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Psychogenic non-epileptic seizures - diagnostic issues: a critical review

NMG Bodde, JL Brooks, GA Baker, Paul Boon UGent, JGM Hendriksen and AP Aldenkamp (2009) Clinical Neurology and Neurosurgery. 111(1). p.1-9
abstract
In this review we systematically assess our current knowledge about psychogenic non-epileptic seizures (PNES), epidemiology, etiology, with an emphasis on the diagnostic issues. Relevant studies were identified by searching the electronic databases. Case reports were not considered. Articles were included when published after 1980 up till 2005 (26 years). A total of 84 papers were identified; 60 of which were actual studies. Most studies have serious methodological limitations. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. The incidence of PNES in the general population is low. However, a relatively high prevalence is seen in patients referred to epilepsy centres (15-30%). Caution is needed in the clinical interpretation of ictal features suggested to be pathognomic for PNES. Video-EEG is widely considered to be the gold standard for diagnosing PNES. Still the differential diagnosis epileptic/non-epileptic seizures can be difficult. Despite the current available technical facilities, the mean latency between onset of PNES and final diagnosis as being non-epileptic and psychogenic is approximately 7 years. One of the reasons for diagnostic delay is that the diagnosis of PNES is often limited to a 'negative' process and consequently PNES is characterized as a 'non-disease' (i.e. 'not epilepsy'). The psychological diagnosis is thus an important, although not a conclusive, 'second phase' aspect of medical decision making. Specific relations between seizure presentation and underlying psychological mechanisms are not conclusive. A classification between major motor manifestations and unresponsiveness is recognized. With respect to psychological etiology, a heterogeneous set of factors have been identified that may be involved in the causation, development and provocation of PNES.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
journal title
Clinical Neurology and Neurosurgery
Clin. Neurol. Neurosurg.
volume
111
issue
1
pages
1 - 9
Web of Science type
Review
Web of Science id
000262801100001
JCR category
SURGERY
JCR impact factor
1.303 (2009)
JCR rank
83/166 (2009)
JCR quartile
3 (2009)
ISSN
0303-8467
DOI
10.1016/j.clineuro.2008.09.028
language
English
UGent publication?
yes
classification
A1
id
691093
handle
http://hdl.handle.net/1854/LU-691093
date created
2009-06-11 15:13:44
date last changed
2009-06-22 12:32:07
@article{691093,
  abstract     = {In this review we systematically assess our current knowledge about psychogenic non-epileptic seizures (PNES), epidemiology, etiology, with an emphasis on the diagnostic issues. Relevant studies were identified by searching the electronic databases. Case reports were not considered. Articles were included when published after 1980 up till 2005 (26 years). A total of 84 papers were identified; 60 of which were actual studies. Most studies have serious methodological limitations. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. The incidence of PNES in the general population is low. However, a relatively high prevalence is seen in patients referred to epilepsy centres (15-30\%). Caution is needed in the clinical interpretation of ictal features suggested to be pathognomic for PNES. Video-EEG is widely considered to be the gold standard for diagnosing PNES. Still the differential diagnosis epileptic/non-epileptic seizures can be difficult. Despite the current available technical facilities, the mean latency between onset of PNES and final diagnosis as being non-epileptic and psychogenic is approximately 7 years. One of the reasons for diagnostic delay is that the diagnosis of PNES is often limited to a 'negative' process and consequently PNES is characterized as a 'non-disease' (i.e. 'not epilepsy'). The psychological diagnosis is thus an important, although not a conclusive, 'second phase' aspect of medical decision making. Specific relations between seizure presentation and underlying psychological mechanisms are not conclusive. A classification between major motor manifestations and unresponsiveness is recognized. With respect to psychological etiology, a heterogeneous set of factors have been identified that may be involved in the causation, development and provocation of PNES.},
  author       = {Bodde, NMG and Brooks, JL and Baker, GA and Boon, Paul and Hendriksen, JGM and Aldenkamp, AP},
  issn         = {0303-8467},
  journal      = {Clinical Neurology and Neurosurgery},
  language     = {eng},
  number       = {1},
  pages        = {1--9},
  title        = {Psychogenic non-epileptic seizures - diagnostic issues: a critical review},
  url          = {http://dx.doi.org/10.1016/j.clineuro.2008.09.028},
  volume       = {111},
  year         = {2009},
}

Chicago
Bodde, NMG, JL Brooks, GA Baker, Paul Boon, JGM Hendriksen, and AP Aldenkamp. 2009. “Psychogenic Non-epileptic Seizures - Diagnostic Issues: a Critical Review.” Clinical Neurology and Neurosurgery 111 (1): 1–9.
APA
Bodde, NMG, Brooks, J., Baker, G., Boon, P., Hendriksen, J., & Aldenkamp, A. (2009). Psychogenic non-epileptic seizures - diagnostic issues: a critical review. Clinical Neurology and Neurosurgery, 111(1), 1–9.
Vancouver
1.
Bodde N, Brooks J, Baker G, Boon P, Hendriksen J, Aldenkamp A. Psychogenic non-epileptic seizures - diagnostic issues: a critical review. Clinical Neurology and Neurosurgery. 2009;111(1):1–9.
MLA
Bodde, NMG, JL Brooks, GA Baker, et al. “Psychogenic Non-epileptic Seizures - Diagnostic Issues: a Critical Review.” Clinical Neurology and Neurosurgery 111.1 (2009): 1–9. Print.