Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area

Jans S. van Ool, Alexandra I. Haenen, Francesca M. Snoeijen-Schouwenaars, Albert P. Aldenkamp, Jos G.M. Hendriksen, H. Jurgen Schelhaas, In Y. Tan, Richard H.C. Lazeron, Nynke M.G. Bodde

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE: To describe the main characteristics of psychogenic nonepileptic seizures (PNES) in adults with epilepsy and intellectual disability (ID), and to analyse the differences regarding psychosocial functioning, epilepsy severity and ID between patients with PNES and a control group without PNES.

METHODS: Medical records of adults with ID and epilepsy living at an epilepsy care facility (N = 240) were screened for PNES and evaluated by a neurologist. A control group consisting of patients with epilepsy and ID, without PNES, was matched according to age, sex and level of ID. Characteristics of PNES and epilepsy were provided by the subject's nursing staff or retrieved from patient charts, psychosocial data were collected by standardised questionnaires and level of ID was individually assessed using psychometric instruments.

RESULTS: The point prevalence of PNES was 7.1%. The patients with PNES (n = 15) were most often female and had a mild or moderate level of ID. Compared to controls, they showed more depressive symptoms, experienced more negative life events and had more often an ID discrepancy (ID profile with one domain particularly more impaired than another). Stress-related triggers were recognised in a large majority by the nursing staff.

CONCLUSION: PNES appears to be a relatively rare diagnostic entity among inpatients with both epilepsy and ID. However, the complexity of diagnosing PNES in this population, and the similarities in stress-related triggers for PNES in patients with and without ID, suggest that PNES may be underdiagnosed in the ID population. Diagnostic challenges of PNES and, as subcategory, reinforced behavioural patterns are discussed.

LanguageEnglish
Pages67-71
Number of pages5
JournalSeizure
Volume59
Early online date4 May 2018
DOIs
StatePublished - 1 Jul 2018

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Intellectual Disability
Epilepsy
Seizures
Nursing Staff
Control Groups
Psychometrics
Population
Medical Records
Inpatients
Depression

Keywords

  • Behaviour
  • Developmental disability
  • Differential diagnosis
  • Functional seizures
  • PNES

Cite this

van Ool, J. S., Haenen, A. I., Snoeijen-Schouwenaars, F. M., Aldenkamp, A. P., Hendriksen, J. G. M., Schelhaas, H. J., ... Bodde, N. M. G. (2018). Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area. Seizure, 59, 67-71. DOI: 10.1016/j.seizure.2018.05.002
van Ool, Jans S. ; Haenen, Alexandra I. ; Snoeijen-Schouwenaars, Francesca M. ; Aldenkamp, Albert P. ; Hendriksen, Jos G.M. ; Schelhaas, H. Jurgen ; Tan, In Y. ; Lazeron, Richard H.C. ; Bodde, Nynke M.G./ Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability : A neglected area. In: Seizure. 2018 ; Vol. 59. pp. 67-71
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title = "Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area",
abstract = "PURPOSE: To describe the main characteristics of psychogenic nonepileptic seizures (PNES) in adults with epilepsy and intellectual disability (ID), and to analyse the differences regarding psychosocial functioning, epilepsy severity and ID between patients with PNES and a control group without PNES.METHODS: Medical records of adults with ID and epilepsy living at an epilepsy care facility (N = 240) were screened for PNES and evaluated by a neurologist. A control group consisting of patients with epilepsy and ID, without PNES, was matched according to age, sex and level of ID. Characteristics of PNES and epilepsy were provided by the subject's nursing staff or retrieved from patient charts, psychosocial data were collected by standardised questionnaires and level of ID was individually assessed using psychometric instruments.RESULTS: The point prevalence of PNES was 7.1{\%}. The patients with PNES (n = 15) were most often female and had a mild or moderate level of ID. Compared to controls, they showed more depressive symptoms, experienced more negative life events and had more often an ID discrepancy (ID profile with one domain particularly more impaired than another). Stress-related triggers were recognised in a large majority by the nursing staff.CONCLUSION: PNES appears to be a relatively rare diagnostic entity among inpatients with both epilepsy and ID. However, the complexity of diagnosing PNES in this population, and the similarities in stress-related triggers for PNES in patients with and without ID, suggest that PNES may be underdiagnosed in the ID population. Diagnostic challenges of PNES and, as subcategory, reinforced behavioural patterns are discussed.",
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van Ool, JS, Haenen, AI, Snoeijen-Schouwenaars, FM, Aldenkamp, AP, Hendriksen, JGM, Schelhaas, HJ, Tan, IY, Lazeron, RHC & Bodde, NMG 2018, 'Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area' Seizure, vol. 59, pp. 67-71. DOI: 10.1016/j.seizure.2018.05.002

Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability : A neglected area. / van Ool, Jans S.; Haenen, Alexandra I.; Snoeijen-Schouwenaars, Francesca M.; Aldenkamp, Albert P.; Hendriksen, Jos G.M.; Schelhaas, H. Jurgen; Tan, In Y.; Lazeron, Richard H.C.; Bodde, Nynke M.G.

In: Seizure, Vol. 59, 01.07.2018, p. 67-71.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability

T2 - Seizure

AU - van Ool,Jans S.

AU - Haenen,Alexandra I.

AU - Snoeijen-Schouwenaars,Francesca M.

AU - Aldenkamp,Albert P.

AU - Hendriksen,Jos G.M.

AU - Schelhaas,H. Jurgen

AU - Tan,In Y.

AU - Lazeron,Richard H.C.

AU - Bodde,Nynke M.G.

PY - 2018/7/1

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N2 - PURPOSE: To describe the main characteristics of psychogenic nonepileptic seizures (PNES) in adults with epilepsy and intellectual disability (ID), and to analyse the differences regarding psychosocial functioning, epilepsy severity and ID between patients with PNES and a control group without PNES.METHODS: Medical records of adults with ID and epilepsy living at an epilepsy care facility (N = 240) were screened for PNES and evaluated by a neurologist. A control group consisting of patients with epilepsy and ID, without PNES, was matched according to age, sex and level of ID. Characteristics of PNES and epilepsy were provided by the subject's nursing staff or retrieved from patient charts, psychosocial data were collected by standardised questionnaires and level of ID was individually assessed using psychometric instruments.RESULTS: The point prevalence of PNES was 7.1%. The patients with PNES (n = 15) were most often female and had a mild or moderate level of ID. Compared to controls, they showed more depressive symptoms, experienced more negative life events and had more often an ID discrepancy (ID profile with one domain particularly more impaired than another). Stress-related triggers were recognised in a large majority by the nursing staff.CONCLUSION: PNES appears to be a relatively rare diagnostic entity among inpatients with both epilepsy and ID. However, the complexity of diagnosing PNES in this population, and the similarities in stress-related triggers for PNES in patients with and without ID, suggest that PNES may be underdiagnosed in the ID population. Diagnostic challenges of PNES and, as subcategory, reinforced behavioural patterns are discussed.

AB - PURPOSE: To describe the main characteristics of psychogenic nonepileptic seizures (PNES) in adults with epilepsy and intellectual disability (ID), and to analyse the differences regarding psychosocial functioning, epilepsy severity and ID between patients with PNES and a control group without PNES.METHODS: Medical records of adults with ID and epilepsy living at an epilepsy care facility (N = 240) were screened for PNES and evaluated by a neurologist. A control group consisting of patients with epilepsy and ID, without PNES, was matched according to age, sex and level of ID. Characteristics of PNES and epilepsy were provided by the subject's nursing staff or retrieved from patient charts, psychosocial data were collected by standardised questionnaires and level of ID was individually assessed using psychometric instruments.RESULTS: The point prevalence of PNES was 7.1%. The patients with PNES (n = 15) were most often female and had a mild or moderate level of ID. Compared to controls, they showed more depressive symptoms, experienced more negative life events and had more often an ID discrepancy (ID profile with one domain particularly more impaired than another). Stress-related triggers were recognised in a large majority by the nursing staff.CONCLUSION: PNES appears to be a relatively rare diagnostic entity among inpatients with both epilepsy and ID. However, the complexity of diagnosing PNES in this population, and the similarities in stress-related triggers for PNES in patients with and without ID, suggest that PNES may be underdiagnosed in the ID population. Diagnostic challenges of PNES and, as subcategory, reinforced behavioural patterns are discussed.

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van Ool JS, Haenen AI, Snoeijen-Schouwenaars FM, Aldenkamp AP, Hendriksen JGM, Schelhaas HJ et al. Psychogenic nonepileptic seizures in adults with epilepsy and intellectual disability: A neglected area. Seizure. 2018 Jul 1;59:67-71. Available from, DOI: 10.1016/j.seizure.2018.05.002