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Epilepsy Behav 2021 Jun 21;122:108085. Epub 2021 Jun 21.

Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Physical Medicine and Rehabilitation Department, Northwestern University, United States. Electronic address:

Objective: To characterize the effective connectivity (EC) between the emotion and motor brain regions in patients with psychogenic nonepileptic seizures (PNES), based on resting-state spectral dynamic causal modeling (spDCM).

Methods: Twenty-three patients with PNES and twenty-five healthy control (HC) subjects underwent resting-state fMRI scanning. The coupling parameters indicating the causal interactions between eight brain regions associated with emotion, executive control, and motion were estimated for both groups, using resting-state fMRI spDCM. Read More

Seizure 2021 Jun 13;91:141-145. Epub 2021 Jun 13.

Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.

Objective: There are three common causes of Transient Loss of Consciousness (TLOC), syncope, epileptic and psychogenic nonepileptic seizures (PNES). Many individuals who have experienced TLOC initially receive an incorrect diagnosis and inappropriate treatment. Whereas syncope can be distinguished relatively easily with a small number of "yes"/"no" questions, the differentiation of the other two causes of TLOC is more challenging. Read More

J Neurol 2021 Jun 18. Epub 2021 Jun 18.

Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1 (Sauerbruchweg 5, 2. Ebene), Campus Charité Mitte, 10117, Berlin, Germany.

Objective: Psychogenic non-epileptic seizures (PNES), a common phenomenon in neurological settings, are regarded as a paroxysmal type of functional neurological disorder (FND). In a substantial proportion, PNES are disabling with poor long-term outcomes and high economic costs. Despite the clinical and financial consequences of PNES, there is still a lack of controlled clinical trials on the treatment of this challenging disorder. Read More

Epilepsy Behav 2021 Jun 14;122:108119. Epub 2021 Jun 14.

Faculty of Psychology and Educational Sciences, Ludwig-Maximilians-University Munich, Germany; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.

Background: This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients' compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful.

Methods: A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system's model at the outset of therapy. Read More

Arq Neuropsiquiatr 2021 Apr;79(4):278-282

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: Nonepileptic events misdiagnosed as epilepsy lead to a risk of iatrogenic morbidity, which increases health costs. Among the patients affected by nonepileptic events, 11-46% are psychogenic nonepileptic seizures (PNESs).

Objective: To investigate the usefulness of the semiological classification of PNESs among patients diagnosed by means of video electroencephalograms (vEEGs). Read More

Arq Neuropsiquiatr 2021 Apr;79(4):269-271

Brown University; Departments of Psychiatry and Neurology, Providence, Rhode Island, USA.

Int J Neurosci 2021 Jun 14:1-9. Epub 2021 Jun 14.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Psychogenic nonepileptic seizures (PNES) or functional seizures are universal phenomena. However, data on their epidemiology is limited. The aim of the current study was to review the literature on the epidemiology of PNES and to provide analytical estimates of its incidence and prevalence based on the direct data that are available from previous studies on PNES. Read More

Neurosci Biobehav Rev 2021 Jun 11;128:58-63. Epub 2021 Jun 11.

Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:

The relationship between functional seizures (FS) and sexual trauma has received attention in many previous studies. However, the mechanisms underlying this relationship have not been elucidated yet. The purpose of this narrative review is to explore and speculate on the underpinning neurobiological mechanisms for the association and link between sexual trauma and functional seizures. Read More

AJNR Am J Neuroradiol 2021 Jun 11. Epub 2021 Jun 11.

Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina

Background And Purpose: Transient loss of consciousness is commonly evaluated in the emergency department. Although typically caused by epileptic seizure, syncope, or psychogenic nonepileptic seizure, the underlying etiology is frequently misdiagnosed. Lateral tongue bites are reportedly a specific clinical finding of seizure. Read More

Neuropsychiatr Dis Treat 2021 4;17:1825-1838. Epub 2021 Jun 4.

Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Buenos Aires, Argentina.

Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. Read More

Neurodiagn J 2021 Jun 10:1-9. Epub 2021 Jun 10.

Department of NeurologyUniversity of Texas Southwestern Medical Center, Dallas, Texas.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36. Read More

Encephale 2021 Jun 4. Epub 2021 Jun 4.

Sorbonne University, Department of Psychiatry, Pitié-Salpêtrière hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), 47, boulevard de l'Hôpital, 75013 Paris, France; Paris Brain Institute-Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, 47, boulevard de l'Hôpital, 75013 Paris, France.

Background: We report the observation of a 47-year-old woman with functional neurological disorder (tetraparesis, mixed tremors and non-epileptic seizures) treated with a protocol of augmented psychotherapy in combination with repeated transcranial magnetic stimulation (rTMS).

