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Neurol Clin Pract 2022 Jun;12(3):234-247

Department of Medicine (SM, US, TGP), School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria; and Department of Neurology (SM, US, CD, TGP), Monash Medical Centre, Clayton, Melbourne, Australia.

Background And Objectives: A misdiagnosis of psychogenic nonepileptic seizures (PNES) and epileptic seizures (ES) is common. In the absence of the diagnostic gold standard (video EEG), clinicians rely on semiology and clinical assessment. However, questions regarding the diagnostic accuracy of different signs remain. Read More

Curr Neurol Neurosci Rep 2022 Jun 8. Epub 2022 Jun 8.

Rhode Island Hospital, Brown University, Providence, RI, USA.

Purpose Of Review: Psychogenic nonepileptic seizures (PNES) are the most common Functional Neurological Disorder/Conversion Disorder subtype. Significant advances have been made related to diagnosis, neurobiology, and treatment. In this review, we summarize updates in diagnosis and management over the past 3 years. Read More

Epilepsy Behav 2022 Jul 28;132:108760. Epub 2022 May 28.

Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH, United States.

Epilepsy Behav 2022 Jul 28;132:108724. Epub 2022 May 28.

Indiana University-Purdue University Indianapolis, School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, United States. Electronic address:

Adolescents with psychogenic nonepileptic seizures (PNES) face many challenges in the school setting. Researchers have identified school stressors as potential predisposing, precipitating, and perpetuating factors for PNES. However, few researchers have explored the perspectives of adolescents with PNES regarding their experiences of attending school, where they spend much of their time. Read More

Epilepsy Behav 2022 Jul 14;132:108710. Epub 2022 May 14.

Neurosciences Research Centre, St George's University of London, London, UK; Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK; Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, National Hospital for Neurology and Neurosurgery, UCLH, Epilepsy Society, UK. Electronic address:

Background: Functional seizures (FS), otherwise known as psychogenic nonepileptic seizures (PNES), are a common symptom presenting to neurology and epilepsy clinics. There is a pressing need for further research to understand the neurobiology of FS to develop mechanistically targeted treatments. Joint hypermobility is an expression of variation in connective tissue structure along a spectrum, and it has received increasing attention in functional neurological disorders, but there is lack of evidence of its relevance in FS. Read More

Epilepsia 2022 May 11. Epub 2022 May 11.

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Objective: This study was undertaken to review the reported performance of noninvasive wearable devices in detecting epileptic seizures and psychogenic nonepileptic seizures (PNES).

Methods: We conducted a systematic review and meta-analysis of studies reported up to November 15, 2021. We included studies that used video-electroencephalographic (EEG) monitoring as the gold standard to determine the sensitivity and false alarm rate (FAR) of noninvasive wearables for automated seizure detection. Read More

Epilepsy Behav 2022 06 5;131(Pt A):108703. Epub 2022 May 5.

Department of Neuroscience and Behavioral Science, Division of Neurology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.

Introduction: Identifying epilepsy in local indigenous populations and describing its epidemiological, etiological, electroencephalographic, and therapeutic aspects can assist public health policies planning toward epilepsy in indigenous communities.

Methods: This descriptive, cross-sectional study investigated epilepsy among indigenous people residing in Jaguapirú Village, Dourados, Mato Grosso do Sul, Brazil. Participants had their clinical histories reviewed and physical examination performed, as well as one or more electroencephalograms (EEG) registered. Read More

Epilepsy Behav 2022 06 5;131(Pt A):108712. Epub 2022 May 5.

VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.

Purpose: In patients with functional seizures (FS), delay in diagnosis (DD) may negatively affect outcomes. Altered brain responses to emotional stimuli have been shown in adults with FS. We hypothesized that DD would be associated with differential fMRI activation in emotion processing circuits. Read More

J Clin Neurophysiol 2022 Apr 28. Epub 2022 Apr 28.

Department of Clinical Neurological Sciences, Western University, London, ON, Canada.

Objective: To compare the rate of EEG and MRI abnormalities in psychogenic nonepileptic seizures (PNES) patients with and without suspected epilepsy. Patients were also compared in terms of their demographic and clinical profiles.

Methods: A retrospective analysis of 271 newly diagnosed PNES patients admitted to the epilepsy monitoring unit between May 2000 and April 2008, with follow-up clinical data collected until September 2015. Read More

Epilepsy Behav 2022 06 21;131(Pt A):108707. Epub 2022 Apr 21.

Department of Neurology, University of Colorado, Aurora, CO, USA.

The ILAE task force has identified a gap in treatment access for patients with nonepileptic seizures (NES) [1]. Access to multidisciplinary treatment clinics for adults with NES is limited with only 18 institutions delivering care across the United States [2]. Patient engagement has been low in the University of Colorado, NES Clinic treatment program despite our clinic's status as the only clinic of its kind in the mountain west. Read More

Cleve Clin J Med 2022 05 2;89(5):260-261. Epub 2022 May 2.

