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Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services: from safety standards to improved effectiveness

Published online by Cambridge University Press:  23 March 2016

Andrea E. Cavanna  and
Stefano Seri
Andrea E. Cavanna*
Affiliation:
School of Life and Health Sciences, Aston Brain Centre, Wellcome Trust Laboratory for MEG Studies, Aston University, Birmingham, UK Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK Institute of Neurology, UCL, London, UK
Stefano Seri
Affiliation:
School of Life and Health Sciences, Aston Brain Centre, Wellcome Trust Laboratory for MEG Studies, Aston University, Birmingham, UK Department of Clinical Neurophysiology and Pediatric Epilepsy Surgery Programme, The Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
*
Prof. Andrea E. Cavanna, Department of Neuropsychiatry, National Centre for Mental Health, 25 Vincent Drive, Birmingham B15 2FG, UK. Tel: +44 121 3012280; Fax: +44 121 3012291; E-mail: a.cavanna@ion.ucl.ac.uk
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Abstract

Objective

The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry.

Methods

We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks.

Results

Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly.

Conclusion

The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.

Keywords

epilepsyneuropsychiatrynon-epileptic attack disordersafetyvideo-EEG telemetry
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 28 , Issue 4 , August 2016 , pp. 185 - 194
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Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

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References

1. Arambepola, NMA, Rickards, H, Cavanna, AE. The evolving discipline and services of neuropsychiatry in the United Kingdom. Acta Neuropsychiatrica 2012;24:191–198.CrossRefGoogle ScholarPubMed
2. Tonkonogy, J, Geller, J. A neuropsychiatry service in a state hospital: Adolf Meyer’s approach revisited. Psychiatr Q 2007;78:219–235.Google Scholar
3. Eddy, CM, Cavanna, AE. Video-electroencephalography investigation of ictal alterations of consciousness in epilepsy and non-epileptic attack disorder: practical considerations. Epilepsy Behav 2014;30:24–27.CrossRefGoogle Scholar
4. McCorry, DJP, Cavanna, AE. New thoughts on first seizure. Clin Med 2010;4:395–398.Google Scholar
5. Whitehead, K, Reuber, M. Illness perceptions of neurologists and psychiatrists in relation to epilepsy and nonepileptic attack disorder. Seizure 2012;21:104–109.Google Scholar
6. National Institute for Health and Clinical Excellence. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. Clinical guideline 137. National Clinical Guideline Centre; 2012.Google Scholar
7. Delgado Nunes, V, Sawyer, L, Neilson, J, Sarri, G, Cross, JH. Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidelines. Br Med J 2012;344:e281.Google Scholar
8. LaFrance, WC, Baker, GA, Duncan, R, Goldstein, LH, Reuber, M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach. Epilepsia 2013;54:2005–2018.Google Scholar
9. Plug, L, Reuber, M. Making the diagnosis in patients with blackouts: it’s all in the history. Pract Neurol 2009;9:4–15.CrossRefGoogle ScholarPubMed
10. Ali, F, Rickards, H, Bagary, M, Greenhill, L, McCorry, D, Cavanna, AE. Ictal consciousness in epilepsy and non-epileptic attack disorder. Epilepsy Behav 2010;19:522–525.CrossRefGoogle Scholar
11. Cavanna, AE, Rickards, H, Ali, F. What makes a simple partial seizure complex? Epilepsy Behav 2011;22:651–658.CrossRefGoogle ScholarPubMed
