Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2025-01-03T13:47:16.253Z Has data issue: false hasContentIssue false

10 - Nonepileptic Events and General Psychiatric Care for Epilepsy Patients

Published online by Cambridge University Press:  28 January 2023

Patrick Landazuri ,
Nuria Lacuey Lecumberri ,
Laura Vilella Bertran ,
Mark Farrenburg  and
Samden Lhatoo
Patrick Landazuri
Affiliation:
University of Kansas Medical Centre
Nuria Lacuey Lecumberri
Affiliation:
University of Texas Health Science Center, Houston
Laura Vilella Bertran
Affiliation:
University of Texas Health Science Center, Houston
Mark Farrenburg
Affiliation:
University of Kansas Medical Centre
Samden Lhatoo
Affiliation:
University of Texas Health Science Center, Houston
Get access

Summary

Epilepsy care often intersects with mental health care. The chapter begins with nonepileptic events.This commonly encountered diagnosis is frequently on the differential for people with new onset seizures. Prompt recognition of a nonepileptic diagnosis can lead to early evidence-based treatment with cognitive behavioral therapy. Moreover, a nonepileptic event diagnosis can avoid inappropriate treatments such as antiseizure medicines (ASMs). It is critical to understand a nonepileptic event diagnosis does not mean that the events are not real or the patient is faking. Specific diagnostic clues for nonepileptic events are thoroughly discussed. The other section of the chapter explores the management of comorbid psychiatric diagnoses in patients with epilepsy and nonepileptic events. The use of most psychiatric medications, including stimulants, can be considered without affecting an epilepsy patient’s treatment plan. An understanding of psychiatric medication and ASM interaction can guide drug selection. As psychiatric diagnoses negatively affect epilepsy patients’ quality of life, prompt recognition and compassionate care can improve your patient’s overall health care.

Keywords

nonepilepticpseudoseizurepsychogenicCBTpsychiatricSSRIstimulantanxietydepressionPNES
Type
Chapter
Information
Seizure and Epilepsy Care
The Pocket Epileptologist
 , pp. 175 - 185
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Works Cited

