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Characteristics of 698 patients with dissociative seizures: A UK multicenter study

Published on Oct 13, 2019in Epilepsia5.562
路 DOI :10.1111/epi.16350
Laura H. Goldstein46
Estimated H-index: 46
('KCL': King's College London),
Emily Robinson8
Estimated H-index: 8
('KCL': King's College London)
+ 15 AuthorsJon Stone61
Estimated H-index: 61
(Edin.: University of Edinburgh)
Abstract
Objective: We aimed to characterise the demographics of adults with dissociative (non-epileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation and dissociative seizure semiology. Methods: We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES Trial, from 27 neurology/specialist epilepsy clinics in the United Kingdom. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socio-economic deprivation and other social and clinical demographic characteristics and their associations. Results: In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19; median age at onset was 28 years. While 74% of the sample was female, importantly, the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by age 40. The frequency of self-reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (p<0.001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking anti-epileptic drugs; this was more common in men. Over 50% of the sample lived in areas characterised by the highest levels of deprivation and over two-thirds were unemployed. Significance: Females with dissociative seizures were more common at all ages while the proportion of males increased with age at onset. This disorder was associated with socio-economic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment.
  • References (15)
  • Citations (2)
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References15
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#1Meltem Korucuk (Karadeniz Technical University)H-Index: 1
#2Sibel Gazioglu (Karadeniz Technical University)H-Index: 7
Last. Sibel Velioglu (Karadeniz Technical University)H-Index: 9
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Abstract Psychogenic nonepileptic seizures (PNES) are more prevalent among women, and diagnosis may sometimes be delayed by as much as seven years. Understanding the effect of gender on the presentation of a PNES may assist with diagnosis based on semiological details in the clinical setting. Although video-EEG monitoring (VEM) is the gold standard for diagnosing PNES, determining gender-related seizure semiology through careful history may prevent diagnostic delay while waiting for VEM. The aim...
3 CitationsSource
#1Gary A. Abel (University of Cambridge)H-Index: 30
#2Matthew Barclay (University of Cambridge)H-Index: 4
Last. Rupert A. Payne (University of Cambridge)H-Index: 16
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Objectives Social determinants can have a major impact on health and as a consequence substantial inequalities are seen between and within countries. The study of inequalities between countries relies on having accurate and consistent measures of deprivation across the country borders. However, in the UK most socioeconomic deprivation measures are not comparable between countries. We give a method of adjusting the Indices of Multiple Deprivation (IMD) for use across the UK, describe the deprivat...
17 CitationsSource
#1Richard J. Brown (University of Manchester)H-Index: 30
#2Markus Reuber (Royal Hallamshire Hospital)H-Index: 47
Psychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of t...
62 CitationsSource
#1Laura H. Goldstein ('KCL': King's College London)H-Index: 46
#2John D. C. Mellers (South London and Maudsley NHS Foundation Trust)H-Index: 23
Last. Trudie Chalder ('KCL': King's College London)H-Index: 53
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Background: The evidence base for the effectiveness of psychological interventions for patients with dissociative non-epileptic seizures (DS) is currently extremely limited, although data from two small pilot randomised controlled trials (RCTs), including from our group, suggest that Cognitive Behavioural Therapy (CBT) may be effective in reducing DS occurrence and may improve aspects of psychological status and psychosocial functioning. Methods/Design: The study is a multicentre, pragmatic para...
28 CitationsSource
#1Ali A. Asadi-Pooya (Thomas Jefferson University)H-Index: 19
#2Michael Sperling (Thomas Jefferson University)H-Index: 60
Abstract We critically review the existing literature about the epidemiology (i.e., diagnosis, occurrence, age, gender, comorbidity with epilepsy, associated factors, prognosis, mortality, and cost) of psychogenic nonepileptic seizures (PNES) and provide suggestions for future research. Psychogenic nonepileptic seizures are commonly diagnosed at epilepsy centers. The diagnosis of PNES relies on a multidisciplinary evaluation and is usually based on different combinations of data. Recording a sei...