12. Ali, F, Rickards, H, Cavanna, AE. The assessment of consciousness during partial seizures. Epilepsy Behav 2012;23:98–102.Google Scholar
13. Mitchell, J, Ali, F, Cavanna, AE. Dissociative experiences and quality of life in patients with non-epileptic attack disorder. Epilepsy Behav 2012;25:307–312.CrossRefGoogle ScholarPubMed
14. Nani, A, Cavanna, AE. The quantitative measurement of consciousness during epileptic seizures. Epilepsy Behav 2014;30:2–5.Google Scholar
15. Roberts, NA, Reuber, M. Alterations of consciousness in psychogenic nonepileptic seizures: emotion, emotion regulation and dissociation. Epilepsy Behav 2014;30:43–49.Google Scholar
16. Drazkowski, JF, Chung, SS. Differential diagnosis of epilepsy. Continuum (Minneap Minn) 2010;16:36–56.Google Scholar
17. Mann, JP, Cavanna, AE. What does epilepsy tell us about the neural correlates of consciousness? J Neuropsychiatry Clin Neurosci 2011;23:375–383.Google Scholar
18. Bagshaw, AP, Cavanna, AE. Resting state networks in paroxysmal disorders of consciousness. Epilepsy Behav 2013;26:290–294.Google Scholar
19. Prigatano, GP, Kirlin, KA. Self-appraisal and objective assessment of cognitive and affective functioning in persons with epileptic and nonepileptic seizures. Epilepsy Behav 2009;14:387–392.CrossRefGoogle ScholarPubMed
20. Khan, AY, Baade, L, Ablah, E, McNerney, V, Golewale, MH, Liow, K. Can hypnosis differentiate epileptic from nonepileptic events in the video/EEG monitoring unit? Data from a pilot study. Epilepsy Behav 2009;15:314–317.Google Scholar
21. Schwabe, M, Howell, SJ, Reuber, M. Differential diagnosis of seizure disorders: a conversation analytic approach. Soc Sci Med 2007;65:712–724.Google Scholar
22. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489–501.Google Scholar
23. Velis, D, Plouin, P, Gotman, J, Lopes da Silva, F, for the ILAE DMC Subcommittee on Neurophysiology. Recommendations regarding the requirements and applications for long-term recordings in epilepsy. Epilepsia 2007;48:379–384.Google Scholar
24. Hall-Patch, L, Brown, R, House, A et al. Acceptability and effectiveness of a strategy for the communication of the diagnosis of psychogenic nonepileptic seizures. Epilepsia 2010;51:70–78.Google Scholar
25. Durrant, J, Rickards, H, Cavanna, AE. Prognosis and outcome predictors in psychogenic non-epileptic seizures. Epilepsy Res Treat 2011:274736.Google Scholar
26. LaFrance, WC Jr, Reuber, M, Goldstein, LH. Management of psychogenic nonepileptic seizures. Epilepsia 2013;54(Suppl 1)):53–67.Google Scholar
27. Ribaï, P, Tugendhaft, P, Legros, B. Usefulness of prolonged video-EEG monitoring and provocative procedure with saline injection for the diagnosis of nonepileptic seizures of psychogenic origin. J Neurol 2006;3:328–332.CrossRefGoogle Scholar
28. Kandler, R, Lai, M, Ponnusamy, A, Bland, J, Pang, C. The safety of UK video telemetry units: Results of a national service evaluation. Seizure 2013;22:872–876.Google Scholar
29. Noe, KH, Drazkowski, JF. Safety of long-term video-electroencephalographic monitoring for evaluation of epilepsy. Mayo Clin Proc 2009;84:495–500.Google Scholar
30. Atkinson, M, Hari, K, Schaefer, K, Shah, A. Improving safety outcomes in the epilepsy monitoring unit. Seizure 2012;21:124–127.Google Scholar
31. Lee, JW, Shah, A. Safety in the EMU: Reaching consensus. Epilepsy Curr 2013;13:107–109.Google Scholar
32. Jones, R, Rickards, H, Cavanna, AE. The prevalence of psychiatric disorders in epilepsy: a critical review of the evidence. Funct Neurol 2010;25:191–194.Google Scholar
33. Shafer, PO, Buelow, J, Ficker, DM et al. Risk of adverse events on epilepsy monitoring units: a survey of epilepsy professionals. Epilepsy Behav 2011;20:502–505.Google Scholar
