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Chapter 32 - Pharmacological Treatments for Psychogenic Nonepileptic Seizures

from Section 5 - Treatment Considerations for Psychogenic Nonepileptic Seizures

Published online by Cambridge University Press:  18 May 2018

W. Curt LaFrance, Jr
Brown Medical School, Providence
Steven C. Schachter
Beth Israel Deaconess Medical Center, Boston
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Publisher: Cambridge University Press
Print publication year: 2018

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LaFrance, WC Jr., Devinsky, O. Treatment of nonepileptic seizures. Epilepsy Behav 2002;3(5 Suppl 1):S1923.CrossRefGoogle ScholarPubMed
Gates, JR, Luciano, D, Devinsky, O. The classification and treatment of nonepileptic events. In: Devinsky, O, Theodore, WH, eds. Epilepsy and Behavior, Chapter 18. New York: Wiley-Liss, 1991; 251263.Google Scholar
Devinsky, O. Nonepileptic psychogenic seizures: quagmires of pathophysiology, diagnosis, and treatment. Epilepsia 1998;39:458462.CrossRefGoogle ScholarPubMed
Kanner, AM, Palac, SM, Lancman, ME, Lambrakis, CC, Steinhardt, MI. Treatment of psychogenic pseudoseizures: what to do after we have reached the diagnosis? In: Ettinger, AB, Kanner, AM, eds. Psychiatry Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment. Philadelphia, PA: Lippincott Williams & Wilkins, 2001;379390.Google Scholar
Iriarte, J, Parra, J, Urrestarazu, E, Kuyk, J. Controversies in the diagnosis and management of psychogenic pseudoseizures. Epilepsy Behav 2003;4:354359.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Barry, JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav 2005;7:364374.CrossRefGoogle ScholarPubMed
Baker, GA, Brooks, JL, Goodfellow, L, Bodde, N, Aldenkamp, A. Treatments for non-epileptic attack disorder. Cochrane Database Syst Rev 2007;(1):CD006370.
Chen, DK, LaFrance, WC. Diagnosis and treatment of nonepileptic seizures. Continuum (Minneap Minn) 2016;22(1, Epilepsy):116131.Google ScholarPubMed
LaFrance, WC Jr., Reuber, M, Goldstein, LH. Management of psychogenic nonepileptic seizures. Epilepsia 2013;54(Suppl 1):5367.CrossRefGoogle ScholarPubMed
Reuber, M, Elger, CE. Psychogenic nonepileptic seizures: an overview. In: Schachter, SC, Holmes, GL, Kasteleijn-Nolst, Trenité D, eds. Behavioral Aspects of Epilepsy: Principles and Practice, Chapter 52. New York: Demos, 2008;411419.Google Scholar
Bowman, ES, Markand, ON. Diagnosis and treatment of pseudoseizures. Psychiatr Ann 2005;35:306316.Google Scholar
Lempert, T, Schmidt, D. Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol 1990;237:3538.CrossRefGoogle ScholarPubMed
Betts, T, Boden, S. Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I. Seizure 1992;1:1926.CrossRefGoogle ScholarPubMed
Kanner, AM, Parra, J, Frey, M, et al. Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology 1999;53:933938.CrossRefGoogle ScholarPubMed
Blumer, D. On the psychobiology of non-epileptic seizures. In: Gates, JR, Rowan, AJ, eds. Non-Epileptic Seizures, 2nd edn, Chapter 24. Boston: Butterworth-Heinemann, 2000;305310.Google Scholar
Braun, B. Unusual medication regimens in the treatment of dissociative disorder patients. Part 1: Noradrenergic agents. Dissociation 1990;3:144150.Google Scholar
Blumer, D, Montouris, G, Hermann, B. Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci 1995;7:445456.Google ScholarPubMed
LaFrance, WC Jr., Baird, GL, Barry, JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 2014;71:9971005.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Ranieri, R, Baird, GB, Blum, A, Keitner, G. One year follow up of cognitive behavioral therapy-informed psychotherapy treatment trial for psychogenic nonepileptic seizures. American Epilepsy Society Annual Meeting Abstract 3.237. 2015.