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Abstract Purpose Different studies have described useful signs to diagnose psychogenic non-epileptic seizure (PNES). A few authors have tried to describe the semiologic groups among PNES patients; each group consisting of combination of features. But there is no uniformity of nomenclature among these studies. Our aim was to find out whether the objective classification system proposed by Hubsch et al. was useful and adequate to classify PNES patient population from South India. Methods We retros...
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#1Ali A. Asadi-Pooya (Thomas Jefferson University)H-Index: 19
#2Mehrdad Emami (Shiraz University of Medical Sciences)H-Index: 11
Last. Yasaman Emami (Shiraz University of Medical Sciences)H-Index: 7
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Abstract Purpose Psychogenic non-epileptic seizures (PNES) are more prevalent among women. We investigated the potential differences in demographic and clinical characteristics of PNES between women and men. Methods In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2012. The epileptologist interviewed all the patients. We compared the de...
19 CitationsSource
#1Ali A. Asadi-Pooya (Thomas Jefferson University)H-Index: 19
#2Mehrdad Emami (Shiraz University of Medical Sciences)H-Index: 11
Abstract Purpose The aim of the current study was to clarify the impact of co-existing epileptic seizures (either in patients themselves or in their family members) on the demographic and clinical characteristics and manifestations of psychogenic non-epileptic seizures (PNES). Methods In this prospective study, all patients with a definite diagnosis of PNES were recruited at the epilepsy center at Shiraz University of Medical Sciences from September 2008 through May 2012. We subdivided the patie...
26 CitationsSource
Some evidence suggests that psychogenic non-epileptic seizures (PNES) are associated with increased mortality. The authors obtained death certificate information in a cohort of 260 patients who presented with PNES between 1999 and 2004. The follow-up period averaged 7.92鈥厃ears, during which 17 patients died, 12/17 were under the age of 75鈥厃ears, giving a premature (<75鈥厃ears) mortality rate of 0.58%, compared with a Scottish mortality rate for the 40鈥75 years age group of 0.41% per year. The mai...
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#1Roderick DuncanH-Index: 28
#2M. OtoH-Index: 10
Last. Anthony J. PelosiH-Index: 32
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Objective: To investigate differences between groups of patients with early vs late onset psychogenic nonepileptic attacks (PNEA). Methods: The authors compared patients with onset of PNEA after age 55 years (n = 26) to patients whose onset of PNEA was before age 55 years (n = 241). The authors examined sociodemographic variables, factors potentially predisposing to PNEA, clinical semiology, and medical and psychiatric background. Results: Patients with late onset PNEA were more likely to be mal...
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#1Ali A. Asadi-Pooya (Thomas Jefferson University)H-Index: 19
#2Maryam Homayoun (Shiraz University of Medical Sciences)H-Index: 2
Abstract Purpose We investigated the sex ratio trajectory across the lifespan in patients with psychogenic nonepileptic seizures (PNES). We hypothesized that there are significant changes in the trajectory of the sex ratio in these patients across the lifespan with respect to the age at onset. Methods In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were investigated. We arbitrarily categorized the patien...
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#1Jon Stone (Edin.: University of Edinburgh)H-Index: 61
#2Hannah Callaghan (Edin.: University of Edinburgh)H-Index: 1
Last. Laura H. Goldstein ('KCL': King's College London)H-Index: 46
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Abstract Purpose Patients with dissociative (non-epileptic) seizures typically receive their diagnosis from neurologists, but are often referred to psychiatrists, whom they may be reluctant to go and see. We aimed to assess which factors were associated with first attendance at psychiatric services. Methods A cohort study of 698 participants involved in the pre-randomisation phase of the CODES trial, a randomised controlled trial assessing the benefit of cognitive behavioural therapy for dissoci...
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