المؤلفون: Cope, Sarah R.¹ sarah.cope@swlstg-tr.nhs.uk, Poole, Norman^1,2, Agrawal, Niruj^1,2,3

المصدر: Epilepsy & Behavior. Aug2017, Vol. 73, p197-203. 7p.

مصطلحات موضوعية: *TREATMENT of epilepsy, *COGNITIVE therapy, *NEUROLOGY, *ACCEPTANCE & commitment therapy, *TREATMENT effectiveness

مستخلص: Patients who experience functional non-epileptic attacks (FNEA) are frequently seen in Neurology clinics. Diagnosis alone can result in cessation of attacks for some patients, but many patients require further treatment. There is evidence that certain psychological therapies, like cognitive-behavioral therapy (CBT) and psychodynamic interpersonal therapy (PIT) can be beneficial. Acceptance and commitment therapy (ACT) is a type of CBT that has been found to be effective at treating other somatic disorders, like epilepsy and chronic pain. In this paper, we explain what ACT is, the current evidence-base for its use, and the rationale for why it may be a beneficial treatment for patients who experience FNEA. We conclude that ACT is a potential treatment option for FNEA, and further research is required. [ABSTRACT FROM AUTHOR]

المؤلفون: Cope, Sarah R.¹ sarah.cope@swlstg-tr.nhs.uk, Smith, Jared G.², King, Tara¹, Agrawal, Niruj^1,2,3

المصدر: Epilepsy & Behavior. May2017:Part A, Vol. 70, p238-244. 7p.

مصطلحات موضوعية: *COGNITIVE therapy, *PSYCHOEDUCATION, *PSYCHOGENIC nonepileptic seizures, *PSYCHOLOGICAL distress, *NEUROPSYCHIATRY, *THERAPEUTICS

مستخلص: A high proportion of patients presenting at epilepsy clinics experience functional non-epileptic attacks (FNEA), and while psychological treatment is generally thought to be the required intervention, evidence regarding psychological treatment of FNEA is limited. A small number of psychoeducation treatments have been evaluated, with promising results. As part of routine care within a neuropsychiatry service, a 3-session cognitive-behavior therapy- (CBT-) informed psychoeducation group was developed. Patients with comorbid epilepsy were included. The group's effectiveness was evaluated in terms of attack frequency, mood, illness perception, dissociative experiences, and patient feedback. Pre- and post-treatment data were obtained for 19 patients. The proportion of patients experiencing attacks significantly decreased, with almost 40% of treatment completers reporting being attack-free at the end of treatment. Significant improvements were also found on level of psychological distress, illness beliefs, and understanding of the condition. No significant changes in mood or general functioning were observed. High satisfaction was reported by almost all patients. Treatment outcome was not significantly affected by the level of dissociative experiences. The results suggest that CBT-based psychoeducation group treatment can be a beneficial part of treatment for those with FNEA, even for those experiencing high levels of dissociation. Further controlled studies with larger sample sizes are required. [ABSTRACT FROM AUTHOR]

المؤلفون: Loewenberger, Alana¹ (AUTHOR) Alana.loewenberger.09@ucl.ac.uk, Cope, Sarah R.² (AUTHOR), Poole, Norman² (AUTHOR), Agrawal, Niruj² (AUTHOR)

المصدر: Epilepsy & Behavior. Oct2020, Vol. 111, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *SEIZURES (Medicine), *PSYCHOGENIC nonepileptic seizures, *MEDICAL personnel, *CONVERSION disorder, *SYMPTOMS

مستخلص: There is considerable debate in the literature regarding what to call functional seizures, with terms such as pseudoseizures, nonepileptic attack disorder (NEAD), and dissociative seizures being used. Provision of an accurate diagnosis and coherent explanation is a vital first step in the management of functional seizures and can result in cessation or reduced frequency for some individuals. This study investigated preferences for and offensiveness of terms used to describe functional seizures, and expectations for recovery with psychological treatment. A sample of 87 healthy adults completed an online survey, in which eight different diagnostic terms were ranked in order of preference (1 — most preferred, 8 — least preferred): functional nonepileptic attacks (FNEA), dissociative seizures, functional seizures, psychogenic seizures, NEAD, pseudoseizures, conversion disorder, and hysteria. Replicating Stone and colleagues protocol, each term was investigated for five connotations. Offense scores were calculated from the number of participants who selected 'yes' to at least one of the negative connotations ('Putting it on', 'Mad', and 'Imagining Symptoms'). Expectations about the possibility of recovering through medical or psychological treatment were also recorded. Functional nonepileptic attack was ranked the highest preferred term with dissociative seizures and functional seizures closely following. Nonepileptic attack disorder was the least offensive term, with FNEA and functional seizures joint second. Unsurprisingly, the three least preferred terms were also the most offensive: pseudoseizures, conversion disorder, and hysteria. Expectations of nonrecovery from psychological treatment were lowest for terms implicating a psychological cause: pseudoseizures, dissociative seizures, psychogenic seizures, and hysteria. The results suggest that either the terms FNEA or functional seizures should be adopted by healthcare professionals and patients, as they are the most preferred, least offensive, and expectations for nonrecovery with psychological treatment were moderate compared with the other terms. Limitations and areas for future research are discussed. • An investigation into preferences for and offensiveness of terms used to describe functional seizures. • Functional non-epileptic attacks (FNEA) was ranked the highest preferred term. • Non-epileptic attack disorder was the least offensive term, with FNEA and functional seizures joint second. • Expectations of not recovering from psychological treatment were lowest for terms implicating a psychological cause. • FNEA and functional seizures are the recommended terms of use. [ABSTRACT FROM AUTHOR]