Bodde, NM, Brooks, JL, Baker, GA et al. Psychogenic non-epileptic seizures – definition, etiology, treatment and prognostic issues: A critical review. Seizure. 2009;18(8):543–53.CrossRefGoogle ScholarPubMed
Benbadis, SR and Allen Hauser, W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure. 2000;9(4):280–1.CrossRefGoogle ScholarPubMed
Duncan, R, Razvi, S, and Mulhern, S. Newly presenting psychogenic nonepileptic seizures: Incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav. 2011;20(2):308–11.Google Scholar
Sigurdardottir, KR and Olafsson, E. Incidence of psychogenic seizures in adults: A population-based study in Iceland. Epilepsia. 1998;39(7):749–52.CrossRefGoogle ScholarPubMed
Szaflarski, JP, Szaflarski, M, Hughes, C et al. Psychopathology and quality of life: Psychogenic non-epileptic seizures versus epilepsy. Med Sci Monit. 2003;9(4):Cr113–18.Google Scholar
LaFrance, WC, Jr. and Benbadis, SR. Avoiding the costs of unrecognized psychological nonepileptic seizures. Neurology. 2006;66(11):1620–1.CrossRefGoogle ScholarPubMed
Benbadis, SR, O’Neill, E, Tatum, WO, and Heriaud, L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia. 2004;45(9):1150–3.Google Scholar
Jones, SG, O’Brien, TJ, Adams, SJ et al. Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosom Med. 2010;72(5):487–97.CrossRefGoogle ScholarPubMed
Reuber, M, Fernández, G, Bauer, J, Helmstaedter, C, and Elger, CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology. 2002;58(3):493–5.CrossRefGoogle ScholarPubMed
Kerr, WT, Janio, EA, Le, JM et al. Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. Seizure. 2016;40:123–6.CrossRefGoogle ScholarPubMed
Avbersek, A and Sisodiya, S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81(7):719–25.CrossRefGoogle ScholarPubMed
Syed, TU, LaFrance, WC, Jr., Kahriman, ES et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol. 2011;69(6):997–1004.CrossRefGoogle ScholarPubMed
Azar, NJ, Tayah, TF, Wang, L, Song, Y, and Abou-Khalil, BW. Postictal breathing pattern distinguishes epileptic from nonepileptic convulsive seizures. Epilepsia. 2008;49(1):132–7.CrossRefGoogle ScholarPubMed
Gates, JR, Ramani, V, Whalen, S, and Loewenson, R. Ictal characteristics of pseudoseizures. Arch Neurol. 1985;42(12):1183–7.CrossRefGoogle ScholarPubMed
Henry, TR and Drury, I. Ictal behaviors during nonepileptic seizures differ in patients with temporal lobe interictal epileptiform EEG activity and patients without interictal epileptiform EEG abnormalities. Epilepsia. 1998;39(2):175–82.CrossRefGoogle ScholarPubMed
Bazil, CW and Walczak, TS. Effects of sleep and sleep stage on epileptic and nonepileptic seizures. Epilepsia. 1997;38(1):56–62.CrossRefGoogle ScholarPubMed
Duncan, R, Oto, M, Russell, AJ, and Conway, P. Pseudosleep events in patients with psychogenic non-epileptic seizures: Prevalence and associations. J Neurol Neurosurg Psychiatry. 2004;75(7):1009–12.CrossRefGoogle ScholarPubMed
Davis, BJ. Predicting nonepileptic seizures utilizing seizure frequency, EEG, and response to medication. Eur Neurol. 2004;51(3):153–6.CrossRefGoogle ScholarPubMed
Benbadis, SR, Agrawal, V, and Tatum, WO. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology. 2001;57(5):915–17.Google Scholar
Chen-Block, S, Abou-Khalil, BW, Arain, A et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: The effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62–5.CrossRefGoogle ScholarPubMed
El-Naggar, H, Moloney, P, Widdess-Walsh, P et al. Simultaneous occurrence of nonepileptic and epileptic seizures during a single period of in-patient video-electroencephalographic monitoring. Epilepsia Open. 2017;2(4):467–71.Google Scholar
Kanner, AM, Parra, J, Frey, M et al. Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology. 1999;53(5):933–8.CrossRefGoogle ScholarPubMed
Arain, AM, Hamadani, AM, Islam, S, and Abou-Khalil, BW. Predictors of early seizure remission after diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav. 2007;11(3):409–12.CrossRefGoogle ScholarPubMed
LaFrance, WC, Jr., Reuber, M, and Goldstein, LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013;54(suppl. 1):53–67.CrossRefGoogle ScholarPubMed
Duncan, R. Psychogenic nonepileptic seizures: Diagnosis and initial management. Expert Rev Neurother. 2010;10(12):1803–9.CrossRefGoogle ScholarPubMed
Hall-Patch, L, Brown, R, House, A et al. Acceptability and effectiveness of a strategy for the communication of the diagnosis of psychogenic nonepileptic seizures. Epilepsia. 2010;51(1):70–8.Google Scholar
LaFrance, WC, Jr., Baird, GL, Barry, JJ et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: A randomized clinical trial. JAMA Psychiatry. 2014;71(9):997–1005.CrossRefGoogle ScholarPubMed
