Home video prediction of epileptic vs. nonepileptic seizures in US veterans.

Objective: Using video-EEG (v-EEG) diagnosis as a gold standard, we assessed the predictive diagnostic value of home videos of spells with or without additional limited demographic data in US veterans referred for evaluation of epilepsy. Veterans, in particular, stand to benefit from improved diagnostic tools given higher rates of PNES and limited accessibility to care.

Methods: This was a prospective, blinded diagnostic accuracy study in adults conducted at the Houston VA Medical Center from 12/2015-06/2019.

Clinical identification of psychogenic nonepileptic events using combinations of psychological tests in a veteran sample.

Objective: Patients with psychogenic nonepileptic events (PNEE) exhibit heterogenous symptoms and are best diagnosed with long-term video-electroencephalogram (vEEG) data. While extensive univariate data suggest psychological tests may confirm the etiology of PNEE, the multivariate discriminant utility of psychological tests is less clear. The current study aggregated likelihood ratios of multiple psychological tests to evaluate incremental and discriminant utility for PNEE.

Differentiation of Epileptic and Psychogenic Nonepileptic Seizures Using Single-Channel Surface Electromyography.

Purpose: Epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) are difficult to differentiate when based on a patient's self-reported symptoms. This study proposes review of objective data captured by a surface electromyography (sEMG) wearable device for classification of events as ES or PNES. This may help clinicians accurately identify ES and PNES.

Assessment of the Predictive Value of Outpatient Smartphone Videos for Diagnosis of Epileptic Seizures.

Importance: Misdiagnosis of epilepsy is common. Video electroencephalogram provides a definitive diagnosis but is impractical for many patients referred for evaluation of epilepsy.

Objective: To evaluate the accuracy of outpatient smartphone videos in epilepsy.

Provocative induction of psychogenic nonepileptic seizures: Noninferiority of an induction technique without versus with placebo.

We aim to demonstrate, in a sufficiently powered and standardized study, that the success rate of inducing psychogenic nonepileptic seizures (PNES) without placebo (saline infusion) is noninferior to induction with placebo. The clinical data of 170 consecutive patients with suspected PNES who underwent induction with placebo from January 21, 2009 to March 31, 2013 were pair-matched with 170 consecutive patients with suspected PNES who underwent the same induction technique but without addition of placebo from April 1, 2013 to February 7, 2018 at the same center. The success rates of induction were 79.

Change in illness perception is associated with short-term seizure burden outcome following video-EEG confirmation of psychogenic nonepileptic seizures.

Objectives: We aimed to evaluate whether potential changes in the patient's illness perception can significantly influence short-term seizure burden following video-electroencephalography (EEG) confirmation/explanation of psychogenic nonepileptic seizures (PNES).

Methods: Patients with PNES were dichotomized to two groups based on a five-point Symptom Attribution Scale: (a) those who prior to diagnosis perceived their seizures to be solely ("5") or mainly ("4") physical in origin (physical group) and (b) the remainder of patients with PNES (psychological group). The physical group (n=32), psychological group (n=40), and group with epilepsy (n=26) also completed the Brief Illness Perception Questionnaire (BIPQ) prior to diagnosis, and were followed up at 3months as well as at 6months postdiagnosis.

Performance on the Test of Memory Malingering is predicted by the number of errors on its first 10 items on an inpatient epilepsy monitoring unit.

Objective: Performance validity testing is an increasingly vital component of neuropsychological evaluation, though administration of stand-alone performance validity tests (PVTs) can be time-consuming. As the Test of Memory Malingering (TOMM) is among the most commonly used and researched PVTs, much work has focused on creating abbreviated versions while preserving diagnostic accuracy. A recent addition to this effort, errors on the first 10 items of Trial 1 (TOMMe10), was analyzed for its utility in predicting TOMM performance.

Psychogenic Non-Epileptic Seizures.

Purpose Of Review: In this review, we elucidate the evaluation process involved in the diagnosis of psychogenic non-epileptic seizures (PNES). Minimum clinical criteria required to attain this diagnosis via a staged approach are delineated. The psychological underpinnings and management of PNES from the neurologists' perspective are also explored.

Diagnosis and Treatment of Nonepileptic Seizures.

Purpose Of Review: This article details the evaluation process involved in the diagnosis of psychogenic nonepileptic seizures (PNES). The psychological underpinnings, prognostic factors, and recent treatment advances of PNES are also reviewed.

Recent Findings: The diagnosis of PNES is determined based on concordance of the composite evidence available, including historical and physical examination findings, seizure symptoms and signs, and ictal/interictal EEG.

Health resource utilization among US veterans with psychogenic nonepileptic seizures: A comparison before and after video-EEG monitoring.

Objective: Prior to establishing the correct diagnosis, patients with psychogenic nonepileptic seizures (PNES) frequently endure significant costs and morbidities associated with utilization of health care resources. In this study of the US veterans population, we aimed to investigate for potential changes in health resource utilization before versus after video-EEG (VEEG) confirmation and disclosure of the PNES diagnosis.

Methods: We prospectively studied 65 veterans with VEEG confirmed diagnosis of PNES, and followed their health care utilization during the subsequent 3 years after the diagnosis.

Cardiac asystole associated with seizures of right hemispheric onset.

Ictal asystole is frequently underrecognized despite being a potentially lethal condition. We report two cases of ictal asystole with right hemispheric onset. These cases are unique since previous literature reports that seizures associated with bradyarrhythmias typically arise from left hemispheric foci.

Functional neuro-imaging as a pre-surgical tool in epilepsy.