المؤلفون: Koreki, Akihiro^1,2 (AUTHOR), Eccles, Jessica³ (AUTHOR), Garfinkel, Sarah⁴ (AUTHOR), Critchley, Hugo³ (AUTHOR), Cope, Sarah⁵ (AUTHOR), Agrawal, Niruj⁵ (AUTHOR), Edwards, Mark^1,5 (AUTHOR), Yogarajah, Mahinda^1,5,6 (AUTHOR) m.yogarajah@ucl.ac.uk

المصدر: Epilepsy & Behavior. Jul2022, Vol. 132, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *PSYCHOGENIC nonepileptic seizures, *JOINT hypermobility, *SEIZURES (Medicine), *NEUROLOGICAL disorders, *CONNECTIVE tissues

مستخلص: • Joint hypermobility of patients with functional seizures was quantified using the Beighton scale. • Joint hypermobility defined with the Beighton scale was more frequently observed in patients with FS. • The association was independent of anxiety and depression. 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. In the present study, forty-two patients with FS and a non-clinical comparison group of 34 age/sex-matched controls were recruited. Joint hypermobility of all participants was quantified using the Beighton scale. In our sample, 24 (57%) patients with FS, and 7 (21%) of the comparison group met criteria for joint hypermobility (p = 0.002). Our statistical model revealed that patients with FS showed a significant degree of hypermobility compared to the comparison group (odds ratio = 11.1; Confidence interval: 2.1–78.0, p = 0.008), even after controlling age, sex, anxiety, and depression. We found a significant association between FS and joint hypermobility, which was independent of anxiety and depression. [ABSTRACT FROM AUTHOR]

المؤلفون: Loewenberger, Alana¹ (AUTHOR) Alana.loewenberger.09@ucl.ac.uk, Davies, Karuna¹ (AUTHOR), Agrawal, Niruj² (AUTHOR), Poole, Norman² (AUTHOR), Cope, Sarah R.² (AUTHOR)

المصدر: Epilepsy & Behavior. Apr2021, Vol. 117, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *PSYCHOGENIC nonepileptic seizures, *DIAGNOSIS, *SEIZURES (Medicine), *MEDICAL personnel, *SEMI-structured interviews, *THEMATIC analysis

مستخلص: • Terms to describe functional seizures were ranked by 39 patients with functional seizures. • Thirteen patients completed semi-structured interviews on their experience of being diagnosed. • NEAD, Functional seizures, FNEA and Dissociative seizures were the most preferred terms. • NEAD was the least offensive term, with Functional seizures and FNEA following closely. • Thematic analysis indicated that a term needs to facilitate shared acceptance and understanding. • Several terms provided this, and there was not a shared agreement among patients. • Following our previous study, we propose that the term Functional Seizures or FNEA is adopted. This study explored the preferred terms for functional seizures, and the experience of being diagnosed, from the patient's perspective. 39 patients in a neuropsychiatry service diagnosed with functional seizures completed an online survey to investigate preferences for, and offensiveness of, 11 common diagnostic terms used to describe functional seizures. Of these 39 patients, 13 consented to take part in a semistructured interview exploring the experience of receiving a diagnosis. Nonepileptic attack disorder (NEAD), functional seizures, functional nonepileptic attacks (FNEA), and dissociative seizures were ranked the highest preferred terms and did not significantly differ from one another. NEAD was the least offensive term, with functional seizures and FNEA following closely. Significant overlap in confidence intervals was found between the offensiveness of all terms. Terms that indicated a psychological origin were the least preferred and viewed as most offensive. Thematic analysis identified three main themes on the experience of being diagnosed: 'being heard and having a shared understanding', 'feeling alone', and 'sense of hope'. Patients favored diagnostic terms that facilitated and alleviated these themes on a personal basis; however, preferences differed across individuals. Our findings suggest that a range of terms have a similar level of preference and offense rating, with NEAD, functional seizures, and FNEA being the most favorable. Qualitative analysis indicates that a term and its accompanying explanation should facilitate shared acceptance and understanding, and several terms provide this. In combination with our previous study on healthy participants, we propose that one of the two terms researched are adopted by patients, health professionals, and the public: Functional nonepileptic attacks or Functional seizures. [ABSTRACT FROM AUTHOR]