Intervention: We carried out a biofeedback psychotherapy protocol with rTMS (twenty sessions, two sessions per day for ten days; 1Hz, 150% of the motor threshold, twenty minute sessions, 300 pulses per session) in which the patient visualized the motor activity of her upper limbs during stimulation of the primary motor area (PMA). The evolution of neurological symptoms was assessed using the Medical Research Council Scale for Muscle Strength (MRC). Read More

J Psychosom Res 2021 May 31;147:110539. Epub 2021 May 31.

Dipartimento di Scienze della Salute, University of Milan, Italy; Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy; Unità di Psichiatria II, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy.

Objective: The contribution of psychological and psychiatric symptoms in the development of Functional Neurological Disorders (FND) is unclear. We therefore aimed to investigate the role of different attachment styles (AS) and their relationship with psychiatric symptoms in FND patients as compared with both subjects with neurological disorders (ND) and healthy controls (HC); and the possible differences between patients with functional movement disorders (FMD) and with functional seizures.

Methods: In this case-control study, forty-six patients with FND were compared to 34 with ND and 30 HC, by means of an extensive battery to investigate the presence of alexithymia, depression, anxiety, dissociation and to explore their AS using the Revised Experiences in Close Relationships instrument (ECR-R). Read More

Epilepsy Behav 2021 Jun 3;121(Pt A):108047. Epub 2021 Jun 3.

Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AB, United Kingdom. Electronic address:

Quantitative markers extracted from resting-state electroencephalogram (EEG) reveal subtle neurophysiological dynamics which may provide useful information to support the diagnosis of seizure disorders. We performed a systematic review to summarize evidence on markers extracted from interictal, visually normal resting-state EEG in adults with idiopathic epilepsy or psychogenic nonepileptic seizures (PNES). Studies were selected from 5 databases and evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. Read More

Epilepsy Behav 2021 May 30;121(Pt A):108070. Epub 2021 May 30.

Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 766 Irving Ave., Syracuse, NY 13210, United States.

Background: Psychogenicnonepilepticseizures (PNES) lack the abnormal electrographical discharges in electroencephalogram seen in epileptic seizures. The notion of the effects of meteorological factors and lunar phases onoccurrence of seizures in patients with PNES has been the subject of very few research studies and the available evidence in the literature is equivocal. In this study, we aimed to study the influence oflunarphases and meteorological factors on the frequency of PNES and its semiological categories. Read More

Epilepsia 2021 Jun 2. Epub 2021 Jun 2.

Division of Clinical Neuroscience, National Center for Epilepsy, Oslo University Hospital, Oslo, Norway.

Objective: This study was undertaken to measure the incidence and prevalence of active psychogenic nonepileptic seizures (PNES) in a Norwegian county.

Methods: Using the Norwegian patient registry, we identified patients in Møre and Romsdal County in Norway diagnosed with F44.5 (conversion disorder with seizures or convulsions) or R56. Read More

J Clin Med 2021 May 12;10(10). Epub 2021 May 12.

Department of Health Sciences, University of Burgos, 09001 Burgos, Spain.

Differential diagnosis in epilepsy is sometimes challenging. Video-electroencephalography (V-EEG) is an essential tool in the diagnosis and management of epilepsy. The prolonged duration of V-EEG recording increases the diagnostic yield of a conventional V-EEG. Read More

Epilepsy Behav 2021 May 27;121(Pt A):108066. Epub 2021 May 27.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: We investigated the marital status (married vs. none) among patients with seizures [i.e. Read More

Epilepsy Behav 2021 May 26;121(Pt A):108044. Epub 2021 May 26.

Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.

Objective: To investigate neuroanatomical changes in patients with psychogenic nonepileptic seizures (PNES) compared to major depressive disorder (MDD) and healthy controls.

Methods: Forty-two drug-naïve PNES subjects and 25 patients with MDD, matched for demographic characteristics and level of depression (as measured by Beck Depression Inventory-II, BDI-II), were consecutively recruited. Patients performed an extensive neuropsychiatric assessment including: Hamilton Anxiety Rating Scale, Traumatic Experience Checklist, Dissociative Experiences Scale, Toronto Alexithymia Scale and Somatoform Dissociation Questionnaire (SDQ-20). Read More

Eur J Neurol 2021 May 25. Epub 2021 May 25.

AP-HP, Epilepsy Unit and Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France.

Background: Psychogenic non-epileptic seizure-status (PNES-status), defined by psychogenic non-epileptic seizures (PNES) over 30 min, are often misdiagnosed as status epilepticus. We aimed to describe the features of patients who experienced PNES-status, admitted to an intensive care unit (ICU).

Methods: We screened the patients hospitalized in our epilepsy unit during a 4-year period, with a diagnosis of PNES-status and ICU admission. Read More

Neurology 2021 May 24. Epub 2021 May 24.

