Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study
Cardeña, Etzel LU
; Pick, Susannah
and Litwin, Richard
(2020)
In Epilepsy & Behavior
109.
- Abstract
- Background: Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES)
from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous
studies have shown that patients' descriptions of their seizures reflect differences in content and delivery.We
aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach.
Methods: We analyzed data from semi-structured interviews in which patients with video-electroencephalography
(EEG)-confirmed ES (n=30) or PNES (n=10) described their seizures. Two masked raters independently
coded the transcripts for relevant psychological categories and discrepancies that were noted... (More) - Background: Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES)
from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous
studies have shown that patients' descriptions of their seizures reflect differences in content and delivery.We
aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach.
Methods: We analyzed data from semi-structured interviews in which patients with video-electroencephalography
(EEG)-confirmed ES (n=30) or PNES (n=10) described their seizures. Two masked raters independently
coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional
analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena
were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic
regression analysis examined the predictive power of the most distinctive phenomena for diagnosis.
Results: As compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety
symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures,
PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired
time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more
fear and weeping and ES more amnesia and aches. The predictive power when including these variables was
97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related
to the use of some pronouns and references to family.
Conclusions: Although no single clinical feature definitively distinguishes PNES from ES, several features may be
suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events,
preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure
amnesia and aches may also indicate the possibility of PNES. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/c545c971-85f6-466d-9c02-62532e2638cf
- author
- Cardeña, Etzel
LU
; Pick, Susannah
and Litwin, Richard
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- epilepsy, Psychogenic seizures
- in
- Epilepsy & Behavior
- volume
- 109
- article number
- 107121
- publisher
- Elsevier
- external identifiers
-
- scopus:85084218931
- pmid:32388401
- ISSN
- 1525-5069
- DOI
- 10.1016/j.yebeh.2020.107121
- language
- English
- LU publication?
- yes
- id
- c545c971-85f6-466d-9c02-62532e2638cf
- date added to LUP
- 2020-05-07 08:54:04
- date last changed
- 2022-04-18 22:17:20
@article{c545c971-85f6-466d-9c02-62532e2638cf,
abstract = {{Background: Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES)<br/>from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous<br/>studies have shown that patients' descriptions of their seizures reflect differences in content and delivery.We<br/>aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach.<br/>Methods: We analyzed data from semi-structured interviews in which patients with video-electroencephalography<br/>(EEG)-confirmed ES (n=30) or PNES (n=10) described their seizures. Two masked raters independently<br/>coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional<br/>analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena<br/>were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic<br/>regression analysis examined the predictive power of the most distinctive phenomena for diagnosis.<br/>Results: As compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety<br/>symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures,<br/>PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired<br/>time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more<br/>fear and weeping and ES more amnesia and aches. The predictive power when including these variables was<br/>97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related<br/>to the use of some pronouns and references to family.<br/>Conclusions: Although no single clinical feature definitively distinguishes PNES from ES, several features may be<br/>suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events,<br/>preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure<br/>amnesia and aches may also indicate the possibility of PNES.}},
author = {{Cardeña, Etzel and Pick, Susannah and Litwin, Richard}},
issn = {{1525-5069}},
keywords = {{epilepsy; Psychogenic seizures}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Epilepsy & Behavior}},
title = {{Differentiating psychogenic nonepileptic from epileptic seizures: A mixed-methods, content analysis study}},
url = {{https://lup.lub.lu.se/search/files/79295870/epilepsy2.pdf}},
doi = {{10.1016/j.yebeh.2020.107121}},
volume = {{109}},
year = {{2020}},
}