Transcript Introduction to Psychogenic non

PSYCHOGENIC NONEPILEPTIC SEIZURES
INTRODUCTION
WHAT ARE PSYCHOGENIC NON
EPILEPTIC SEIZURES (PNES)?
• Involuntary behavioral changes
 movements of body parts
• alteration of consciousness
• loss of certain functions e.g. speech
• Look like epileptic seizures but there are no changes
on EEG.
• Typically:
• triggered by emotion (often unaware)
 psychological trauma is part of the adult
patient’s history
WHAT ARE PSYCHOGENIC NON
EPILEPTIC SEIZURES (PNES)?
• In children, trauma is less often evident as a
predisposing factor.
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Undiagnosed learning problems
Bullying and interpersonal problems
Family dynamics
Recent stressors or changes in the child’s life
HOW CAN THESE HAPPEN IF PATIENT
IS NOT FEELING ANXIOUS?
• Conscious awareness is not initially involved in the
reactions our body has to many stimuli.
NEUROPERCEPTION (electrical discharges are processed
at a neuronal level) versus PERCEPTION (conscious
awareness and recognition of the stimuli). Neurons finish
processing an event half a second before the
information it processed reaches the conscious brain;
this is called: Pre-attentive emotion processing.
Emotional responses in certain brain structures involved
in emotional and memory processing can occur rapidly
without conscious awareness, triggering responses that
have not reached or been processed by the conscious
mind. Therefore, a psychogenic non-epileptic seizure
might easily be triggered without the person who suffers
the seizure being aware of what triggered it.
WHAT DO WE CALL THESE
SEIZURES/EVENTS?
• Over the centuries, PNES events have been called a lot
of things.
• Pseudo seizures
• Hysterical seizures
• Possession
Now:
• NEAD-Non epileptic attack disorder (UK)
• Dissociative seizures
• Psychogenic seizures
• Psychological/psychogenic non epileptic seizures or
events
HOW IMPORTANT IS IT TO MAKE THE
DIAGNOSIS QUICKLY?
The sooner, the better!
A misdiagnosis of epilepsy can lead to:
• Dangerous interventions in the emergency
room, (e.g. being "loaded up" with powerful
drugs and being intubated)
• Spending years taking unnecessary
medications
• Making life choices that are based on a
wrong diagnosis
HOW IS THE DIAGNOSIS OF PNES
MADE?
• Can someone tell if it is PNES or epileptic seizures
(ES) just by looking at the event itself? NO!
• Video EEG is the gold standard. It allows doctors to
look at both the brain wave data, as well as the
images on video during the actual episode.
• In PNES, there are no electrical changes in the brain
at the time of the seizure (different from the
epileptic seizures)
HOW IS THE DIAGNOSIS OF PNES
MADE?
ARE THERE OTHER TESTS?
• Neuropsychological testing (cognitive and
psychological).
• Psychiatric/psychological interview.
• Possibly other diagnoses need to be ruled out -nonepileptic seizures (physiological)
DIAGNOSTIC DELAY
• Even with cutting-edge technology available to
medical doctors these days, the average delay
between the time symptoms begin and the person
is diagnosed with PNES is between 7-10 years.
A CORRECT DIAGNOSIS OF PNES WILL ALLOW
THE PATIENT TO:
• Start psychological treatment ASAP.
• Allow the psychologist/psychiatrist and epilepsy
doctor decide when and if anti-epileptic-drugs can
be tapered off.
• Start making changes in life based on this new
diagnosis (i.e. gradually become more independent
and make important life decisions)
CAN PSYCHOGENIC NON-EPILEPTIC SEIZURES
CAUSE BRAIN DAMAGE OR BE FATAL?
Short answer, is no.
• However, if during the seizure,
the patient suffers a blow or physical injury, the
situation changes.
• Usually an ambulance or hospital visit is not
necessary when a typical PNES occurs UNLESS there
has been a secondary injury suffered during the
seizure.
CAN YOU STILL BE DIAGNOSED WITH PNES IF YOU
ALSO HAVE A NEUROLOGICAL CONDITION?
• A past history of mild traumatic brain injury (TBI) is
not uncommon in those with PNES and the
association is stronger in PNES than in epilepsy.