Epilepsy Center, Cleveland Clinic; Professor of Neurology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

Cleve Clin J Med 2022 05 2;89(5):252-259. Epub 2022 May 2.

Department of Neurology, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

Psychogenic nonepileptic seizure (PNES) is often misdiagnosed as epilepsy, leading to unnecessary treatments and procedures, as well as failure to engage patients in needed mental health care. To establish an accurate diagnosis, video electroencephalography (EEG) in the context of and simultaneous with a comprehensive neurologic and psychosocial evaluation is recommended for any patient with seizures that are not responding to treatment. Delivering the diagnosis with empathy and respect is a crucial component of care that helps patients establish trust with caregivers and follow treatment recommendations. Read More

J Pers Med 2022 Apr 18;12(4). Epub 2022 Apr 18.

Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK.

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas that experts in the field of speech-language pathology, neurology, and related fields face? How far has research gone in investigating psychogenic nonepileptic seizures, the misdiagnosis of which can be a thorny issue for clinicians and a detrimental factor for the patients' health? In order to address these questions, the study at hand focuses on a common, ever-intensified (by the COVID-19 pandemic) speech disorder-stuttering, and explores the pathophysiological and psychogenic background of the phenomenon. It also looks at the role of stuttering as a contributing factor to the appearance of epileptic seizures, in the hope of drawing attention to the complexity and importance of precise detection of stuttering-induced epilepsy, as a specific subcategory of language-induced epilepsy. Read More

Semin Pediatr Neurol 2022 04 16;41:100949. Epub 2021 Dec 16.

Nationwide Children's Hospital/The Ohio State University, Department of Pediatrics, Division of Neurology, Columbus, OH. Electronic address:

Psychogenic nonepileptic seizures (PNES) are a common condition seen in children and adolescents. The diagnosis is clinical, based on a description of events, and can be supported using video electroencephalography recording. Children and adolescents with PNES often have comorbid psychiatric conditions and psychosocial stressors, although this is not a requisite for diagnosis. Read More

Epilepsy Curr 2022 Mar-Apr;22(2):114-116. Epub 2021 Oct 31.

Children's Hospital Colorado Department of Neurology, Aurora, USA.

Seizure 2022 May 30;98:79-86. Epub 2022 Mar 30.

Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, United States. Electronic address:

Purpose: To date, laboratory-based experimental behavioral methods have not been used to identify factors associated with pediatric functional seizures (FS), leaving a critical gap for effective treatment development.

Methods: Children ages 13-18 with video-EEG-confirmed FS were matched to controls (MCs) based on income, sex, race, and age. A modified Stroop task which included a condition requiring participants to report the ink colors in which seizure symptom words were written (e. Read More

Lancet Neurol 2022 06 14;21(6):537-550. Epub 2022 Apr 14.

Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Read More

Clin Neurol Neurosurg 2022 06 31;217:107221. Epub 2022 Mar 31.

University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, HI USA; University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA. Electronic address:

Introduction: Patients with psychogenic non-epileptic seizures (PNES) experience significant morbidity and early mortality, secondary to delayed diagnosis. Better characterizing risk factors and exploring how PNES differentially affects sex and racial strata may facilitate earlier diagnosis.

Methods: From a Hawai'i neuroscience institution, 101 PNES patients were investigated in relation to sociodemographic and medical comorbidities. Read More

Brain Behav 2022 May 12;12(5):e2567. Epub 2022 Apr 12.

Epilepsy Center, Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.

Background: Clinical characteristics, outpatient situation, and outcome in patients with psychogenic nonepileptic seizures (PNES) remain to be elucidated.

Methods: Patients diagnosed with PNES after video-electroencephalography (EEG) monitoring (VEM) 03/2000-01/2016 at the Erlangen Epilepsy Center were surveyed between June 2016 and February 2017. Primary outcome was PNES cessation defined as no PNES episodes within > = 12 months prior to the interview. Read More

Epilepsy Behav 2022 May 31;130:108670. Epub 2022 Mar 31.

Department of Neurology, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, United States; Harvard Medical School, 99 Brookline Avenue, RN-301, Boston, MA 02215, United States; Massachusetts General Hospital, Boston, MA, United States; Consortia for Improving Medicine with Innovation & Technology (CIMIT), 125 Nashua St., Suite 324, Boston, MA 02114, United States. Electronic address:

We examined whether T-wave heterogeneity (TWH) on the surface electrocardiographic (EKG) could predict epileptic seizure onset. Patients with electroencephalography-confirmed generalized tonic-clonic seizures (GTCS) (n = 6) exhibited abnormal elevations in TWH (>80 µV) at baseline (105 ± 20.4 µV), which increased from 30 min prior to seizure without heart rate increases > 2 beats/min until 10 min pre-seizure. Read More

J Psychosom Res 2022 Jun 11;157:110782. Epub 2022 Mar 11.

