PTSD-PNES, epilepsy and MBI potential: an overview

Epilepsy & Behavior, 2020

Background: Mindfulness-based therapies (MBTs) are effective in many neuropsychiatric disorders, and represent a potential therapeutic strategy for psychogenic nonepileptic seizures (PNES). Objective: The objective of this study was to investigate the clinical effect of a manualized 12-session MBT for PNES in an uncontrolled trial. We hypothesized reductions in PNES frequency, intensity, and duration, and improvements in quality of life and psychiatric symptom severity at treatment completion. Methods: Between August 2014 and February 2018, 49 patients with documented PNES (with video electroencephalography [EEG]) were recruited at Brigham and Women's Hospital to participate in the MBT for PNES treatment study. Baseline demographic and clinical information and self-rating scales were obtained during the diagnostic evaluation (T0). Baseline PNES frequency, intensity, and duration were collected at the first followup postdiagnosis (T1). Frequency was obtained at each subsequent MBT session and analyzed over time with median regression analysis. Outcomes for other measures were collected at the last MBT session (T3), and compared to baseline measures using linear mixed models. Results: Twenty-six patients completed the 12-session MBT program and were included in the analysis. Median PNES frequency decreased by 0.12 events/week on average with each successive MBT session (p = 0.002). At session 12, 70% of participants endorsed a reduction in PNES frequency of at least 50%. Freedom from PNES was reported by 50% of participants by treatment conclusion. Seventy percent reported a 50% reduction in frequency from baseline and 50% reported remission at session 12. By treatment end, PNES intensity decreased (p = 0.012) and quality of life improved (p = 0.002). Event duration and psychiatric symptom severity were lower after treatment, but reductions were not statistically significant. Conclusions: Completion of a manualized 12-session MBT for PNES provides improvement in PNES frequency, intensity, and quality of life. The high dropout rate is consistent with adherence studies in PNES. Possible reasons for dropout are discussed. Randomized controlled trials and longer-term outcomes are needed to demonstrate the efficacy of MBT in PNES.

A memory-based neuronal substrate model of psychogenic non-epileptic seizure and posttraumatic stress disorder, 2019

Background and objectives: Unspecific and broad associations between adverse life events exposure and PNES and PTSD have been reported in the literature. This review aimed to explore the differences in the effect of psychogenic trauma or the cumulative effects of multi psy-chogenic traumas in PTSD and PNES on the memory neuronal subsystems (using evidence from functional neuroimaging studies and animal models), which could have consequences on the constellation of PNES and PTSD symptomatology. Method: The author performed a non-systematic review of the literature. Midline was searched using relevant terms and list of references for certain articles were reviewed as well. Key articles and conclusion from systemic reviews and meta-analysis papers were included. Results: Evidence from neuroimaging studies show that PNES patients exhibited increased resting-state functional activity and alterations in functional connectivity in tier 4-5 memory subsystems that are involved in appraising distant and complex contextual and social threats, such as the frontal cortex, sensorimotor cortex, cingulate gyrus, insula, and the default-mode network, while neuroimaging studies and animal models in PTSD revealed hypoactive tier 4-5 memory subsystems (volumetric reduction in the hippocampi and the anterior cingulate cortex , with hypoactive prefrontal areas) and hyperactive tier 1-3 memory subsystems (ventral tegmentum, dorsal and ventral striatum, and amygdala), which deals with close and imminent physical threats. Conclusion: Inferences can be made that the effect of a psychogenic trauma will differ according to the way the brain analyses the trauma which might determine the cluster of PNES and PTSD symptomology. Crown

Clinical EEG and neuroscience, 2014

Psychogenic nonepileptic seizures (PNES) were first described in the medical literature in the 19th century, as seizure-like attacks not related to an identified central nervous system lesion, and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment, and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less we...

OBJECTIVE: Several cross-sectional studies reported a relationship between post-traumatic stress disorder (PTSD) and epilepsy. However, the temporal association between PTSD and epilepsy has rarely been investigated. We hypothesized that the risk of developing epilepsy later in life would be higher in patients with PTSD than in those without PTSD. METHODS: Using the Taiwan National Health Insurance Research Database, 6425 individuals with PTSD and 24,980 age-/sex-matched controls were enrolled between 2002 and 2009 in our study, and followed up to the end of 2011. Those who developed epilepsy during the follow-up period were identified. RESULTS: Individuals with PTSD had a higher incidence of developing epilepsy (2.65 vs. 0.33 per 1000 person-years, p < 0.001), with an earlier onset of epilepsy (37.53 ± 15.80 vs. 48.11 ± 23.97 years, p = 0.002), than did the controls. Individuals with PTSD had an elevated risk of developing epilepsy (hazard ratio [HR]: 3.72, 95% confidence interval [CI]: 2.27-6.11) during the follow-up after adjustment for demographic data and medical and psychiatric comorbidities. Sensitivity analyses after excluding the observation in the first year (HR: 2.53, 95% CI: 1.44-4.47) and the first 3 years (HR: 2.14, 95% CI: 1.15-4.01) revealed consistent results. CONCLUSIONS: These results supported a temporal association between PTSD and the development of epilepsy. Further studies are warranted to investigate the underlying pathophysiological pathways that explain the longitudinal association of PTSD with subsequent epilepsy.