Mökleby, K, Blomhoff, S, Malt, UF, et al. Psychiatric comorbidity and hostility in patients with psychogenic nonepileptic seizures compared with somatoform disorders and healthy controls. Epilepsia 2002;43:193198.CrossRefGoogle ScholarPubMed
Reuber, M, Fernandez, G, Bauer, J, Helmstaedter, C, Elger, CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology 2002;58:493495.CrossRefGoogle ScholarPubMed
Benbadis, SR. How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? Eur Neurol 1999;41:114115.CrossRefGoogle Scholar
Wyler, AR, Hermann, BP, Blumer, D, Richey, ET. Pseudo-pseudoepileptic seizures. In: Rowan, AJ, Gates, JR, eds. Non-Epileptic Seizures, 1st edn, Chapter 8. Stoneham, MA: Butterworth-Heinemann, 1993; 7384.Google Scholar
Pakalnis, A, Paolicchi, J, Gilles, E. Psychogenic status epilepticus in children: psychiatric and other risk factors. Neurology 2000;54:969970.CrossRefGoogle ScholarPubMed
Holtkamp, M, Othman, J, Buchheim, K, Meierkord, H. Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting. Neurology 2006;66:17271729.CrossRefGoogle ScholarPubMed
Gunatilake, SB, De Silva, HJ, Ranasinghe, G. Twenty-seven venous cutdowns to treat pseudostatus epilepticus. Seizure 1997;6:7172.CrossRefGoogle ScholarPubMed
Pakalnis, A, Drake, ME Jr., Phillips, B. Neuropsychiatric aspects of psychogenic status epilepticus. Neurology 1991;41:11041106.CrossRefGoogle ScholarPubMed
Rechlin, T, Loew, TH, Joraschky, P. Pseudoseizure “status”. J Psychosom Res 1997;42:495498.CrossRefGoogle ScholarPubMed
Britton, J, Rathke, K, Cascino, G, Cicora, KM, Schauble, B. Abstract 2.098. Vagus nerve stimulator implantation in patients with nonepileptic events: a costly result of misdiagnosis. Epilepsia 2002;43(Suppl 7):161.Google Scholar
Henry, TR, Drury, I. Non-epileptic seizures in temporal lobectomy candidates with medically refractory seizures. Neurology 1997;48:13741382.CrossRefGoogle ScholarPubMed
Krahn, LE, Reese, MM, Rummans, TA, et al. Health care utilization of patients with psychogenic nonepileptic seizures. Psychosomatics 1997;38:535542.CrossRefGoogle ScholarPubMed
Niedermeyer, E, Blumer, D, Holscher, E, Walker, BA. Classical hysterical seizures facilitated by anticonvulsant toxicity. Psychiatr Clin (Basel) 1970;3:7184.Google ScholarPubMed
Krumholz, A, Niedermeyer, E. Psychogenic seizures: a clinical study with follow-up data. Neurology 1983;33:498502.CrossRefGoogle ScholarPubMed
Oto, M, Espie, C, Pelosi, A, Selkirk, M, Duncan, R. The safety of antiepileptic drug withdrawal in patients with non-epileptic seizures. J Neurol Neurosurg Psychiatry 2005;76:16821685.CrossRefGoogle ScholarPubMed
Duncan, R. The withdrawal of antiepileptic drugs in patients with non-epileptic seizures: safety considerations. Expert Opin Drug Saf 2006;5:609613.CrossRefGoogle ScholarPubMed
Mondon, K, de Toffol, B, Praline, J, et al. Comorbidité psychiatrique au cours des événements non épileptiques: étude rétrospective dans un centre de vidéo-EEG [Psychiatric comorbidity in patients with pseudoseizures: retrospective study conducted in a video-EEG center]. Rev Neurol (Paris) 2005;161:10611069.CrossRefGoogle Scholar
Bowman, ES, Markand, ON. Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry 1996;153:5763.Google ScholarPubMed
Benbadis, SR, Agrawal, V, Tatum IV, WO. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 2001;57:915917.CrossRefGoogle ScholarPubMed
Ozkara, C, Dreifuss, FE. Differential diagnosis in pseudoepileptic seizures. Epilepsia 1993;34:294298.CrossRefGoogle ScholarPubMed
Walczak, TS, Williams, DT, Berten, W. Utility and reliability of placebo infusion in the evaluation of patients with seizures. Neurology 1994;44:394399.CrossRefGoogle ScholarPubMed
