Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T09:46:41.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Pitfalls of Psychogenic Non-epileptic Status Epilepticus

Published online by Cambridge University Press:  17 January 2013

Hulya Karatas ,
F. Irsel Tezer ,
Nese Dericioglu  and
Serap Saygi
Hulya Karatas*
Affiliation:
Hacettepe University, Institute of Neurological Sciences and Psychiatry, Ankara, Turkey
F. Irsel Tezer*
Affiliation:
Hacettepe University, Institute of Neurological Sciences and Psychiatry, Ankara, Turkey
Nese Dericioglu
Affiliation:
Hacettepe University, Institute of Neurological Sciences and Psychiatry, Ankara, Turkey
Serap Saygi
Affiliation:
Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
*
Address for correspondence: Hulya Karatas, MD and F. Irsel Tezer, MD, PhD, Hacettepe University, Institute of Neurological Sciences and Psychiatry, Sihhiye, 06100, Ankara, Turkey. E-mails: hulyak@hacettepe.edu.tr, irseltezer@yahoo.com.tr
Address for correspondence: Hulya Karatas, MD and F. Irsel Tezer, MD, PhD, Hacettepe University, Institute of Neurological Sciences and Psychiatry, Sihhiye, 06100, Ankara, Turkey. E-mails: hulyak@hacettepe.edu.tr, irseltezer@yahoo.com.tr
Get access

Abstract

Objectives and Background: In patients with medically refractory seizures 20–30% do not have epilepsy, and the majority are diagnosed with psychogenic non-epileptic seizures (PNES). Almost one-third of this group has a prolonged episode that is termed as PNES status epilepticus (PNES-SE). The aim of this study was to describe the characteristics of patients with (1) PNES-SE only and (2) PNES-SE with concurrent epileptic seizures.

Methods: We screened retrospectively all patients who underwent video-electroencephalogram (video-EEG) long-term monitoring at our institution between 1996 and 2009. Patients with PNES were identified by typical clinical features with no ictal EEG changes. Patients with continuous episodes for at least 30 min that led to intubation were identified as PNES-SE. They were divided into two groups: group 1, pure PNES-SE and group 2, PNES-SE with concurrent epilepsy. Group characteristics were defined with respect to demographic, clinical, electroencephalographic, neuroimaging and psychiatric variables.

Results: PNES were recorded in 88/916 patients (10%) of whom 6 (7%) were treated intensively due to misdiagnosis of status epilepticus (SE), with two having coexistent epileptic seizures. All patients had concurrent psychiatric disorder(s), diagnosed by a psychiatrist. Duration of time until correct diagnosis was lengthy in all cases, and particularly for patients with PNES-SE with coexisting epileptic seizures (more than 10 years).

Conclusion: To avoid iatrogenic complications and to treat the underlying psychiatric conditions, early diagnosis of PNES is necessary. Understanding the clinical characteristics of PNES-SE leads to early diagnoses, which may avoid iatrogenesis and economic burden.

Keywords

epilepsypsychogenic non-epileptic seizurespsychogenic non-epileptic status epilepticusvideo-EEG monitoringlong-term monitoring
Type
Articles
Information
Brain Impairment , Volume 13 , Issue 3 , December 2012 , pp. 333 - 338
Copyright
Copyright © The Authors 2013