• Fibromyalgia and chronic pain
• 10-30% of patients with PNES also have past or
present epilepsy as well
WHAT ARE INTELLIGENCE AND MENTAL
FUNCTIONS LIKE IN PERSONS WITH PNES?
• Intellectual functioning of patients with PNES is not
different than the norm.
• Patients with PNES report difficulties with:
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Memory
attention and concentration
word finding
other language functions
CAN PNES OCCUR AT ANY AGE?
• Although PNES can occur at almost any age, it is
most common in people in the teen years and in
adults between the ages of 25-35.
• PNES is rare in children younger than 5 and less
common in adults older than 55 but it certainly has
been reported as occurring at these ages as well.
IS THIS A RARE CONDITION?
• Estimates of 2-33 out of every 100,000 people have
PNES.
• Up to 30% of patients seen on inpatient epilepsy
monitoring units will be diagnosed with PNES.
• PNES is about as prevalent as Multiple Sclerosis but
receives much less exposure and is relatively
unknown to the public.
• PNES has been around for centuries. 1800’s Freud
and Charcot.
WHY MIGHT SOMEONE DEVELOP PNES?
• Problems coping with stress (tendency to deal with
stress with emotion and avoidance over task
oriented response)
• History of trauma and possibly PTSD
• Tendency toward dissociation under stress
• Alexithymia (misread and detach from emotion)
• Difficulties with anger management (lack of
assertiveness).
• The non-stop chipping of life stressors and the
“perfect storm” scenario
IS TREATMENT AVAILABLE?
• Cognitive behavioral treatments
• Psychodynamic therapy
• Mindfulness-based treatments
• Hypnotherapy
• Group therapies and
psychoeducation
• Medication
IS TREATMENT AVAILABLE?
• For those with combined PNES and PTSD:
• There are several PTSD specific treatments that may prove
useful.
• Prolonged exposure for PTSD
• Cognitive Processing therapy
• Eye Movement Desensitization Reprocessing
therapy (EMDR)
• Dialectical Behavioral therapy (DBT)
OTHER CHALLENGES OF PNES
• Quality of life
• Safety issues
• Practical issues (driving, working, studying,
relationships)
• What resources are there if any?
IS THERE AN OFFICIAL AWARENESS
COLOR FOR PNES?
• 2014, a grassroots movement on Facebook, chose
two colors to represent PNES. Since PNES typically
combines seizures and psychological trauma, PNES
advocate, Eric L. Nelson, proposed Purple to
represent seizures and Teal to represent PTSD. These
received strong support.
• PNES colors: Purple/Teal.
• LeeLee N. Mike has to date created a multitude of
graphics featuring these colors to spread
awareness.
OFFICIAL PNES AWARENESS RIBBON
A LEELEE N. MIKE GRAPHIC
PNES ACTIVISTS
• Authors:
• Mary Martiros (In Our Own Words: Stories of those living with,
learning from and overcoming the challenges of
psychogenic non-epileptic seizures)
• Kate Berger (View From The Floor: Psychogenic NonEpileptic Seizures: A Patient's Perspective)
• Kate Taylor and Jeffrey Underwood RN (The Color of
seizures: Living with PNES)
• Gretha Cronje and Pretorius (article in scientific journal: The
coping styles and health-related quality of life of South
African patients with psychogenic nonepileptic seizures;
Epilepsy & Behavior 2013)
PERSONAL ACCOUNTS OF LIVING WITH
NON-EPILEPTIC SEIZURES (THE
BRAINSTORMS SERIES)
• You are invited to participate in this international
project that will become a book: write about what
it is like to live with PNES.
• For more information and consent forms:
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Gregg Rawlings
Academic Neurology Unit, University of Sheffield
Royal Hallamshire Hospital
Glossop Road, Sheffield S10 2JF
Email: [email protected]
Telephone: 0114 2711597
RESOURCES AND CONTACT
• Psychogenic Non-epileptic Seizures: A Guide by
Lorna Myers
• Taking control of your seizures by Reiter et al.
• Website: www.nonepilepticseizures.com
• Webinar on Introduction to Psychogenic nonepileptic seizures on YouTube
• Facebook: Psychological non epileptic seizures
• [email protected]
• www.epilepsyfree.com for continuing education
scholarships and funds for educational programs