34. Dobesberger, J, Walser, G, Unterberger, I et al. Video-EEG monitoring: safety and adverse events in 507 consecutive patients. Epilepsia 2011;52:443–452.Google Scholar
35. Tomson, T, Nashef, L, Ryvlin, P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol 2008;7:1021–1031.CrossRefGoogle ScholarPubMed
36. Bateman, L, Spitz, M, Seyal, M. Ictal hypoventilation contributes to cardiac arrhythmia and SUDEP: Report on two deaths in video-EEG-monitored patients. Epilepsia 2009;51:916–920.CrossRefGoogle Scholar
37. Espinosa, PS, Lee, JW, Tedrow, UB, Bromfield, EB, Dworetzky, BA. Sudden unexpected near death in epilepsy: malignant arrhythmia from a partial seizure. Neurology 2009;72:1702–1703.Google Scholar
38. Buelow, JM, Privitera, M, Levisohn, P, Barkley, GL. A description of current practice in epilepsy monitoring units. Epilepsy Behav 2009;15:308–313.Google Scholar
39. American Clinical Neurophysiology Society. Guideline Twelve: Guidelines for long term monitoring for epilepsy. Am J Electroneurodiagnostic Technol 2008;48:265–286.Google Scholar
40. American Clinical Neurophysiology Society. Guideline twelve: guidelines for long term monitoring for epilepsy. J Clin Neurophysiol 2008;25:170–180.Google Scholar
41. Bagić, AI, Knowlton, RC, Rose, DF, Ebersole, JS, ACMEGS Clinical Practice Guideline Committee. American Clinical Magnetoencephalography Society Clinical Practice Guideline 1: Recording and analysis of spontaneous cerebral activity. J Clin Neurophysiol 2011;28:348–354.Google ScholarPubMed
42. Bagić, AI, Barkley, GL, Rose, DF, Ebersole, JS, ACMEGS Clinical Practice Guideline Committee. American Clinical Magnetoencephalography Society Clinical Practice Guideline 4: qualifications of MEG-EEG personnel. J Clin Neurophysiol 2011;28:364–365.Google Scholar
43. Shafer, PO, Buelow, JM, Noe, K et al. A consensus-based approach to patient safety in epilepsy monitoring units: recommendations for preferred practices. Epilepsy Behav 2012;25:449–456.Google Scholar
44. Linstone, HA, Turoff, M. The Delphi method: techniques and applications. Reading, MA: Addison-Wesley Publishing, 1975.Google Scholar
45. Eddy, CM, Rickards, H, Cavanna, AE. Behavioral adverse effects of antiepileptic drugs in epilepsy. J Clin Psychopharmacol 2012;32:362–375.Google Scholar
46. Piedad, J, Rickards, H, Besag, F, Cavanna, AE. Beneficial and adverse psychotropic effects of antiepileptic drugs in patients with epilepsy: a summary of prevalence, underlying mechanisms and data limitations. CNS Drugs 2012;26:319–335.Google Scholar
47. Cavanna, AE, Ali, F, Rickards, HE, McCorry, D. Behavioural and cognitive effects of anti-epileptic drugs. Discov Med 2010;9:138–144.Google Scholar
48. Eddy, CM, Rickards, HE, Cavanna, AE. The cognitive impact of antiepileptic drugs. Ther Adv Neurol Dis 2011;4:380–402.Google Scholar
49. Labiner, DM, Bagic, AI, Herman, ST, Fountain, NB, Walczak, TS, Gumnit, RJ, for the National Association of Epilepsy Centers. Essential services, personnel, and facilities in specialized epilepsy centres: revised 2010 guidelines. Epilepsia 2010;51:2322–2333.CrossRefGoogle ScholarPubMed
50. Kanner, AM, Bergey, G. Editorial comment (safety in the EMU: reaching consensus). Epilepsy Curr 2013;13:61.Google Scholar
51. Spanaki, MV, McCloskey, C, Remedio, V et al. Developing a culture of safety in the epilepsy monitoring unit: a retrospective study of safety outcomes. Epilepsy Behav 2012;25:185–188.Google Scholar
52. Walczak, TS, Papacostas, S, Williams, DT, Scheuer, ML, Lebowitz, N, Notarfrancesco, A. Outcome after diagnosis of psychogenic nonepileptic seizures. Epilepsia 1995;36:1131–1137.Google Scholar
