Psychogenic nonepileptic seizure - Revision history

Rossdonaldson1: /* Management */

2022-05-12T20:57:16Z

Management

← Older revision		Revision as of 20:57, 12 May 2022
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	==Management==		==Management==
	*Avoid invasive medical procedures		*Avoid invasive medical procedures
	*Some patients will improve after they are told the diagnosis in a compassionate, non-~~jugdemental~~ fashion.		*Some patients will improve after they are told the diagnosis in a compassionate, non-judgmental fashion.
	*If new diagnosis or diagnostic uncertainty consider admission for neurology consult and video EEG.		*If new diagnosis or diagnostic uncertainty consider admission for neurology consult and video EEG.
	*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).		*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).
	**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.		**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.
	*In case of significant emotional stress, administer a mild tranquilizing agent (e.g. [[~~Lorazepam~~]] 1-2mg IM/IV; [[~~Hydroxyzine~~]] 50-100mg IM)		*In case of significant emotional stress, administer a mild tranquilizing agent (e.g. [[lorazepam]] 1-2mg IM/IV; [[hydroxyzine]] 50-100mg IM)

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2022-05-12T20:56:49Z

Management

← Older revision		Revision as of 20:56, 12 May 2022
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	*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).		*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).
	**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.		**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.
	*In case of significant emotional stress, administer a ~~mil~~ tranquilizing agent ~~like~~ [[~~Hydroxyzine~~]] 50-~~100mg~~ IM or [[~~Lorazepam~~]] 1-~~2mg~~ IM~~/IV~~		*In case of significant emotional stress, administer a mild tranquilizing agent (e.g. [[Lorazepam]] 1-2mg IM/IV; [[Hydroxyzine]] 50-100mg IM)

	==Disposition==		==Disposition==

Beren85: /* Management */

2022-05-05T17:45:17Z

Management

← Older revision		Revision as of 17:45, 5 May 2022
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	*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).		*Psychiatric intervention is the main treatment modality (e.g. outpatient cognitive behavioral therapy).
	**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.		**The purpose of psychiatric consultation is to identify underlying psychiatric conditions that can help direct treatment.
			*In case of significant emotional stress, administer a mil tranquilizing agent like [[Hydroxyzine]] 50-100mg IM or [[Lorazepam]] 1-2mg IM/IV

	==Disposition==		==Disposition==

Beren85: /* Evaluation */

2022-05-05T17:43:16Z

Evaluation

← Older revision		Revision as of 17:43, 5 May 2022
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	*May be a clinical diagnosis		*May be a clinical diagnosis
	*Consider standard [[seizure]] workup		*Consider standard [[seizure]] workup
			**Always check glucose
	**Lactic acid may be able to differentiate from true generalized tonic-clonic seizure<ref>Ebru Apaydın Doğan, Ali Ünal, Aslıhan Ünal, Çağla Erdoğan, Clinical utility of serum lactate levels for differential diagnosis of generalized tonic–clonic seizures from psychogenic nonepileptic seizures and syncope, Epilepsy & Behavior, Volume 75, 2017, Pages 13-17, ISSN 1525-5050, https://doi.org/10.1016/j.yebeh.2017.07.003. (http://www.sciencedirect.com/science/article/pii/S1525505017304821)</ref>		**Lactic acid may be able to differentiate from true generalized tonic-clonic seizure<ref>Ebru Apaydın Doğan, Ali Ünal, Aslıhan Ünal, Çağla Erdoğan, Clinical utility of serum lactate levels for differential diagnosis of generalized tonic–clonic seizures from psychogenic nonepileptic seizures and syncope, Epilepsy & Behavior, Volume 75, 2017, Pages 13-17, ISSN 1525-5050, https://doi.org/10.1016/j.yebeh.2017.07.003. (http://www.sciencedirect.com/science/article/pii/S1525505017304821)</ref>
			*Consider obtaining a drug screen (and a pregnancy test in women)
	*If unsure, an urgent neuro consult with EEG can determine the diagnosis		*If unsure, an urgent neuro consult with EEG can determine the diagnosis

