 4th. How many patients with psychogenic non-epileptic seizures also have epilepsy? Neurology. 2001;57:915-917.
3. Martin RC, Gilliam FG, Kilgore M, et al. Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure. psychogenic nonepileptic seizure patients. Epilepsia. 2000;41:447-452.
15. Thompson NC, Osorio I, Hunter EE. Nonepileptic seizures: reframing the diagnosis. Perspect Psychiatr Care. 2005;41:71-78.
16. Quigg M, Armstrong RF, Farace E, Fountain NB. Quality of life outcome is associated with cessation rather than reduction of psychogenic nonepileptic seizures. Epilepsy Behav. 2002;3:455-459.
17. Ettinger AB, Devinsky O (Orrin), Weisbrot DM, et al. A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia. 1999;40:1292-1298.
18. Lesser RP. Psychogenic seizures. Neurology. 1996;46:1499-1507.
19. Aboukasm M, Mahr G, Gahry BR, et al. Retrospective analysis of the effects of psychotherapeutic interventions on outcomes of psychogenic nonepileptic seizures. Epilepsia. 1998;39:470-473.
20. Shen W, Bowman ES, Markand ON. Presenting the diagnosis of pseudoseizure. Neurology. 1990;40:756-759.

Again
Other earlier names for psychogenic nonepileptic seizure
were pseudoseizure pseudo-seisure or pseudo seizure .

Possible Category folders : psychogenic pseudoseizure or pseudo seizure, medical condition ,diagnosis, Living with epilepsy
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Old 08-19-2007, 01:19 AM
lexiathedragongirl lexiathedragongirl is offline
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Any chance we can get this stickied at the top, because this subject comes up reasonably frequently on the forum, and I think Linnie's information is very helpful.
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Old 08-19-2007, 04:00 PM
RobinN RobinN is offline
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We were given this diagnosis after a 20 min exam. at a well respected ed. hospital. 6 mo later we were given a dx of epilepsy at a well respected private hospital
A calendar of events, catamenial seizures, symptoms that were opposite of the ones listed above were not even used in the PNES dx. Such disservice was done in our behalf by jumping to this conclusion. There was a VEEG done without any episodes occurring. Doctors must not dx this before other approaches are examined. Certainly life is upside down for a family when a medical situation such as this occurs. This should be a careful and proven diagnosis.
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Old 08-21-2007, 07:52 PM
resqgirl911 resqgirl911 is offline
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I agree- my neuro is headed in that direction, have not had en EEG yet, but still having seizures. Having problems getting the neuro to listen, he thinks that its all a big lie- well tell that to my boyfriend who has to deal with me when I seize.
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Old 08-26-2007, 11:30 AM
otto_ otto_ is offline
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Default Man, that's silly

Quote:
Originally Posted by resqgirl911 View Post
I agree- my neuro is headed in that direction, have not had en EEG yet, but still having seizures. Having problems getting the neuro to listen, he thinks that its all a big lie- well tell that to my boyfriend who has to deal with me when I seize.

It seems to me that the easiest way of recognizing epilepsy is to do an EEG.
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Old 08-26-2007, 04:11 PM
annie annie is offline
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Quote:
Originally Posted by otto_ View Post
It seems to me that the easiest way of recognizing epilepsy is to do an EEG.
unfortunately it is not always simple.

epilepsy is generally (but not always) defined as two separate seizures with no known cause. so first two seizures have to be identified and then all possible causes have to be investigated. for example, seizures can be caused by high fevers or sometimes by heart problems.

unless a seizure happens during an EEG, the EEG generally won't show anything. there are exceptions but not many. some of us have had major seizures in the hospital captured on videotape that did not show on the EEG. if the seizures are deep in the brain an ordinary EEG can't find them.

if the EEG catches a seizure, then that is proof of a seizure. if the EEG does not show any seizures, that proves nothing.

the only seizures that an EEG can diagnose are absence seizures. people with absence seizures have a distinctive three second spike and wave pattern. tho there are probably people out there having absence seizures without the spike and wave, a great many people with absence seizures do have it.

unfortunately there is no definite way to diagnose seizures or epilepsy.
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Old 08-28-2007, 06:46 PM
dogsmom dogsmom is offline
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The whole EEG thing confuses me. I've had 3 since my TLE dx in 2005. The first one, which was performed 2 weeks after my first and only 'grand mal' seizure was abnormal and the others, were performed after I had been on AEDs for over a yr., were 'normal.' But my epi. doc. cautioned me, "That does NOT mean you don't have Epilepsy!" when I half-kiddingly suggested I stop taking meds because the EEGs were normal.

Anyway, the first EEG report stated ... "Eye opening brought about blocking of the posterior rhythm. There were spikes seen on the right side with the highest amplitude in the temporal area. This is an abnormal EEG with spikes seen predominantly with the highest amplitude in the right temporal area. This indicates a predisposition to seizures."

So does that mean I had a seizure while the test was being done? I do recall my left arm started to jerk at one point during the EEG.....
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Old 08-29-2007, 01:16 AM
RobinN RobinN is offline
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That would be my understanding.
I truly don't understand why they jump directly to PNES, because even with a psychogenic seizure, it seems to me that there just might be a nutritional reason the body is unable to handle stress at the moment. There is a deficiency in Alzheimers, Autism, depression, ADHD, so why not with a seizure disorder. Why just ship a patient off to a therapist to work it out. There is a biomed reason the body is reacting this way. IMO
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