Sex differences in demographic and clinical characteristics of psychogenic nonepileptic seizures: A retrospective multicenter international study

Purpose Sex-related differences have been reported in patients with neurological and psychiatric disorders. It is also plausible to assume that there might be differences between females and males with psychogenic nonepileptic seizures (PNES). Methods In this retrospective study, we investigated patients with PNES, who were admitted to the epilepsy monitoring units at centers in Iran, the USA, Canada, Brazil, Argentina, and Venezuela. Age, sex, age at seizure onset, seizure semiology, factors potentially predisposing to PNES, and video-electroencephalography recording of all patients were registered routinely. Results Four hundred and fifty-one patients had PNES-only and were eligible for inclusion; 305 patients (67.6%) were females. We executed a logistic regression analysis, evaluating significant variables in univariate analyses (i.e., age, age at onset, aura, presence of historical sexual or physical abuse, and family dysfunction). The only variables retaining significance were historical sexual abuse (p = 0.005) and presence of aura (p = 0.01); physical abuse was borderline significant (p = 0.05) (all three were more prevalent among females). Conclusion Similarities between females and males outweigh the differences with regard to the demographic and clinical characteristics of PNES. However, notable differences are that females more often report lifetime adverse experiences (sexual and probably physical abuse) and auras. While social, psychological, and genetic factors may interact with lifetime adverse experiences in the inception of PNES, the link is not yet clear. This is an interesting avenue for future studies.Fil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences; Irán. Thomas Jefferson University; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette Dualibi Ramos. Universidade de Sao Paulo; BrasilFil: Daza Restrepo, Anilu. La Trinidad Medical Center; VenezuelaFil: D`alessio, Luciana. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Sawchuk, Tyson. Alberta Children's Hospital; Canadá. University of Nicosia; ChipreFil: Homayoun, Maryam. Shiraz University of Medical Sciences; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Buchhalter, Jeffrey. Alberta Children's Hospital; Canadá. University of Calgary; CanadáFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados UnidosFil: Pick, Susannah. Kings' College London; Reino UnidoFil: Nicholson, Timothy. Kings' College London; Reino Unid

Clinical characteristics of psychogenic nonepileptic seizures across the lifespan:An international retrospective study

Purpose: Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. Methods: In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). Results: A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). Conclusion: While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.Fil: Sawchuk, Tyson. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; ChipreFil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences. Shiraz Medical School; Irán. Thomas Jefferson University. Jefferson Comprehensive Epilepsy Center. Department of Neurology; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette D.. Universidade de Sao Paulo; BrasilFil: Restrepo, Anilu Daza. Universidade de Sao Paulo; BrasilFil: D'Alessio, Luciana. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Homayoun, Maryam. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados Unidos. Hackensack University Medical Center. Hackensack Meridian School of Medicine; Estados UnidosFil: Pick, Susannah. King's College London; Reino UnidoFil: Nicholson, Timothy R.. Kings' College London. Institute of Psychiatry, Psychology and Neuroscience. Section of Cognitive Neuropsychiatry; Reino UnidoFil: Buchhalter, Jeffrey. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; Chipre. University of Calgary; Canad

Pediatric-onset psychogenic nonepileptic seizures: A retrospective international multicenter study

Purpose: We compared various clinical characteristics of pediatric-onset psychogenic nonepileptic seizures(PNES) between patients from fie countries. The purpose of this study was to advance our understanding ofpediatric-onset PNES cross-culturally.Methods: In this retrospective study, we compared consecutive patients with PNES with an age at onset of 16years and younger from epilepsy monitoring units in Iran, Brazil, the USA, Canada, and Venezuela. Age, gender,age at seizure onset, seizure semiology, predisposing factors, and video-EEG recordings of all patients wereextracted. Pearson Chi-Square, one-way ANOVA and Bonferroni correction tests were used for statistical analyses.Results: Two hundred twenty-nine patients were studied (83 from Iran, 50 from Brazil, 39 from Canada, 30 fromthe USA, and 27 from Venezuela). Mean age at the onset of seizures was 12.1 ± 3.2 years (range: 4?16 years).The sex ratio of the patients was 1.83: 1 (148 females and 81 males). Clinical characteristics of pediatric-onsetPNES showed some signifiant diffrences among the nations. However, factors associated with pediatric-onsetPNES in these fie nations were similar.Conclusion: This study underscores how international cross-cultural studies can make important contributions toour understanding of PNES. Patients with pediatric-onset PNES from diffrent countries were similar on manyrisk factors associated with PNES. This suggests universality in many features of PNES. However, intriguingdiffrences were also noted with regard to seizure semiology, which might be the result of cultural factors.Fil: Asadi Pooya, Ali A.. Universidad de Ciencias Médicas, Shiraz; Irán. Universidad Thomas Jefferson; Estados UnidosFil: Myers, Lorna. Grupo regional de epilepsia del noreste; Estados UnidosFil: Valente, Kette. Universidad de Sao Paulo; BrasilFil: Sawchuk, Tyson. Hospital de niños de Alberta, Calgary; Canadá. Universidad de Nicosia; ChipreFil: Daza Restrepo, Anilu. Centro Médico La Trinidad; VenezuelaFil: Homayouna, Maryam. Universidad de Ciencias Médicas, Shiraz; IránFil: Buchhalter, Jeffey. Universidad de Nicosia; Chipre. Universidad de Calgary; CanadáFil: Bahramia, Zahra. Universidad de Ciencias Médicas, Shiraz; IránFil: Taha, Firas. Grupo regional de epilepsia del noreste; Estados UnidosFil: Lazar, Lorraine M.. Grupo regional de epilepsia del noreste; Estados UnidosFil: Aroni Paytan, Angélica. Centro Médico La Trinidad; VenezuelaFil: D`alessio, Luciana. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina; ArgentinaFil: Alessi, Rudá. Universidad de Sao Paulo; BrasilFil: Pick, Susannah. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino UnidoFil: Nicholson, Timothy R.. Instituto de Psiquiatría, Psicología y Neurociencia, King's College London; Reino Unid