Goldstein, LH, Robinson, EJ, Mellers, JDC et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): A pragmatic, multicentre, randomised controlled trial. Lancet Psychiatry. 2020;7(6):491–505.Google Scholar
Oto, M, Espie, C, Pelosi, A, Selkirk, M, and Duncan, R. The safety of antiepileptic drug withdrawal in patients with non-epileptic seizures. J Neurol Neurosurg Psychiatry. 2005;76(12):1682–5.Google Scholar
Scott, AJ, Sharpe, L, Hunt, C, and Gandy, M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia. 2017;58(6):973–82.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, and Walters, EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.Google ScholarPubMed
Fiest, KM, Patten, SB, Altura, KC et al. Patterns and frequency of the treatment of depression in persons with epilepsy. Epilepsy Behav. 2014;39:59–64.Google Scholar
Johnson, EK, Jones, JE, Seidenberg, M, and Hermann, BP. The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy. Epilepsia. 2004;45(5):544–50.CrossRefGoogle ScholarPubMed
Tian, N, Cui, W, Zack, M et al. Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003–2011. Epilepsy Behav. 2016;61:210–17.Google Scholar
O’Donoghue, MF, Goodridge, DM, Redhead, K, Sander, JW, and Duncan, JS. Assessing the psychosocial consequences of epilepsy: A community-based study. Br J Gen Pract. 1999;49(440):211–14.Google ScholarPubMed
Alper, K, Schwartz, KA, Kolts, RL, and Khan, A. Seizure incidence in psychopharmacological clinical trials: An analysis of Food and Drug Administration (FDA) summary basis of approval reports. Biol Psychiatry. 2007;62(4):345–54.Google Scholar
Jobe, PC, Dailey, JW, and Wernicke, JF. A noradrenergic and serotonergic hypothesis of the linkage between epilepsy and affective disorders. Crit Rev Neurobiol. 1999;13(4):317–56.Google Scholar
Kanner, AM. Most antidepressant drugs are safe for patients with epilepsy at therapeutic doses: A review of the evidence. Epilepsy Behav. 2016;61:282–6.Google Scholar
Blanchet, P and Frommer, GP. Mood change preceding epileptic seizures. J Nerv Ment Dis. 1986;174(8):471–6.CrossRefGoogle ScholarPubMed
Kanner, AM, Soto, A, and Gross-Kanner, H. Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy. Neurology. 2004;62(5):708–13.Google Scholar
Hirschfeld, RMA, Bowden, CL, Gitlin, MJ et al. Practice guideline for the treatment of patients with bipolar disorder (revision). FOCUS. 2003;1(1):64–110.Google Scholar
Patsalos, PN and Perucca, E. Clinically important drug interactions in epilepsy: Interactions between antiepileptic drugs and other drugs. Lancet Neurol. 2003;2(8):473–81.Google ScholarPubMed
Nelson, MH, Birnbaum, AK, and Remmel, RP. Inhibition of phenytoin hydroxylation in human liver microsomes by several selective serotonin re-uptake inhibitors. Epilepsy Res. 2001;44(1):71–82.Google Scholar
Haney, EM, Warden, SJ, and Bliziotes, MM. Effects of selective serotonin reuptake inhibitors on bone health in adults: Time for recommendations about screening, prevention and management? Bone. 2010;46(1):13–17.Google Scholar
Jacob, S and Spinler, SA. Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Ann Pharmacother. 2006;40(9):1618–22.CrossRefGoogle ScholarPubMed
Andrade, C. Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Mens Sana Monogr. 2010;8(1):146–50.Google Scholar
Thompson, NJ, Walker, ER, Obolensky, N et al. Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy Behav. 2010;19(3):247–54.CrossRefGoogle ScholarPubMed
Ciechanowski, P, Chaytor, N, Miller, J et al. PEARLS depression treatment for individuals with epilepsy: A randomized controlled trial. Epilepsy Behav. 2010;19(3):225–31.Google Scholar
Dunn, DW, Austin, JK, and Perkins, SM. Prevalence of psychopathology in childhood epilepsy: Categorical and dimensional measures. Dev Med Child Neurol. 2009;51(5):364–72.CrossRefGoogle ScholarPubMed
Wiggs, KK, Chang, Z, Quinn, PD et al. Attention-deficit/hyperactivity disorder medication and seizures. Neurology. 2018;90(13):e1104–10.CrossRefGoogle ScholarPubMed
Feeney, DJ and Klykylo, WM. Medication-induced seizures. J Am Acad Child Adolesc Psychiatry. 1997;36(8):1018–19.CrossRefGoogle ScholarPubMed
Goetz, M, Surman, CB, Mlynarova, E, and Krsek, P. Status epilepticus associated with the administration of long-acting methylphenidate in a 7-year-old girl. J Clin Psychopharmacol. 2012;32(2):300–2.Google Scholar
Schertz, M and Steinberg, T. Seizures induced by the combination treatment of methylphenidate and sertraline. J Child Adolesc Psychopharmacol. 2008;18(3):301–3.CrossRefGoogle ScholarPubMed
Tavakoli, SA and Gleason, OC. Seizures associated with venlafaxine, methylphenidate, and zolpidem. Psychosomatics. 2003;44(3):262–4.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×