Functional neuro-imaging techniques are helpful in the pre-surgical evaluation of epilepsy for localization of the epileptogenic zone as ancillary tools to electroencephalography (EEG) and magnetic resonance imaging (MRI) or when other localization techniques are normal, non-concordant or discordant. Positron emission tomography (PET) and ictal single photon emission computed tomography (ictal SPECT) imaging are traditional tests that have been reported to have good sensitivity and specificity although the results are better with more expertise as is true for any technique. More recently magnetoencephalogram/magnetic source imaging (MEG/MSI), diffusion tensor imaging and functional magnetic resonance imaging (fMRI) have been used in localization and functional mapping during the pre-surgical work-up of epilepsy.

Brief group psychoeducation for psychogenic nonepileptic seizures: a neurologist-initiated program in an epilepsy center.

Objective: To evaluate therapeutic efficacy upon augmenting the initial communication to patients regarding the diagnosis of psychogenic nonepileptic seizures (PNES) with a novel, brief group psychoeducation administered by the same team that provided the video-electroencephalography (VEEG) confirmed diagnosis and within 4 weeks of the diagnosis.

Methods: Prior to discharge from the epilepsy monitoring unit (EMU), a standardized communication strategy was utilized to explain the diagnosis of PNES to all patients prior to enrollment. Enrolled patients were then randomized to either participation in three successive and monthly group psychoeducational sessions (intervention group), or routine seizure clinic follow-up visits (control group).

Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events.

The Structured Interview of Malingered Symptomatology (SIMS) is a self-report instrument that asks patients whether they experience atypical or implausible symptoms. The instrument has not been evaluated in an epilepsy population, and the potential for it to accurately distinguish between patients with psychogenic non-epileptic events (PNEE) and epileptic event groups has not been established. The SIMS was administered to patients in long-term video-EEG monitoring of these patients, 91 with PNEE and 29 with epilepsy were included in this study.

Intact vs. impaired ictal sensorium: does it affect outcome of psychogenic nonepileptic events following disclosure of diagnosis?

It remains uncertain whether particular ictal manifestations of psychogenic nonepileptic events (PNEE) can reflect distinctive psychological processes or prognostic outcomes. We hypothesize that the integrity of ictal sensorium may affect the clinical outcome of PNEE following disclosure of diagnosis. We prospectively studied 47 veterans who were diagnosed with video-EEG-confirmed PNEE, presented with the diagnosis utilizing a standardized communication strategy, and followed for their clinical progress.

The use of all three Test of Memory Malingering trials in establishing the level of effort.

Assessment of the effort level is an essential step in establishing the internal validity of any neuropsychological evaluation. The use of response bias measures as part of a core battery, however, is less common outside of forensic evaluations. The amount of time needed to administer many of these tests is often cited as a likely explanation for their exclusion from routine neuropsychological evaluations.

Induction of psychogenic nonepileptic events: success rate influenced by prior induction exposure, ictal semiology, and psychological profiles.

Purpose: To evaluate whether certain preinduction clinical characteristics may influence the success rate of induction.

Methods: We prospectively enrolled and attempted inductions on 51 patients who were suspected to have psychogenic nonepileptic events based on clinical grounds. In addition to careful examination of the reported ictal semiology, we administered a battery of four psychological instruments to our enrolled patients.

Analysis of retinal cell development in chick embryo by immunohistochemistry and in ovo electroporation techniques.

Background: Retinal cell development has been extensively investigated; however, the current knowledge of dynamic morphological and molecular changes is not yet complete.

Results: This study was aimed at revealing the dynamic morphological and molecular changes in retinal cell development during the embryonic stages using a new method of targeted retinal injection, in ovo electroporation, and immunohistochemistry techniques. A plasmid DNA that expresses the green fluorescent protein (GFP) as a marker was delivered into the sub-retinal space to transfect the chick retinal stem/progenitor cells at embryonic day 3 (E3) or E4 with the aid of pulses of electric current.

Characteristics of psychogenic nonepileptic events among veterans with posttraumatic stress disorder: an association of semiology with the nature of trauma.

Various psychiatric disorders can contribute to psychogenic nonepileptic events (PNEEs), including posttraumatic stress disorder (PTSD). We hypothesize that among patients with PNEEs and PTSD, the nature of the traumatic experience leading to PTSD has an association with the clinical manifestations of PNEEs. We found that the presence of PTSD, in general, did not demonstrate significant association with any particular PNEE semiology in a veterans population.

Sensitivity and specificity of video alone versus electroencephalography alone for the diagnosis of partial seizures.

We examined the usefulness of video versus EEG in isolation for the differentiation of epileptic seizures (ES) from psychogenic nonepileptic events (PNEE). Video-EEG recordings of 43 events in 43 patients (27 with ES and 16 with PNEE) were analyzed by experienced clinical epileptologists/electroencephalographers blinded to the patients' clinical histories. Both the video and EEG were scored independently by the same reader for each event.

New routes for delivery of anti-epileptic medications.

Use of novel drug delivery methods might enhance efficacy and reduce toxicity, in comparison with currently existing oral anti-epileptic drugs (AEDs). Novel methods aim to deliver optimal drug concentration more specifically to the seizure focus or foci. In this review, we first consider unconventional routes of drug delivery to the peripheral system, then potential new methods of targeted CNS drug delivery.

Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

Objective: The purpose of this article is to review the use of serum prolactin assay in epileptic seizure diagnosis.

Methods: The authors identified relevant studies in multiple databases and reference lists. Studies that met inclusion criteria were summarized and rated for quality of evidence, and the results were analyzed and pooled where appropriate.