Working restrictions and disability benefits eligibility in patients with functional (psychogenic) seizures: An international survey of physicians' opinions

Objectives: In this international study, we aimed to investigate the opinions of physicians dealing with patients with functional seizures (FS) worldwide on working restrictions and disability benefits eligibility. Methods: International online survey of neurologists/mental health professionals from Argentina, Venezuela, Colombia, Italy, France, Iran, Iraq, United Arab Emirates (UAE), Qatar, Saudi Arabia, Georgia, and Russia. Results: Six hundred and twenty-seven physicians from 12 countries participated in the study. Working as a neurologist was a predictor to think that patients with FS should not be counseled to avoid performing all jobs or professions as long as they have active disease (OR: 0.46; 95% CI: 0.30 to 0.68; p < 0.001). Having managed more than 200 patients was associated with the opinion that patients should not be counseled to avoid performing any type of work (OR: 2.17; 95% CI: 1.02 to 4.59; p = 0.043). Working as a psychiatrist/psychologist was associated with the idea that patients with FS should be qualified for disability benefits (OR: 1.97; 95% CI: 1.21-3.21; p = 0.006), and receive these benefits lifelong (OR: 0.43; 95% CI: 0.22-0.84; p = 0.014). Conclusion: Neurologists and mental health professionals have different attitudes and opinions toward working restrictions and disability benefits for patients with FS. Further studies should investigate the reasons for these differences, and propose solutions to avoid discrimination and unequal access to employment and disability benefits

Working restrictions and disability benefits eligibility in patients with functional (psychogenic) seizures: An international survey of physicians’ opinions

Objectives: In this international study, we aimed to investigate the opinions of physicians dealing with patients with functional seizures (FS) worldwide on working restrictions and disability benefits eligibility. Methods: International online survey of neurologists/mental health professionals from Argentina, Venezuela, Colombia, Italy, France, Iran, Iraq, United Arab Emirates (UAE), Qatar, Saudi Arabia, Georgia, and Russia. Results: Six hundred and twenty-seven physicians from 12 countries participated in the study. Working as a neurologist was a predictor to think that patients with FS should not be counseled to avoid performing all jobs or professions as long as they have active disease (OR: 0.46; 95% CI: 0.30 to 0.68; p < 0.001). Having managed more than 200 patients was associated with the opinion that patients should not be counseled to avoid performing any type of work (OR: 2.17; 95% CI: 1.02 to 4.59; p = 0.043). Working as a psychiatrist/psychologist was associated with the idea that patients with FS should be qualified for disability benefits (OR: 1.97; 95% CI: 1.21–3.21; p = 0.006), and receive these benefits lifelong (OR: 0.43; 95% CI: 0.22–0.84; p = 0.014). Conclusion: Neurologists and mental health professionals have different attitudes and opinions toward working restrictions and disability benefits for patients with FS. Further studies should investigate the reasons for these differences, and propose solutions to avoid discrimination and unequal access to employment and disability benefits.Fil: Asadi Pooya, Ali A.. Shiraz University Of Medical Sciences; IránFil: Brigo, Francesco. Hospital Of Merano; ItaliaFil: Lattanzi, Simona. Universitã Politecnica Delle Marche; ItaliaFil: Daza-Restrepo, Anilu. Centro Medico Docente la Trinidad; VenezuelaFil: D`alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Calle-Lopez, Yamile. Universidad de Antioquia; ColombiaFil: Hingray, Coraline. No especifíca;Fil: Alsaadi, Taoufik. No especifíca;Fil: Mesraoua, Boulenouar. No especifíca;Fil: Gigineishvili, David. No especifíca;Fil: Kutlubaev, Mansur A.. Bashkir State Medical University; RusiaFil: Yaghmoor, Bassam E.. King Abdulaziz University; Arabia SauditaFil: Aljandeel, Ghaieb Bashar. No especifíca;Fil: Sarudiasnky, Mercedes. Universidad de Buenos Aires; ArgentinaFil: Scévola, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Contreras, Guilca. Centro Medico Docente la Trinidad; VenezuelaFil: Lozada, Maria E.. Centro Medico Docente la Trinidad; Venezuel