Psychiatry, Aalborg University Hospital, Denmark.

Objective: Knowledge regarding psychiatric disorders in children and adolescents with psychogenic nonepileptic seizures (PNES) is limited. This study outlines the spectrum and risk of psychiatric disorders in childhood-onset PNES.

Methods: A nationwide matched cohort study of children and adolescents with PNES aged 5-17 years at time of diagnosis between January 1, 1996 and December 31, 2014. Read More

Epilepsy Behav 2021 May 21;121(Pt A):108030. Epub 2021 May 21.

Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. Electronic address:

Background: Psychogenic nonepileptic attacks (PNEA) are events of altered behavior that resemble epileptic seizures (ES) but are not caused by abnormal electrical cortical activity. Understanding which clinical signs and symptoms are associated with PNEA may allow better triaging for video-electroencephalogram monitoring (VEM) and for a more accurate prediction when such testing is unavailable.

Methods: We performed a systematic review searching Medline, Embase, and Cochrane Central from inception to March 29, 2019. Read More

Seizure 2021 May 9;89:65-72. Epub 2021 May 9.

Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Epilepsy Surgery Program, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; Neurosciences and Surgical Departments, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil. Electronic address:

Objective: The differential diagnosis between epileptic and psychogenic nonepileptic seizures (PNES) is challenging, yet suspicion of PNES is crucial to rethink treatment strategies and select patients for diagnostic confirmation through video EEG (VEEG). We developed a novel scale to prospectively suspect PNES.

Methods: First, we developed a 51-item scale in two steps, based upon literature review and panel expert opinion. Read More

J Psychosom Res 2021 May 15;147:110514. Epub 2021 May 15.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: We investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis).

Methods: In a retrospective study of a prospectively developed and maintained database, all patients diagnosed with FS before and during the COVID-19 pandemic were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2008 until February 2021.

Results: Three hundred and eighty-eight patients were studied. Read More

Brain Nerve 2021 May;73(5):595-604

Department of Neurology, Kitasato University.

Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune disease caused by autoantibodies against the extracellular conformational epitope of the NR1 subunit of the NMDAR (GluN1 antibodies). A series of autoantibodies directed against neuronal surface (NS) or synaptic proteins play an important role in the pathophysiological mechanisms of post-herpes simplex encephalitis (post-HSE), overlapping autoimmune encephalitis and demyelinating syndrome, epileptic seizures, psychosis, involuntary movements (orofacial and limb dyskinesias, catatonia, dystonia, chorea, myoclonus, psychogenic nonepileptic seizures, and faciobrachial dystonic seizures), postpartum psychosis, stiff-person spectrum disorder (including progressive encephalomyelitis with rigidity and myoclonus [PERM]), cerebellar ataxia, and sleep behavior disorders. These NS antibodies are identified with cell-based assays and immunohistochemistry using nonperfused paraformaldehyde-fixed rodent brain tissue. Read More

Epilepsy Behav 2021 Jul 10;120:108004. Epub 2021 May 10.

Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Psychology, Western University, London, Ontario, Canada.

Objective: To identify predictors of Psychogenic NonEpileptic Seizure (PNES) improvement and anti-seizure medication (ASM) discontinuation in patients with PNES only.

Methods: This is a retrospective study of a consecutively enrolled cohort of 271 patients diagnosed with PNES by video-EEG (vEEG) telemetry in our Epilepsy Monitoring Unit (EMU) between May 2000 and February 2010. Patients with any possibility of past or present comorbid epilepsy based on clinical, EEG, and neuroimaging, or less than one year of follow-up after discharge were excluded. Read More

Epilepsy Behav 2021 Jul 9;120:107987. Epub 2021 May 9.

Department of Medicine (RMH), The University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Australia.

Objective: To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit.

Method: This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Read More

Seizure 2021 May 1;89:38-40. Epub 2021 May 1.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: The aim of the current study was to compare the frequency of significant head injuries in three groups of people with seizures [idiopathic generalized epilepsies (IGE) vs. temporal lobe epilepsy (TLE) vs. functional seizures (FS)]. Read More

Epilepsy Behav 2021 Jul 6;120:107999. Epub 2021 May 6.

Department of Psychiatry, Alexandria University School of Medicine, Egypt.

Epilepsy Behav 2021 Jul 5;120:108000. Epub 2021 May 5.

Service de Neurologie, CHRU Central Nancy, 54000 Nancy, France; Université Paris Descartes, Faculté de Médecine, 75006 Paris, France. Electronic address:

Medical international guidelines recommend regular psychiatric consultations for patients with epilepsy, in order to detect comorbidities. However, there is a lack of guidance about PNES that constitute both a differential diagnosis and a comorbidity of epilepsy. While waiting for the ideal collaboration between neurologists and psychiatrists, we develop a pragmatic approach. Read More