Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencepha...Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.展开更多
MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antib...MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antibodies is anti-N- methyl-D-aspartate （NMDA） receptor encephalitis. It is a form of paraneoplastic limbic encephalitis associated with ovarian teratoma and has recently been described.The NMDA receptor mediates excitatory neurotransmission. It is important for synaptic plasticity, and thus for higher function such as learning and memory. This disorder results in prominent psychiatric symptoms followed by a rapid decline of the level of consciousness, central hypoventilation, seizures, involuntary movements and dysautonomia.展开更多
Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the g...Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be completed.The issue is further complicated in cases of combined PNES with ES.In emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging investigations.Outside of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.Early recognition is thus desirable to initiate adequate treatment and improve prognosis.Considering experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and neuropsychiatrists.In such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be inaccurate.Thorough analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence level.Indeed,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of PNES.Moreover,induction and/or inhibition tests of PNES have a good diagnostic value when positive.Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic seizures.Finally,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.展开更多
Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress...Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.展开更多
PNES represents an alternative diagnosis for refractory epilepsy in the EMU, however it is less frequent in males. The impact of ethnicity on PNES was evaluated retrospectively in 54 males with confirmed diagnosis of ...PNES represents an alternative diagnosis for refractory epilepsy in the EMU, however it is less frequent in males. The impact of ethnicity on PNES was evaluated retrospectively in 54 males with confirmed diagnosis of PNES. We evaluated and compared the demographic, clinical and psycho-social characteristics of both AAMs and WMs. In both AAMs and CMS, over half of all patients were <50 years of age, had a shorter history of spells, and took between 1 to 3 AEDS. However, the spells were more frequent in AAM (2.25) compared to CM, but the CMs had more frequent limp/unresponsive events. Also there was higher incidence of head injury report, alcohol and substance abuse, unemployment and disability benefits in AAMs compared to CMs. These differences may provide insight into the causative factors in PNES.展开更多
Epilepsy and non-epileptic attack disorder (NEAD) share a vast number of clinical features, however the aetiology and management are very different. Video-EEG is the gold standard diagnostic tool and relies on the occ...Epilepsy and non-epileptic attack disorder (NEAD) share a vast number of clinical features, however the aetiology and management are very different. Video-EEG is the gold standard diagnostic tool and relies on the occurrence of seizure activity during assessment to make a diagnosis. Added complexity arises from the co-existence of epilepsy and NEAD, occurring in a significant proportion of patients. Comprehensive assessment and investigation is therefore required to prevent gross mistreatment in this diagnostically difficult subgroup. We present a case of NEAD with co-existing epilepsy and the challenges that this may present in clinical practice.展开更多
From 1979 to 2012,the Chinese government implemented the one-child policy to control population growth.In 2013,families in which either parent was the only one child were allowed to apply for a second child.In 2016,Ch...From 1979 to 2012,the Chinese government implemented the one-child policy to control population growth.In 2013,families in which either parent was the only one child were allowed to apply for a second child.In 2016,China’s universal two-child policy was finally imposed.As such,many children who had always been the center of their family’s universe due to the unique family structure stemming from the one-child policy era became elder siblings during their adolescence.We report a case of a 9-year-old girl who developed seizures after the birth of her younger sister.The combination of clinical observation,laboratory examinations,and video-electroencephalography was not enough to make a confident diagnosis of epilepsy initially.Given her patient history and follow-up investigation,we speculated the two-child policy was related to her seizures.To our knowledge,this is the first report of seizures strongly related to the two-child policy.展开更多
Psychogenic nonepileptic seizures present as paroxysmal symptoms and signs mimicking epileptic seizures.The gold standard test is the synchronous recording by video,electrocardiogram and electroencephalogram.However,v...Psychogenic nonepileptic seizures present as paroxysmal symptoms and signs mimicking epileptic seizures.The gold standard test is the synchronous recording by video,electrocardiogram and electroencephalogram.However,video electroencephalogram is not available at many centers and not entirely independent of semiology.Recent studies have focused on semiological characteristics distinguishing these two circumstances.Clinical signs and symptoms provide important clues when making differential diagnosis.The purpose of this review is to help physicians differentiating psychogenic nonepileptic seizures better from epileptic seizures based on semiology,and improve care for those patients.展开更多
文摘Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.
文摘MOST cases of encephalitis are caused by viruses but a few have an immunological basis, such as paraneoplastic encephalitis, with specific antibodies identified. One recently characterized encephalitis caused by antibodies is anti-N- methyl-D-aspartate （NMDA） receptor encephalitis. It is a form of paraneoplastic limbic encephalitis associated with ovarian teratoma and has recently been described.The NMDA receptor mediates excitatory neurotransmission. It is important for synaptic plasticity, and thus for higher function such as learning and memory. This disorder results in prominent psychiatric symptoms followed by a rapid decline of the level of consciousness, central hypoventilation, seizures, involuntary movements and dysautonomia.
