Treatment strategies for focal epilepsy.

Background: Treatment strategies for focal epilepsy need to take account of the phase and severity of the seizure disorder, comorbidity, gender and age.

Methods: Expert review and evaluation of major studies on the treatment of focal epilepsy.

Results: Complete seizure control is most often achieved with antiepileptic drug (AED) monotherapy.

An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures.

Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given that NES occur in the context of many different psychopathologies, it remains uncertain whether there is 1 intervention that can benefit all comers or whether it is necessary to offer individualized psychotherapy.

Seizure metaphors differ in patients' accounts of epileptic and psychogenic nonepileptic seizures.

Purpose: To increase understanding of the subjective symptomatology of seizure experiences and improve differential diagnosis by studying the seizure metaphors used by patients with (psychogenic) nonepileptic seizures (NES) and epilepsy.

Methods: Twenty-one unselected patients taking part in this study were admitted for 48 h of video-EEG (electroenceophalography) observation because of uncertainty about the diagnosis. Eight were proven to have epilepsy, 13 to have psychogenic nonepileptic seizures (PNES).

What is it like to receive a diagnosis of nonepileptic seizures?

The aim of this qualitative study was to provide insight into the experience of receiving the diagnosis of nonepileptic seizures (NES) from the patient's perspective. Semistructured interviews were conducted with eight patients who had received the diagnosis of NES over the preceding 6 months. All participants were on a waiting list for psychological treatment.

Making the diagnosis in patients with blackouts: it's all in the history.

The distinction between the different causes of blackouts is an important and challenging clinical task. Given that treatment is very diagnosis-specific, therapeutic success depends entirely on the correct categorisation of the problem. However, despite impressive technological advances in brain imaging and improved access to tests such as video-EEG monitoring and tilt-table testing, the act of taking and interpreting the patient's history is still the most important diagnostic tool in the evaluation of patients presenting with blackouts; in many if not most cases it provides the only diagnostic pointers.

Intravenous levetiracetam for epileptic seizure emergencies in older people.

Purpose And Background: Clinical experience with intravenous levetiracetam (LEV IV) is still very limited, especially in elderly subjects. The primary objective of this retrospective observational study was to describe the efficacy and tolerability of LEV IV in older patients presenting with epileptic seizure emergencies.

Methods: Medical records of 14 older people treated with LEV IV were analysed retrospectively.

Psychogenic nonepileptic seizures and health-related quality of life: the relationship with psychological distress and other physical symptoms.

This study explores the relationship between the frequency of psychogenic nonepileptic seizures (PNES) and health-related quality of life (HRQoL), as well as the effect of psychological distress and other physical symptoms on this relationship. Data were collected on 96 patients with PNES. Correlations of seizure frequency with HRQoL, psychological distress, and physical symptoms were computed.

Conversation analysis can help to distinguish between epilepsy and non-epileptic seizure disorders: a case comparison.

Purpose: Factual items in patients' histories are of limited discriminating value in the differential diagnosis of epilepsy and non-epileptic seizures (NES). A number of studies using a transcript-based sociolinguistic research method inspired by Conversation Analysis (CA) suggest that it is helpful to focus on how patients talk. Previous reports communicated these findings by using particularly clear examples of diagnostically relevant interactional, linguistic and topical features from different patients.

Listening to people with seizures: how can linguistic analysis help in the differential diagnosis of seizure disorders?

Despite advances in medical technology, the patients' history remains the most crucial tool in the differential diagnosis of epileptic or non-epileptic seizures (NES). The distinction of these two types of seizures is a common and important task for neurologists. Whereas epileptic seizures would be treated with antiepileptic drugs, non-epileptic seizures are thought to be a manifestation of psychological or social distress and can improve with psychotherapy.

Psychogenic nonepileptic seizures: answers and questions.

Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient.

Tailored psychotherapy for patients with functional neurological symptoms: a pilot study.

Objective: The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being, quality of life, as well as somatic symptoms and whether this treatment modality is likely to be cost-effective.

Methods: We conducted an uncontrolled prospective pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using validated questionnaires [Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), Short Function (SF)-36 Health Survey, and Patient Health Questionnaire (PHQ)-15]. Patients had a median of 6 treatment sessions (range=1-24).

Ictal neuropsychological findings in focal nonconvulsive status epilepticus.

Objective: This study was intended to describe the neuropsychological phenomenology of focal nonconvulsive status epilepticus (NCSE).

Methods: Ictal, postictal, and interictal neuropsychological testing (NPT) was performed on six patients who developed NCSE during video/electroencephalographic monitoring in the context of presurgical evaluation.

Results: Neuropsychological impairments were marked in four of six and discrete in two of six patients.

