Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures.

Purpose: Several studies have indicated that psychogenic nonepileptic seizures (PNES) are associated with psychological trauma, but only a few studies have examined the associations with neurobiologic stress systems, such as the hypothalamus-pituitary-adrenal (HPA) axis and its end-product cortisol. We tested several relevant HPA-axis functions in patients with PNES and related them to trauma history.

Methods: Cortisol awakening curve, basal diurnal cortisol, and negative cortisol feedback (using a 1 mg dexamethasone suppression test) were examined in 18 patients with PNES and 19 matched healthy controls (HCs) using saliva cortisol sampling on two consecutive days at 19 time points.

Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures.

Purpose: Psychogenic nonepileptic seizures (PNES) have long been considered as paroxysmal dissociative symptoms characterized by an alteration of attentional functions caused by severe stress or trauma. Although interpersonal trauma is common in PNES, the proposed relation between trauma and attentional functions remains under explored. We examined the attentional processing of social threat in PNES in relation to interpersonal trauma and acute psychological stress.

Psychological treatment of patients with psychogenic non-epileptic seizures: an outcome study.

Introduction: It is estimated that up to 25% of patients referred to specialised epilepsy centers suffer from psychogenic non-epileptic seizures (PNES). The prognosis is unfavourable and there are no generally accepted treatment protocols.

Method: In this study, the effect of an uncontrolled, prospective inpatient treatment program for PNES patients is evaluated.

Interictal depression, anxiety, personality traits, and psychological dissociation in patients with temporal lobe epilepsy (TLE) and extra-TLE.

Purpose: This study was performed to investigate the relation between symptoms of interictal depression, anxiety, personality traits, and psychological dissociation with the localization and lateralization of the epileptogenic zone in patients with partial epilepsy.

Methods: All patients were diagnosed according to the localization-related concept of the 1989 International League Against Epilepsy (ILAE) Classification of Epilepsies and Epileptic Syndromes, and the localization and lateralization of the epileptogenic zone was established by using the clinical criteria for noninvasive presurgical evaluation. This resulted in 67 patients with temporal lobe epilepsy (TLE) and 64 patients with extra-TLE.

Psychometric properties of the Dutch version of the Washington Psychosocial Seizure Inventory.

Purpose: The psychometric properties of the Dutch version of the Washington Psychosocial Seizure Inventory (WPSI) were investigated.

Methods: The dimensional structure, reliability, and validity of the WPSI scales were assessed in 218 patients with epilepsy. The association with relevant patient and epilepsy characteristics also was studied.

Controversies in the diagnosis and management of psychogenic pseudoseizures.

Since the advent of video-EEG telemetry studies (V-EEG) neurologists have become increasingly aware of psychogenic pseudoseizures (PPS) given the relatively high prevalence of these events among patients seen in epilepsy centers. The use of V-EEG has been accepted as the gold standard study in establishing this diagnosis; some clinicians, however, have suggested that the clinical phenomena of PPS are so obvious in many patients that V-EEG may not be necessary. This is one of many controversial points that clinicians face when evaluating patients suspected of having PPS.