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PSYCHOGENIC NON EPILEPTIC EVENTS Dr. M.Almohammadi
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Outlines Definition Is it a problem Epidemiology Etiology Presentation investigations Diagnosis Management prognosis
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Definition Paroxysmal psychological events that mimic epileptic seizures Has various terms pseudoseizures Non epileptic seizures Non epileptic events Psychogenic seizures Psychogenic attacks{events}
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Is it a problem? Misdiagnosis occurs in approximately 25% of patients with a previous diagnosis of epilepsy that does not respond to drugs. PNES is by far the most commonly misdiagnosed condition, accounting for >90% of misdiagnoses at epilepsy centers Comorbidity presence of both epilepsy & pnes Benbadis SR, Tatum WO. Overintepretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiol. Feb 2003;20(1):42-4. [Medline].[Medline] Benbadis SR, Lin K. Errors in EEG interpretation and misdiagnosis of epilepsy. Which EEG patterns are overread?. Eur Neurol. 2008;59(5):267-71. [Medline].[Medline] Benbadis SR. Errors in EEGs and the misdiagnosis of epilepsy: importance, causes, consequences, and proposed remedies. Epilepsy Behav. Nov 2007;11(3):257-62. [Medline].[Medline]
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Epidemiology 20-30% of patient referred for refractory seizures 3-33 per100,000population More in young adulthood&old age More in women 70% than men Prevalent as MS Trigeminal neuralgia more in our homeland
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Etiology theories psycho analytic( 1ry gain&2ry gain) Social theory(family discord,stressors, abuse) Behavioral theory (modeling) Cognitive theory(communication)
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Presentation marked involvement of the truncal muscles with opisthotonos lateral rolling of the head or body is present 4 limbs may exhibit random thrashing movements Bicycling limb movements Shouting, stuttering, weeping Happened in presence of audience. waiting room physician office Intensified by holding of bystanders
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Comparison Pnes&Epil.seizures Cyanosis is rare Tongue biting -ve incontinence –ve In presence of others Injury rare Long duration Labelle indifference Eyes closed, flickering Increase by others holding Recovered immediately after sei EEG mostly negative Video EEG negative Common Frequent Alone &others presence Injury more frequent Short duration few minutes Stressed Opened No Drowsy,confused post ictal Mostly positive positive PnesEpileptic seizure
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Investigations EEG CT MRI Video EEG
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Inter episodic EEG of pnes
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Records of these 2female young patient s are confusing unless you haven't seen the patients talking full history and detail description about the seizures Unipolar montage for patient with pnes
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Diagnosis Pay more attention to history -abuse -family discord Look for triggers - emotional -stressors Comorbid psychiatric disorders -anxiety -depression -others Presentation during suggestion Inter-ictal EEG Video EEG
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Treatment Delivering diagnosis to patient &family Disbeliefs -patient -family, -referral sour anger hostility Family&patient education Psychotherapy Cognitive-behavioral therapy Medication(SSRIs) depression and anxiety
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Prognosis Unfavorable outcome Long duration 7 years and more Adult subject Mores somatic symptoms Long duration on AEDs
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Thanks for your attention
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