Background: Mindfulness based interventions (MBIs) are increasingly used to help patients cope with physical and mental long-term conditions (LTCs). Epilepsy is associated with a range of mental and physical comorbidities that have a detrimental effect on quality of life (QOL), but it is not clear whether MBIs can help. We systematically reviewed the literature to determine the effectiveness of MBIs in people with epilepsy. Methods: Medline, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Allied and Complimentary Medicine Database, and PsychInfo were searched in March 2016. These databases were searched using a combination of subject headings where available and keywords in the title and abstracts. We also searched the reference lists of related reviews. Study quality was assessed using the Cochrane Collaboration risk of bias tool.

Epilepsy & Behavior, 2010

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.

Frontiers in Psychiatry

with exposure to neutral and Iraq combat-related slides and sound before and after treatment. Nine patients in the MBSR group and 8 in the PCGT group completed all study procedures. results: Post-traumatic stress disorder patients treated with MBSR (but not PCGT) had an improvement in PTSD symptoms measured with the CAPS that persisted for 6 months after treatment. MBSR also resulted in an increase in mindfulness measured with the FFMQ. MBSR-treated patients had increased anterior cingulate and inferior parietal lobule and decreased insula and precuneus function in response to traumatic reminders compared to the PCGT group. conclusion: This study shows that MBSR is a safe and effective treatment for PTSD. Furthermore, MBSR treatment is associated with changes in brain regions that have been implicated in PTSD and are involved in extinction of fear responses to traumatic memories as well as regulation of the stress response.

Background. Previous reviews have concluded that whilst mindfulness-based interventions reduce PTSD symptoms through fear extinction and cognitive restructuring, further research is needed. Objective. The aim of this report is to systematically review existing literature about the association between standardized mindfulness-based interventions and PTSD with the aim of identifying implications for practice and recommendations for future research. Method. The CINAHL Complete, PsycINFO, Medline, and PsycArticles databases were searched, looking for full-text articles from 2018 up to march 2022. Results. There was a significant improvement in PTSD symptoms in MBCT participants, even if some experienced a high increase at baseline. MBSR participants with moderate to severe trauma symptoms showed a greater reduction in symptoms whereas mild trauma symptoms at baseline showed slightly higher symptomatology at the end of treatment. Discussion and conclusion. From the results, MBCT, MBSR, and their variations seem to tackle different domains of the diagnosis. Whilst MBSR is associated with improvements in terms of attentional difficulties, MBCT facilitates the connection between dysfunctional cognitive concepts and avoidant behaviours that maintain the symptomatology. Nevertheless, the active components of MBCT or MBSR that have an impact on symptom reduction are undetermined. Future studies will be enhanced by monitoring the change in underlying mechanisms attached to the practice of mindfulness through outcome measurements, among other considerations. (English)

Epilepsy & behavior : E&B, 2017

Although there is general consensus that psychogenic non-epileptic seizures (PNES) are treated with psychotherapy, the effectiveness of most psychotherapeutic modalities remains understudied. In this treatment series of 16 patients dually diagnosed with PNES and post-traumatic stress disorder (PTSD), we evaluated the effect of prolonged exposure therapy (PE) on reduction of PNES. Secondary measures included Beck Depression Inventory (BDI-II) and Post-Traumatic Disorder Diagnostic Scale (PDS). Subjects diagnosed with video EEG-confirmed PNES and PTSD confirmed through neuropsychological testing and clinical interview were treated with traditional PE psychotherapy with certain modifications for the PNES. Treatment was conducted over the course of 12-15 weekly sessions. Seizure frequency was noted in each session by examining the patients&#39; seizure logs, and mood and PTSD symptomatology was assessed at baseline and on the final session. Eighteen subjects enrolled, and 16 (88.8%) com...

Clinical Case Studies

Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures but are not associated with epileptic discharges in the brain. Instead, these episodes, which tend to occur with alterations in consciousness and body movements, are thought to be the result of mechanisms of conversion and dissociation. Psychological trauma and PTSD are very prevalent among patients with PNES. PNES can be conceived of as an extreme avoidance mechanism that serves the function of modulating distress and, in some cases, eliminating the precipitant stressor. Avoidance is also an essential component of PTSD. In patients who carry a dual diagnosis of PNES and PTSD, it is sensible that an empirically validated treatment for PTSD such as prolonged exposure (PE) therapy which targets avoidance by promoting exposure might be a useful approach to treat these patients. In this report, we present the case of a 52-year-old male with a 7-year history of PNES. His seizures, which were characterized ...