Which patients become seizure free with antiepileptic drugs? An observational study in 821 patients with epilepsy.

Objectives: Analysis of factors influencing seizure outcome in antiepileptic drug treatment of epilepsy.

Patients And Methods: Retrospective analysis of 500 patients with complete seizure control and 321 patients with refractory epilepsy (mean ages 33.3 and 32.

Engagement in psychological treatment for functional neurological symptoms--Barriers and solutions.

This naturalistic study explores how many patients with functional neurological symptoms referred for specialist psychotherapy engage with and complete treatment, and whether routinely recorded demographic or clinical features predict engagement. Of 77 consecutive patients referred, 14.3% were considered unsuitable for therapy and excluded from between group comparisons, 23.

Epileptic automatisms in the criminal courts: 13 cases tried in England and Wales between 1975 and 2001.

Objectives: To explore the relationship of epilepsy and criminal behavior.

Methods: Case series based on all criminal cases found "not guilty by reason of insanity" (NGRI) because of epilepsy in England and Wales between 1975 and 2001. Data were extracted from medico-legal reports held by the Mental Health Unit at the Home Office and the Department for Constitutional Affairs in London, UK.

Audit of healthcare provision for UK prisoners with suspected epilepsy.

Purpose: To describe the prevalence and nature of epileptic seizure disorders in a typical UK prison and compare the care offered to prisoners to the recommendations of the National Institute for Clinical Excellence (NICE).

Methods: Over a 14-month period, all prisoners identified as having epilepsy were registered by prison primary healthcare services at a category 'C' prison holding 640 male adults. Prison and National Health Service health records were reviewed, prisoners were re-assessed by members of a specialist secondary care service based in the local general hospital NHS.

Examining a community model of epilepsy care for people with learning disabilities.

Purpose: To assess the use of specialised medical epilepsy services by people with learning disabilities (LD) and epilepsy in a community healthcare setting, to compare medical epilepsy care in this group to current management guidelines, and to contrast important outcomes with those achieved in different healthcare settings.

Methods: Postal survey with a carer completed questionnaire addressed to all adults with epilepsy registered on an LD register in Sheffield, UK (n=442).

Results: An analysis based on 225 returned questionnaires revealed that 22.

Acute confusion or altered mental state: consider nonconvulsive status epilepticus.

Background: The diagnosis of nonconvulsive status epilepticus (NCSE) is particularly challenging in elderly patients. Confusion, personality change, dysphasia, subtle motor activity and nystagmus may be the only presenting signs.

Objective: To review current knowledge about NCSE with special focus on older people.

Differential diagnosis of seizure disorders: a conversation analytic approach.

"Taking the history" remains the most important diagnostic tool in the assessment of people who have lost consciousness. The distinction of epileptic and non-epileptic seizures (NES) is particularly difficult and relevant. Whereas epileptic seizures can usually be controlled with antiepileptic drugs, NES are considered an expression of psychosocial distress and may improve with psychotherapy.

Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors.

This naturalistic study describes potential etiological factors in outpatients with functional neurological symptoms recorded during a screening interview with a single psychotherapist in 59 consecutive patients. The most commonly identified predisposing/precipitating factors were trauma (78.0%), family dysfunction (62.

Is valproate encephalopathy under-recognised in older people? A case series.

Background: Valproate (VPA) is an antiepileptic drug with a broad spectrum of efficacy. Although usually well-tolerated, it may have side-effects of which encephalopathy is one of the most serious.

Objective: To describe the clinical characteristics of valproate encephalopathy (VE) in five older patients with remote symptomatic seizures treated with rapid VPA loading.

Left hippocampal pathology is associated with atypical language lateralization in patients with focal epilepsy.

It is well recognized that the incidence of atypical language lateralization is increased in patients with focal epilepsy. The hypothesis that shifts in language dominance are particularly likely when epileptic lesions are located in close vicinity to the so-called language-eloquent areas rather than in more remote brain regions such as the hippocampus has been challenged by recent studies. This study was undertaken to assess the effect of lesions in different parts of the left hemisphere, lesions present during language acquisition, on language lateralization.

Measuring outcome in psychogenic nonepileptic seizures: how relevant is seizure remission?

Purpose: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs).

Methods: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow-up, 38.

Psychologic treatment of patients with psychogenic nonepileptic seizures.

Psychogenic nonepileptic seizures are relatively common, often disabling and costly to patients and society. Most authorities consider psychologic treatment as the therapeutic intervention of choice. This review is intended primarily for psychologists and therapists who treat patients with psychogenic nonepileptic seizures, and for neurologists who make the diagnosis and wish to find out more about psychologic treatment options.