Devinsky, O, Gordon, E. Epileptic seizures progressing into nonepileptic conversion seizures. Neurology 1998;51:12931296.CrossRefGoogle ScholarPubMed
Blumer, D, Adamolekun, B. Treatment of patients with coexisting epileptic and nonepileptic seizures. Epilepsy Behav 2006;9:498502.CrossRefGoogle ScholarPubMed
Matsumoto, J, Hallett, M. Startle syndromes. In: Marsden, CD, Fahn, S, eds. Movement Disorders 3. Oxford, Boston: Butterworth-Heinemann, 1994; 418433.Google Scholar
Blumer, D. The biologic basis of hysteria and its polarity to epilepsy. Szondiana 2005;5:1619.Google Scholar
Blumer, D, Rice, S, Adamolekun, B. Electroconvulsive treatment for nonepileptic seizure disorders. Epilepsy Behav 2009;15:382387.CrossRefGoogle ScholarPubMed
Ramani, V, Gumnit, RJ. Management of hysterical seizures in epileptic patients. Arch Neurol 1982;39:7881.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Devinsky, O. The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia 2004;45(Suppl 2):1521.CrossRefGoogle ScholarPubMed
Reuber, M, Pukrop, R, Bauer, J, et al. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003;53:305311.CrossRefGoogle ScholarPubMed
Walker, MC, Howard, RS, Smith, SJ, et al. Diagnosis and treatment of status epilepticus on a neurological intensive care unit. QJM 1996;89:913920.CrossRefGoogle ScholarPubMed
O'Malley, PG, Jackson, JL, Santoro, J, et al. Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Pract 1999;48:980990.Google ScholarPubMed
Voon, V. Treatment of psychogenic movement disorder: psychotropic medications. In: Hallett, M, Fahn, S, Jankovic, J, et al., eds. Psychogenic Movement Disorders: Neurology and Neuropsychiatry, Chapter 34. Philadelphia: Lippincott Williams & Wilkins, and American Academy of Neurology Press, 2006; 302310.Google Scholar
Lambert, C, Rees, WL. Intravenous barbiturates in the treatment of hysteria. Br Med J 1944;2:7073.CrossRefGoogle ScholarPubMed
Shulman, KI, Silver, IL. Hysterical seizures as a manifestation of “depression” in old age. Can J Psychiatry 1985;30:278280.Google ScholarPubMed
Ramani, V. Review of psychiatric treatment strategies in non-epileptic seizures. In: Rowan, AJ, Gates, JR, eds. Non-Epileptic Seizures, 1st edn, Chapter 25. Stoneham, MA: Butterworth-Heinemann, 1993;259267.Google Scholar
Bowman, ES. Nonepileptic seizures. Curr Treat Options Neurol 2000;2:559570.CrossRefGoogle ScholarPubMed
Rampello, L, Raffaele, R, Nicoletti, G, et al. Hysterical neurosis of the conversion type: therapeutic activity of neuroleptics with different hyperprolactinemic potency. Neuropsychobiology 1996;33:186188.CrossRefGoogle ScholarPubMed
LaFrance, WC Jr., Blum, AS, Miller, IW, Ryan, CE, Keitner, GI. Methodological issues in conducting treatment trials for psychological nonepileptic seizures. J Neuropsychiatry Clin Neurosci 2007;19:391398.CrossRefGoogle ScholarPubMed
Ataoglu, A, Sir, A, Ozkan, M. Paradoxical therapy in conversion disorder. Turk J Med Sci 1998;28:419421.Google Scholar
LaFrance, WC Jr., Keitner, GI, Papandonatos, GD, et al. Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures. Neurology 2010;75:11661173.CrossRefGoogle ScholarPubMed
Sieveking, EH. Analysis of fifty-two cases of epilepsy observed by the author. Lancet 1857;1:527528.Google Scholar
Gowers, WR. Treatment. Hysteroid attacks. In: Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms, and Treatment, 2nd edn, Chapter XII. London: Churchill, 1901;299301.Google Scholar
Ataoglu, A, Ozcetin, A, Icmeli, C, Ozbulut, O. Paradoxical therapy in conversion reaction. J Korean Med Sci 2003;18:581584.CrossRefGoogle ScholarPubMed