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

Benbadis, S.R. (2001). Provocative techniques should be used for the diagnosis of psychogenic nonepileptic seizures. Archives of Neurology, 58 (12), 2063–2065.CrossRefGoogle ScholarPubMed
Benbadis, S.R., & Allen Hauser, W. (2000). An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure, 9 (4), 280–281.CrossRefGoogle ScholarPubMed
Benbadis, S.R. & Lin, K. (2008). Errors in EEG interpretation and misdiagnosis of epilepsy. Which EEG patterns are overread? European Neurology, 59 (5), 267–271.CrossRefGoogle ScholarPubMed
Betting, L.E., Mory, S.B., Lopes-Cendes, I., Li, L.M., Guerreiro, M.M., Guerreiro, C.A., . . . Cendes, F. (2006). MRI reveals structural abnormalities in patients with idiopathic generalized epilepsy. Neurology, 67 (5), 848–852.CrossRefGoogle ScholarPubMed
Dericioglu, N., Saygi, S., & Ciger, A. (1999). The value of provocative methods in patients suspected of having non-epileptic seizures. Seizure, 8 (3), 152–156.CrossRefGoogle ScholarPubMed
Dworetzky, B.A., Mortati, K.A., Rosetti, A.O., Vaccaro, B., Nelson, A., & Bromfield, E.B. (2006). Clinical characteristics of psychogenic seizure status in long term monitoring unit. Epilepsy and Behavior, 9, 335–338.CrossRefGoogle ScholarPubMed
Gates, J.R. (2001). Provocative testing should not be used for nonepileptic seizures. Archives of Neurology, 58, 2065–2066.CrossRefGoogle Scholar
Krumholz, A. (1999). Nonepileptic seizures: diagnosis and management. Neurology, 53 (Suppl 2), S76–S83.Google ScholarPubMed
Krumholz, A., & Niedermeyer, E. (1983). Psychogenic seizures: a clinical study with follow-up data. Neurology, 33, 498–502.CrossRefGoogle ScholarPubMed
Martin, R., Burneo, J.G., Prasad, A., Powell, T., Faught, E., Knowlton, R., . . . Kuzniecky, R. (2003). Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology, 61 (12), 1791–1792.CrossRefGoogle ScholarPubMed
Neidermeyer, E., Blumer, D., Holscher, E., & Walker, B.A. (1970). Classical hysterical seizures facilitated by anticonvulsant toxicity. Psychiatria Clinica, 3, 71–84Google Scholar
Reuber, M., Baker, G.A., Gill, R., Smith, D.F., & Chadwick, D.W. (2004). Failure to recognize psychogenic nonepileptic seizures may cause death. Neurology, 62 (5), 834–835.CrossRefGoogle ScholarPubMed
Reuber, M., & Elger, C. (2003). Psychogenic nonepileptic seizures: review and update. Epilepsy and Behavior, 4, 205–216.CrossRefGoogle ScholarPubMed
Reuber, M., Fernandez, G., Bauer, J., Helmstaedter, C., & Elger, C.E. (2002). Diagnostic delay in psychogenic nonepileptic seizures. Neurology, 58, 493–495.CrossRefGoogle ScholarPubMed
Reuber, M., Pukrop, R., Mitchell, A.J., Bauer, J., & Elger, C.E. (2003). Clinical significance of recurrent psychogenic nonepileptic seizure status. Journal of Neurology, 250, 1335–1362.CrossRefGoogle ScholarPubMed
Saygi, S., Katz, A., Marks, D.A., & Spencer, S.S. (1992). Frontal lobe partial seizures and psychogenic seizures. Neurology, 42, 1274–1277.CrossRefGoogle ScholarPubMed
Sigurdardottir, K.R., & Olafsson, E. (1998). Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia, 39 (7), 749–752.CrossRefGoogle ScholarPubMed
Slater, J.D., Brown, M.C., Jacobs, W., & Ramsay, R.E. (1995). Induction of pseudoseizures with intravenous saline placebo. Epilepsia, 36, 580–585.CrossRefGoogle ScholarPubMed
Vanderzant, C.W., Giordani, B., Berent, S., Dreifuss, F.E., & Sackellares, J.C. (1986). Personality of patients with pseudoseizures. Neurology, 36, 664–668.CrossRefGoogle ScholarPubMed
Weaver, D.F. (2004). Organic pseudoseizures as an unrecognized side-effect of anticonvulsant therapy Seizure, 13 (7), 467–469.CrossRefGoogle ScholarPubMed