Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T23:31:32.263Z Has data issue: false hasContentIssue false

Psychogenic non-epileptic seizures in an Irish tertiary referral centre for epilepsy

Published online by Cambridge University Press:  13 June 2014

Finian M O'Brien*
Affiliation:
Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
Norman Delanty
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
Catherine Dineen
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
Kieran C Murphy
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
*
*Correspondence E-mail: finobrien@rcsi.ie

Abstract

Objectives: To examine the prevalence, psychiatric co-morbidity and management of psychogenic non-epileptic seizures (PNES) in patients admitted to a tertiary referral Epilepsy Monitoring Unit (EMU).

Methods: Medical records of patients admitted to the EMU between 2003 and 2005 were examined and data from neurological, neuropsychiatric and neuropsychological assessments were analysed.

Results: Over a three year period 224 patients were referred to the EMU and 44 (20%) were diagnosed with psychogenic non-epileptic seizures (PNES). A total of 13 people (6%) were diagnosed with both PNES and epilepsy. Of those diagnosed with PNES 34 (75%) were referred to psychology services for cognitive behavioural therapy (CBT) and 26 (58%) were followed-up by psychiatry services.

Conclusions: The prevalence rates for PNES and co-existing PNES and epilepsy are consistent with previous reports. Rates of psychiatric co-morbidity were less than would be expected in this clinical population. Clear evidence-based guidelines to manage people with PNES are required.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Walker, MC, Howard, RS, Smith, SJ. Diagnosis and treatment of status epilepticus on a neurological intensive care unit. QJM 1996; 89: 913–20.CrossRefGoogle ScholarPubMed
2.Gates, JR. Part summary: neurologic aspects of non-epileptic seizures in the adult and pediatric patient. In: Gates, JR, Rowan, AJ (eds). Non-epileptic seizures. 2nd ed. Boston: Butterworth-Heineman 2000: 111112.Google Scholar
3.Reuber, M. Psychogenic nonepiieptic seizures: diagnosis, etiology and prognosis. Schweiz Arch Neurol Psychiatr 2005; 156: 4757.Google Scholar
4.World Health Organisation. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research, Geneva, Switzerland: WHO, 1993.Google Scholar
5.Benbadis, SR, Agrawal, V, Tatum, WO. 4th. How many patients with psychogenic nonepiieptic seizures also have epilepsy? Neurology 2001; 57: 915917.CrossRefGoogle Scholar
6.Martin, R, Burneo, JG, Prasad, Aet al. Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology 2003; 61: 17911792.CrossRefGoogle ScholarPubMed
7.Alsaadi, TM, Marquez, AV. Psychogenic Nonepiieptic seizures. Am Fam Physician 2005; 72(5): 849856.Google ScholarPubMed
8.Krahn, LE, Reese, MM, Rummans, TA, Peterson, GC, Suman, V, Sharbrough, FW. Health utilization of patients with psychogenic nonepiieptic seizures. Psychosomatics 1997; 38: 535–42.CrossRefGoogle ScholarPubMed
9.Martin, R, Bell, B, Hermann, B, Mennemeyer, S. Nonepiieptic seizures and their costs: the role of neuropsychology. In: Prigatano, GP, Pliskin, NH, eds. Clin Neuropsychology and Cost Outcome Research: A Beginning. New York: Psychology Press, 2003: 235–58.Google Scholar
10.Martin, RC, Gilliam, FG, Kilgore, M, Faught, E, Kuzniecky, R. Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure 1998; 7: 385–90CrossRefGoogle ScholarPubMed
11.O'Sullivan, SS, Spillane, JE, McMahon, EMet al.Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: A 5-year review. Epilepsy Behav 2007; 11(1): 7784.CrossRefGoogle ScholarPubMed
12.Pallant, J. SPSS survival manual: A step by step guide to data analysis using SPSS for Windows Version 11. Buckingham: Open University Press, Maidenhead, UK, 2001.Google Scholar
13.Sigurdardottir, KR, Olafsson, E. Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia 1998; 39: 749752.CrossRefGoogle ScholarPubMed
14.Howell, SJ, Owen, L, Chadwick, DW. Pseudostatus epilepticus CUM 1989; 71: 507519.Google ScholarPubMed
15.Carton, S, Thompson, PJ, Duncun, JS. Non-epileptic seizures: patients' understanding and reaction to the diagnosis and impact on outcome. Seizure 2003; 12(5): 287–94.CrossRefGoogle Scholar
16.Mellers, JDC. The approach to patients with ‘non-epileptic seizures’. Postgrad Med J 2005; 81: 498504.CrossRefGoogle ScholarPubMed
17.Aboukasm, A, Mahr, G, Gahry, BR, Thomas, A, Barkley, GL. Retrospective analysis of the effects of psychotherapeutic interventions on outcomes of psychogenic nonepileptic seizures. Epilepsia 1998; 39(5): 470473.CrossRefGoogle ScholarPubMed
18.Bowman, ES, Markand, ON. Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatr 1996; 153: 5763.Google ScholarPubMed
19.Bowman, ES. Psychopathology and outcome in pseudoseizures. In: Ettinger, AB, Kanner, AM (eds). Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment. Philadelphia: Lippincott Williams & Wilkins, 2001: 355377.Google Scholar
20.Brooks, JL, Baker, GA, Goodfellow, L, Bodde, N, Aldenkamp, A. Behavioural treatments for non-epileptic attack disorder. Cochrane Database of Systematic Reviews 2007;lssue 1: Art. No.: CD006370. DOI: 10.1002/14651858.CD006370.CrossRefGoogle Scholar
21.Stone, J, Binzer, M, Sharpe, M. Illness beliefs, and locus of control in pseudoseizures. J Psychosomatic Res 2004; 57: 541547.CrossRefGoogle ScholarPubMed
22.Reuber, M, Pukrop, R, Bauer, J, Helmstaedter, C, Tessendorf, N, Elger, CE. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003; 53: 305–11.CrossRefGoogle ScholarPubMed
23.Reuber, M, Elger, CE. Psychogenic nonepileptic seizures: review and update. Epilepsy and Behavior 2003; 4: 205216.CrossRefGoogle ScholarPubMed
24.National Institute for Clinical Excellence. The Epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. NICE Clinical Guideline 20 2004; October: 57.Google Scholar