Convulsive Pseudoseizures: A Review of Current Concepts

Convulsive pseudoseizures thought to represent psychiatric disease can usually be detected early if they are considered in the epileptologist's differential diagnosis. No single diagnostic criterion for this behavioural disorder is known to be pathognomonic. Epilepsy and all physiological explanations have to be thoroughly ruled out and positive evidence of relevant psychopathology has to be gathered. The presence of pseudo seizures often heralds severe psychopathology, most frequently major affective disorder and major personality disorder, and occasionally, factitious disorder. Pseudoseizures can coexist with epileptic seizures and are often triggered by anticonvulsant toxicity. Diagnostic problems are more likely to be encountered in patients with frontal or parietal epilepsies, and in patients whose severe psychopathology is refractory to psychiatric intervention

Emotional processing in early and late stage non-demented Parkinson's disease patients

Background: The basal ganglia are thought to be critical for the expression and possibly the perception of emotions. Processing of emotional faces was found to be impaired in Parkinson's disease (PD) in some but not all studies. The aim of this study was to test whether performance in emotion discrimination would differ as a function of stage of the disease. Method: Early (N=21) and late stage (N=18) nondemented PD patients, and healthy controls (N=21), matched for age, sex and education level were studied. Early PD patients (mean±S.D. age: 61.7± 8.6; Hoehn and Yahr rating score: 2±0.5; PD duration (year): 3.9±1.9), had no signs of dementia as per the Mattis Dementia Rating Scale. Late stage PD patients (mean±S.D. age: 61.2± 9.5; H&Y: 3.9±0.5; disease duration (year): 11.9±5.4), were candidates for STNDBS neurosurgery, and not demented as per a comprehensive neuropsychological assessment (CAPSIT); a sub-sample was reassessed under STN-DBS. Emotion discrimination was assessed with a computeradministered task presenting facial exemplars of basic emotions paired to convey the same or different emotions. Results: Late but not early stage PD patients showed significantly lower performance than healthy controls in emotion discrimination (p<0.0001). Performance did not differ on a control task for face recognition (Benton); lower performance in advanced PD was not explained by other variables such as depression, or impairments in executive functions. Conclusion: Emotional processing is impaired in non-demented late stage PD patients and appears to be stage dependent

Mood stability during acute stimulator challenge in Parkinson's disease patients under long-term treatment with subthalamic deep brain stimulation

Acute and chronic behavioral effects of subthalamic stimulation (STN-DBS) for Parkinson's disease (PD) are reported in the literature. As the technique is relatively new, few systematic studies on the behavioral effects in long-term treated patients are available. To further study the putative effects of STN-DBS on mood and emotional processing, 15 consecutive PD patients under STN-DBS for at least 1 year, were tested ON and OFF stimulation while on or off medication, with instruments sensitive to short-term changes in mood and in emotional discrimination. After acute changes in experimental conditions, mood core dimensions (depression, elation, anxiety) and emotion discrimination processing remained remarkably stable, in the face of significant motor changes. Acute stimulator challenge in long-term STN-DBS-treated PD patients does not appear to provoke clinically relevant mood effects. © 2007 Movement Disorder Societ