Vaswani, M, Linda, FK, Ramesh, S. Role of selective serotonin reuptake inhibitors in psychiatric disorders: a comprehensive review. Progr Neuropsychopharmacol Biol Psychiatry 2003;27:85102.CrossRefGoogle ScholarPubMed
Brown, RJ, Schrag, A, Trimble, MR. Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry 2005;162:899905.CrossRefGoogle ScholarPubMed
Roelofs, K, Keijsers, GP, Hoogduin, KA, Naring, GW, Moene, FC. Childhood abuse in patients with conversion disorder. Am J Psychiatry 2002;159:19081913.CrossRefGoogle ScholarPubMed
Southwick, SM, Paige, S, Morgan, CA 3rd, et al. Neurotransmitter alterations in PTSD: catecholamines and serotonin. Semin Clin Neuropsychiatry 1999;4:242248.Google ScholarPubMed
Nutt, DJ. The psychobiology of posttraumatic stress disorder. J Clin Psychiatry 2000;61(Suppl 5):2429; discussion 3022.Google ScholarPubMed
Pearlstein, T. Antidepressant treatment of posttraumatic stress disorder. J Clin Psychiatry 2000;61(Suppl 7):4043.Google ScholarPubMed
Van der Kolk, BA. The body keeps the score: approaches to the psychobiology of posttraumatic stress disorder. In: Van der Kolk, BA, McFarlane, AC, Weisaeth, L, eds. Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: Guilford Press, 1996; 214241.Google Scholar
Varia, I, Logue, E, O'Connor, C, et al. Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin. Am Heart J 2000;140:367372.CrossRefGoogle ScholarPubMed
Menza, M, Lauritano, M, Allen, L, et al. Treatment of somatization disorder with nefazodone: a prospective, open-label study. Ann Clin Psychiatry 2001;13:153158.CrossRefGoogle ScholarPubMed
March, JS, Silva, S, Petrycki, S, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry 2007;64:11321143.Google ScholarPubMed
Glass, RM. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. J Pediatr 2005;146:145.CrossRefGoogle ScholarPubMed
Lenze, EJ, Dew, MA, Mazumdar, S, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: effects on social adjustment. Am J Psychiatry 2002;159:466468.CrossRefGoogle ScholarPubMed
Sammons, MT, Schmidt, NB. Combined Treatments for Mental Disorders. A Guide to Psychological and Pharmacological Interventions, 1st edn. Washington, DC: American Psychological Association, 2001.CrossRef
Pettit, JW, Voelz, ZR, Joiner, TE Jr. Combined treatments for depression. In: Sammons, MT, Schmidt, NB, eds. Combined Treatments for Mental Disorders. A Guide to Psychological and Pharmacological Interventions, 1st edn. Washington, DC: American Psychological Association, 2001;131159.CrossRefGoogle Scholar
Barlow, DH, Gorman, JM, Shear, MK, Woods, SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA 2000;283:25292536.CrossRefGoogle ScholarPubMed
Berlin, HA. Antiepileptic drugs for the treatment of post-traumatic stress disorder. Curr Psychiatry Rep 2007;9:291300.CrossRefGoogle ScholarPubMed
McEwen, BS. Allostasis, allostatic load, and the aging nervous system: role of excitatory amino acids and excitotoxicity. Neurochem Res 2000;25:12191231.CrossRefGoogle ScholarPubMed
McEwen, BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology 2000;22:108124.CrossRefGoogle ScholarPubMed
Benbadis, SR. A spell in the epilepsy clinic and a history of “chronic pain” or “fibromyalgia” independently predict a diagnosis of psychogenic seizures. Epilepsy Behav 2005;6:264265.CrossRefGoogle ScholarPubMed
Hantke, NC, Doherty, MJ, Haltiner, AM. Medication use profiles in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2007;10:333335.CrossRefGoogle ScholarPubMed
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