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Epilepsia Feb 2016Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients' lives. Patients, family members, and clinicians have yet to fully understand the... (Review)
Review
Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients' lives. Patients, family members, and clinicians have yet to fully understand the mechanisms and treatment of this disorder. Although reviews exist about epileptic seizures, there have been no systematic reviews of studies focusing on the impact of PNES. This review considers research on factors associated with the health-related quality of life (HRQoL) of patients with PNES. Searches of Medline, PsycINFO, CINAHL, and Cochrane Library were conducted. Search terms identified studies that examined factors associated with HRQoL in PNES. Factors fell into three categories: (1) seizure and somatic factors, (2) psychological factors, and (3) coping strategies and family functioning. Fourteen articles were included. The majority of studies were cross-sectional and were of weak to moderate quality. Depressive symptoms were negatively associated with HRQoL. Other factors associated with poorer HRQoL included dissociation, somatic symptoms, escape-avoidance coping strategies, and family dysfunction. Variables such as seizure frequency and demographic factors were not significantly associated with HRQoL. Psychological and interpersonal factors, not seizure reduction, are important for the HRQoL of patients with PNES. The avoidance of emotions is proposed as a perpetuating factor in the difficulties associated with poorer HRQoL. A biopsychosocial approach has relevance for both the clinical and theoretical understanding of PNES. Larger scale research on psychological and relational factors is needed to inform therapeutic approaches to enhance HRQoL in patients with PNES.
Topics: Adaptation, Psychological; Adult; Depression; Dissociative Disorders; Family Relations; Health Status; Humans; Quality of Life; Seizures; Somatoform Disorders
PubMed: 26701628
DOI: 10.1111/epi.13268 -
Seizure Jul 2024Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes.
METHODS
This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes.
RESULTS
Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis.
CONCLUSIONS
The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
Topics: Adult; Humans; Dissociative Disorders; Psychotherapy; Seizures; Treatment Outcome
PubMed: 38824867
DOI: 10.1016/j.seizure.2024.05.016 -
Medicina (Kaunas, Lithuania) Feb 2020The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of... (Meta-Analysis)
Meta-Analysis
Safety and Tolerability of Ketamine Use in Treatment-Resistant Bipolar Depression Patients with Regard to Central Nervous System Symptomatology: Literature Review and Analysis.
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration.
Topics: Administration, Intravenous; Administration, Oral; Antidepressive Agents; Bipolar Disorder; Comorbidity; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Dissociative Disorders; Humans; Ketamine
PubMed: 32050466
DOI: 10.3390/medicina56020067