53. Mitchell, JW, Seri, S, Cavanna, AE. Pharmacotherapeutic options for refractory and difficult-to-treat seizures. J Central Nerv Syst Dis 2012;4:105–115.Google ScholarPubMed
54. Atkinson, M, Shah, A, Hari, K, Schaefer, K, Bhattacharya, P, Shah, A. Safety considerations in the epilepsy monitoring unit for psychogenic nonepileptic seizures. Epilepsy Behav 2012;25:176–180.Google Scholar
55. Asadi-Pooya, AA, Emami, Y, Emami, M, Sperling, MR. Prolonged psychogenic nonepileptic seizures or pseudostatus. Epilepsy Behav 2014;30:304–306.Google Scholar
56. Dworetzky, BA, Mortati, KA, Rossetti, AO, Vaccaro, B, Nelson, A, Bromfield, EB. Clinical characteristics of psychogenic nonepileptic seizure status in the long-term monitoring unit. Epilepsy Behav 2006;9:335–338.Google Scholar
57. Mostacci, B, Bisulli, F, Alvisi, L, Licchetta, L, Baruzzi, A, Tinuper, P. Ictal characteristics of psychogenic nonepileptic seizures: what we have learned from video/EEG recordings: a literature review. Epilepsy Behav 2011;22:144–153.Google Scholar
58. Peguero, E, Abou-Khalil, B, Fakhoury, T, Mathews, G. Self-injury and incontinence in psychogenic seizures. Epilepsia 2005;36:586–591.Google Scholar
59. National Association of Epilepsy Centers (NAEC). Recommended guidelines for diagnosis and treatment in specialized epilepsy centers. Epilepsia 1990;31:S1–S12.Google Scholar
60. Walczak, TS, and the Committee to Revise the Guidelines for Specialized Epilepsy Centers. Guidelines for essential services, personnel, and facilities in specialized epilepsy centers. Epilepsia 2001;42:804–814.Google Scholar
61. Kwan, P, Brodie, MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314–319.Google Scholar
62. Shin, HW, Pennell, PB, Lee, JW, Doucette, H, Srinivasan, S, Dworetzky, BA. Efficacy of safety signals in the epilepsy monitoring unit (EMU): Should we worry? Epilepsy Behav 2012;23:458–461.Google Scholar
63. Carton, S, Thompson, PJ, Duncan, JS. Non-epileptic seizures: patients’ understanding and reaction to the diagnosis and impact on outcome. Seizure 2003;12:287–294.CrossRefGoogle Scholar
64. Brown, RJ, Syed, TU, Benbadis, S, LaFrance, WC Jr, Reuber, M. Psychogenic nonepileptic seizures. Epilepsy Behav 2011;22:85–93.Google Scholar
65. Mayor, R, Brown, RJ, Cock, H et al. Short-term outcome of psychogenic non-epileptic seizures after communication of the diagnosis. Epilepsy Behav 2012;25:676–681.Google Scholar
66. 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;53:305–311.Google Scholar
67. Farias, ST, Thieman, C, Alsaadi, TM. Psychogenic nonepileptic seizures: acute change in event frequency after presentation of the diagnosis. Epilepsy Behav 2003;4:424–429.Google Scholar
68. Bodde, NM, Janssen, AM, Theuns, C, Vanhoutvin, JF, Boon, PA, Aldenkamp, AP. Factors involved in the long-term prognosis of psychogenic nonepileptic seizures. J Psychosom Res 2007;62:545–551.Google Scholar
69. Zhang, YC, Bromfield, EB, Hurwitz, S, Nelson, A, Sylvia, K, Dworetzky, BA. Comparison of outcomes of video/EEG monitoring between patients with epileptic seizures and those with psychogenic nonepileptic seizures. Epilepsy Behav 2009;15:303–307.Google Scholar
70. Carson, AJ, Brown, R, David, AS et al. Functional (conversion) neurological symptoms: research since the millennium. J Neurol Neurosurg Psychiatry 2012;83:842–850.Google Scholar
71. Ryvlin, P, Nashef, L, Lhatoo, SD et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol 2013;12:966–977.Google Scholar
72. Sander, JW. Reducing the risk of sudden death during epilepsy monitoring. Lancet Neurol 2013;12:935–936.Google Scholar