文摘Distinguishing non-epileptic events,especially psychogenic non-epileptic seizures(PNES),from epileptic seizures(ES)constitutes a diagnostic challenge.Misdiagnoses are frequent,especially when video-EEG recording,the gold-standard for PNES confirmation,cannot be completed.The issue is further complicated in cases of combined PNES with ES.In emergency units,a misdiagnosis can lead to extreme antiepileptic drug escalade,unnecessary resuscitation measures(intubation,catheterization,etc.),as well as needless biologic and imaging investigations.Outside of the acute window,an incorrect diagnosis can lead to prolonged hospitalization or increase of unhelpful antiepileptic drug therapy.Early recognition is thus desirable to initiate adequate treatment and improve prognosis.Considering experience-based strategies and a thorough review of the literature,we aimed to present the main clinical clues for physicians facing PNES in non-specialized units,before management is transferred to epileptologists and neuropsychiatrists.In such conditions,patient recall or witness-report provide the first orientation for the diagnosis,recognizing that collected information may be inaccurate.Thorough analysis of an event(live or based on home-video)may lead to a clinical diagnosis of PNES with a high confidence level.Indeed,a fluctuating course,crying with gestures of frustration,pelvic thrusting,eye closure during the episode,and the absence of postictal confusion and/or amnesia are highly suggestive of PNES.Moreover,induction and/or inhibition tests of PNES have a good diagnostic value when positive.Prolactinemia may also be a useful biomarker to distinguish PNES from epileptic seizures,especially following bilateral tonic-clonic seizures.Finally,regardless the level of certainty in the diagnosis of the PNES,it is important to subsequently refer the patient for epileptological and neuropsychiatric follow-up.
文摘Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifestations of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and specialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves discontinuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.
文摘PNES represents an alternative diagnosis for refractory epilepsy in the EMU, however it is less frequent in males. The impact of ethnicity on PNES was evaluated retrospectively in 54 males with confirmed diagnosis of PNES. We evaluated and compared the demographic, clinical and psycho-social characteristics of both AAMs and WMs. In both AAMs and CMS, over half of all patients were <50 years of age, had a shorter history of spells, and took between 1 to 3 AEDS. However, the spells were more frequent in AAM (2.25) compared to CM, but the CMs had more frequent limp/unresponsive events. Also there was higher incidence of head injury report, alcohol and substance abuse, unemployment and disability benefits in AAMs compared to CMs. These differences may provide insight into the causative factors in PNES.
文摘Epilepsy and non-epileptic attack disorder (NEAD) share a vast number of clinical features, however the aetiology and management are very different. Video-EEG is the gold standard diagnostic tool and relies on the occurrence of seizure activity during assessment to make a diagnosis. Added complexity arises from the co-existence of epilepsy and NEAD, occurring in a significant proportion of patients. Comprehensive assessment and investigation is therefore required to prevent gross mistreatment in this diagnostically difficult subgroup. We present a case of NEAD with co-existing epilepsy and the challenges that this may present in clinical practice.
文摘From 1979 to 2012,the Chinese government implemented the one-child policy to control population growth.In 2013,families in which either parent was the only one child were allowed to apply for a second child.In 2016,China’s universal two-child policy was finally imposed.As such,many children who had always been the center of their family’s universe due to the unique family structure stemming from the one-child policy era became elder siblings during their adolescence.We report a case of a 9-year-old girl who developed seizures after the birth of her younger sister.The combination of clinical observation,laboratory examinations,and video-electroencephalography was not enough to make a confident diagnosis of epilepsy initially.Given her patient history and follow-up investigation,we speculated the two-child policy was related to her seizures.To our knowledge,this is the first report of seizures strongly related to the two-child policy.
基金Department of Education Zhejiang Province Scientific Research Project(No.Y201839721).
文摘Psychogenic nonepileptic seizures present as paroxysmal symptoms and signs mimicking epileptic seizures.The gold standard test is the synchronous recording by video,electrocardiogram and electroencephalogram.However,video electroencephalogram is not available at many centers and not entirely independent of semiology.Recent studies have focused on semiological characteristics distinguishing these two circumstances.Clinical signs and symptoms provide important clues when making differential diagnosis.The purpose of this review is to help physicians differentiating psychogenic nonepileptic seizures better from epileptic seizures based on semiology,and improve care for those patients.