Graduate Program in Medical Sciences, CCS/UFSC, Florianópolis, SC, Brazil.

Epilepsy Behav 2022 May 17;130:108633. Epub 2022 Mar 17.

Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address:

Objective: The aim of the study was to determine risk factors associated with pseudoresistance in a large, representative cohort of patients with Idiopathic/Genetic Generalized Epilepsy (IGE) and the impact of pseudoresistance on socioeconomic parameters.

Methods: We performed a literature review on definitions of pseudoresistance in IGE. In an established cohort of patients with IGE from Funen, patients with current or previous pseudoresistant seizures were retrospectively identified based on a comprehensive evaluation of the patients' medical records and direct patient contact, if required. Read More

Epilepsy Behav 2022 04 16;129:108656. Epub 2022 Mar 16.

Department of Neurology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom.

Epileptic seizures are well recognized as a presenting symptom in patients with brain tumors, however much less is known about coexisting nonepileptic attack disorder (NEAD) in this population. Establishing a diagnosis of NEAD can be challenging, especially in those with concomitant epilepsy. Nonepileptic attack disorder is associated with a high rate of morbidity, often due to coexisting psychological factors which may require the input of multiple services. Read More

Epilepsy Behav 2022 04 14;129:108655. Epub 2022 Mar 14.

Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel. Electronic address:

Psychogenic nonepileptic seizures (PNES) clinically resemble epileptic seizures (ES) but lack epileptic activity at the time of the seizure and are also not due to any other pathophysiological disorder. The integrative cognitive model (ICM) suggests that PNES is an automatic reaction generated from distorted memory and is perceived as uncontrollable and unwanted. Furthermore, the ICM model implies that a PNES event occurs due to an external or internal cue. Read More

Epilepsy Behav Rep 2022 16;18:100517. Epub 2021 Dec 16.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

We report a survey of neurology residency program directors (PDs) and recent neurology residency graduates about the education provided during residency on functional seizures (FS), a subtype of functional neurological disorder (FND). The purpose of our study was to assess the education gap for neurology residents about FS since patients with FS are frequently seen by neurologists, who typically conduct the evaluation and share the findings with the patient. A survey was sent to 93 Neurology residency program directors and 71 recent graduates. Read More

J Autism Dev Disord 2022 Feb 25. Epub 2022 Feb 25.

Division of Child Neurology, Nationwide Children's Hospital, Columbus, OH, USA.

This is a retrospective case series of pediatric patients referred to the psychogenic nonepileptic events clinic (PNEE) who had comorbid diagnoses of autism spectrum disorder (ASD) or intellectual disability (ID). We describe 15 patients, nine with ASD and six with ID who had a telephone visit follow-up at 12 months. There were higher rates of male gender (40%) and comorbid epilepsy (53%) compared to the larger PNEE cohort. Read More

Indian J Psychol Med 2021 Nov 2;43(6):479-484. Epub 2020 Nov 2.

Dept. of Psychiatry, Grant Govt Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.

Background: Psychogenic nonepileptic seizures (PNES) commonly present both to neurologists and psychiatrists and include a wide range of psychopathology. In order to understand the demographics, dissociative experiences, stressful life events, abuse, and coping in these patients, this study was undertaken.

Methods: This was a cross-sectional, observational study. Read More

Indian J Psychol Med 2021 Nov 25;43(6):469-472. Epub 2021 Oct 25.

Amity Institute of Psychology and Allied Sciences, Amity University, Sector 125, Noida, Uttar Pradesh, India.

Background: Psychotherapy improves seizure frequency and psychosocial aspects in psychogenic nonepileptic seizures (PNES). Although randomized controlled trials (RCTs) on different psychotherapies have been conducted for almost two decades now, no review has exclusively assessed RCTs of different psychotherapies.

Methods: The objective was to review RCTs of psychotherapy for PNES, to understand the impact of different psychotherapies. Read More

Epilepsy Behav Rep 2022 26;18:100510. Epub 2021 Nov 26.

Northwestern University Feinberg School of Medicine, Department of Neurology, Chicago, IL, United States.

The objective of this paper is to compare and contrast FMD and FS, and highlight important differences in etiology and the clinical approach towards these two entities. While patients with FMD often experience abnormal movements on a daily basis, FS is characterized by paroxysmal events. Both patient populations share psychiatric and environmental comorbidities, but patients with FS may have increased anxiety and neuroticism and a higher percentage of childhood trauma. Read More