Physicians' beliefs about brain surgery for drug-resistant epilepsy: A global survey

Purpose: To investigate the opinions of physicians about brain surgery for drug-resistant epilepsy worldwide. Methods: Practicing neurologists, psychiatrists, and neurosurgeons from around the world were invited to participate in an online survey. The survey anonymously collected data about demographics, years in clinical practice, discipline, nation, work setting, and answers to the questions about beliefs and attitudes about brain surgery for drug-resistant epilepsy. Results: In total, 1410 physicians from 20 countries and different world regions participated. The propensity to discuss brain surgery with patients, who have drug-resistant seizures, was higher among men (versus women) [Odds Ratio (OR) 1.67, 95% CI 1.20-2.31; p = 0.002]. In comparison to neurologists, psychiatrists were less likely (OR 0.28, 95% CI 0.17-0.47; p < 0.001) and neurosurgeons were more likely (OR 2.00, 95% CI 1.08-3.72; p = 0.028) to discuss about it. Survey participants working in Africa, Asia, the Middle East, and the Former Union of Soviet Socialist Republics showed a lower propensity to discuss epilepsy surgery with patients. Conclusion: This study showed that on an international level, there is still a knowledge gap concerning epilepsy surgery and much needs to be done to identify and overcome barriers to epilepsy surgery for patients with drug-resistant seizures worldwide

Complementary and alternative medicine in epilepsy: A global survey of physicians’ opinions

Purpose: To investigate the opinions of physicians on the use of complementary and alternative medicine (CAM) in patients with epilepsy (PWE) worldwide. Methods: Online survey addressed to neurologists and psychiatrists from different countries. Results: Totally, 1112 physicians from 25 countries (different world region: Europe, North America, South America, Middle-East, Africa, Former Soviet Union Republics) participated; 804 (72.3%) believed that CAM might be helpful in PWE. The most commonly endorsed CAM included meditation (41%) and yoga (39%). Female sex, psychiatry specialization, and working in North and South America were associated with the belief that CAM is helpful in PWE. Two-hundred and forty five out of 1098 participants (22.3%) used/prescribed CAM to PWE; among them, 174 (71%) people perceived CAM to be less effective and 114 (46.5%) people found CAM to be safer than conventional antiseizure medications (ASMs). The most common reasons to prescribe CAM for PWE were: to satisfy the patient (49.9%), dissatisfaction with the efficacy (35.6%), and dissatisfaction with the adverse effects (31.2%) of conventional therapies. Conclusion: Although the evidence supporting the use of CAM for the treatment of epilepsy is extremely sparse, most physicians worldwide believe that it could be integrated with the use of conventional ASMs, at least in some patients. High-quality controlled trials are warranted to provide robust evidence on the usefulness of CAM options in PWE.Fil: Asadi Pooya, Ali A.. Thomas Jefferson University; Estados UnidosFil: Brigo, Francesco. Hospital of Merano; ItaliaFil: Lattanzi, Simona. Università Politecnica Delle Marche; ItaliaFil: Karakis, Ioannis. University of Emory; Estados UnidosFil: Asadollahi, Marjan. Shahid Beheshti University Of Medical Sciences; IránFil: Trinka, Eugen. Paracelsus Medical University; Austria. Centre for Cognitive Neuroscience; AustriaFil: Talaat El Ghoneimy, Lobna. Cairo University; EgiptoFil: Pretorius, Chrisma. Stellenbosch University; SudáfricaFil: Contreras, Guilca. Hospital Metropolitano; EcuadorFil: Daza Restrepo, Anilu. La Trinidad Medical Center; VenezuelaFil: Valente, Kette. Universidade de Sao Paulo; BrasilFil: D`alessio, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Turuspekova, Saule T.. Asfendiyarov Kazakh National Medical University; KazajistánFil: Aljandeel, Ghaieb. Medical City; IraqFil: Khachatryan, Samson. National Institute Of Health; ArmeniaFil: Ashkanani, Abdulaziz. Ahmadi Hospital; KuwaitFil: Tomson, Torbjörn. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Kutlubaev, Mansur. Bashkir State Medical University; RusiaFil: Guekht, Alla. Pirogov Russian National Research Medical University; RusiaFil: Alsaadi, Taoufik. American Center for Psychiatry and Neurology; Emiratos Arabes UnidosFil: Calle Lopez, Yamile. Universidad de Antioquia; ColombiaFil: Mesraoua, Boulenouar. Weill Cornell Medical College; Qatar. Hamad Medical Corporation; QatarFil: Ríos Pohl, Loreto. Clinica Integral de Epilepsia Infanto-Juvenil; ChileFil: Al-Asmi, Abdullah. Sultan Qaboos University; OmánFil: Villanueva, Vicente. Hospital Universitario y Politécnico La Fe; EspañaFil: Igwe, Stanley C.. Alex Ekwueme Federal University Teaching Hospital; NigeriaFil: Kissani, Najib. Cadi Ayyad University; MarruecosFil: Jusupova, Asel. Kyrgyz State Medical Academy; Kirguistá