Beren85: /* Background */

2022-05-05T17:40:55Z

Background

← Older revision		Revision as of 17:40, 5 May 2022
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	**Estimated incidence rate ranges from 1.5 to 5 per 100,000 persons per year.		**Estimated incidence rate ranges from 1.5 to 5 per 100,000 persons per year.
	**Estimate prevalence 2 to 33 per 100,000 persons.		**Estimate prevalence 2 to 33 per 100,000 persons.
			**More common in women
	*Etiology		*Etiology
			**There may be a history of sexual abuse, eating disorders, depression, substance abuse, anxiety disorders or personality disorders, and the episode may be preceded by a stressful event
	**Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.		**Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.
	*Some patients may have both psychogenic nonepileptic seizures '''and''' true epileptiform [[seizures]]		*Some patients may have both psychogenic nonepileptic seizures '''and''' true epileptiform [[seizures]]

Elcatracho: /* Evaluation */

2021-01-18T04:21:14Z

Evaluation

← Older revision		Revision as of 04:21, 18 January 2021
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	*May be a clinical diagnosis		*May be a clinical diagnosis
	*Consider standard [[seizure]] workup		*Consider standard [[seizure]] workup
			**Lactic acid may be able to differentiate from true generalized tonic-clonic seizure<ref>Ebru Apaydın Doğan, Ali Ünal, Aslıhan Ünal, Çağla Erdoğan, Clinical utility of serum lactate levels for differential diagnosis of generalized tonic–clonic seizures from psychogenic nonepileptic seizures and syncope, Epilepsy & Behavior, Volume 75, 2017, Pages 13-17, ISSN 1525-5050, https://doi.org/10.1016/j.yebeh.2017.07.003. (http://www.sciencedirect.com/science/article/pii/S1525505017304821)</ref>
	*If unsure, an urgent neuro consult with EEG can determine the diagnosis		*If unsure, an urgent neuro consult with EEG can determine the diagnosis

ClaireLewis at 04:38, 3 October 2019

2019-10-03T04:38:43Z

← Older revision		Revision as of 04:38, 3 October 2019
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	*Etiology		*Etiology
	**Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.		**Dissociative disorders and conversion disorders are felt to be the underlying cause to most episodes of PNES.
			*Some patients may have both psychogenic nonepileptic seizures '''and''' true epileptiform [[seizures]]

	==Clinical Features==		==Clinical Features==
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	**Rapid eye movements		**Rapid eye movements
	**Tongue biting		**Tongue biting
	**Loss of bladder/bowel control		**[[urinary incontinence\|Loss of bladder]]/bowel control
	**Grunting		**Grunting
	**Loss of consciousness		**[[syncope\|Loss of consciousness]]
	**Altered mental status		**[[Altered mental status]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 02:43, 11 June 2018

2018-06-11T02:43:24Z

← Older revision		Revision as of 02:43, 11 June 2018
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	==External Links==		==External Links==


	==References==		==References==

Rossdonaldson1: /* See Also */

2018-06-11T02:42:21Z

Rossdonaldson1: /* Disposition */

2018-06-11T02:42:04Z

Disposition

← Older revision		Revision as of 02:42, 11 June 2018
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	*If symptoms improve consider discharge with close neurology and psychiatry follow-up to rule out epilepsy and identify and treat the underlying psychiatric origin of symptoms.		*If symptoms improve consider discharge with close neurology and psychiatry follow-up to rule out epilepsy and identify and treat the underlying psychiatric origin of symptoms.
	*If symptoms cannot be controlled or patient/family are not accepting of diagnosis. Consider admission for observation and further evaluation.		*If symptoms cannot be controlled or patient/family are not accepting of diagnosis. Consider admission for observation and further evaluation.
	*Prognosis:
	**25-38 percent of patients achieve seizure freedom		==Prognosis==
	**Children have a better prognosis than adults, with 70 to 80 ~~percent~~ achieving ~~seizure~~ remission		*25-38 percent of patients achieve "seizure" freedom
			*Children have a better prognosis than adults, with 70-80% achieving remission

	==See Also==		==See Also==

← Older revision		Revision as of 02:42, 11 June 2018
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	==See Also==		==See Also==
			*[[Seizure]]

	==External Links==		==External Links==