Psychogenic Nonepileptic Seizures

Toward the Integration of Care

Edited by Barbara A. Dworetzky and Gaston Baslet

Pulls together comtributors from many specialties for an interdisciplinary perspective to intergrative care for Psychogenic Nonepileptic Seizures;
Covers the different stages of care, from the initial evaluation to long-term outcomes;
Provides up-to-date evidence and discoveries in the field; and
Illustrated with descriptive figures and tables for overall comprehension.

Psychogenic Nonepileptic Seizures

Toward the Integration of Care

Edited by Barbara A. Dworetzky and Gaston Baslet

Description

Psychogenic nonepileptic seizures (PNES) are attacks that mimic epileptic seizures, but are not caused by abnormal electrical discharges in the brain. Instead, PNES are typically considered involuntary expressions of distress, making diagnosis and treatment a challenge. Historically, patients are referred to neurologists who, after completing a diagnostic work up, refer patients to mental health professionals, including psychiatrists, for treatment. For a number of reasons, this transition of care between specialists is often not successful, and this impacts patient treatment and outcomes.

Psychogenic Nonepileptic Seizures: Toward the Integration of Care offers new insights into the practical diagnostic and treatment challenges faced by clinicians who manage this condition. This book covers the different stages of care, from the initial evaluation to long-term outcomes, and highlights the need to work collaboratively to provide patients with comprehensive care and improved outcomes. It provides up-to-date evidence and shares clinical expertise for the management of this challenging diagnosis that requires the expertise of a multi-disciplinary team. The authors provide a new framework on how to conceptualize and manage this disorder to more effectively address the needs of patients.

Psychogenic Nonepileptic Seizures

Toward the Integration of Care

Edited by Barbara A. Dworetzky and Gaston Baslet

Table of Contents

Preface

Contributors List

Section I: Clinical Setting
Chapter 1: Ambulatory Presentations in Adults and Children
Mary Angela O'Neal, MD and Rochelle Caplan, MD
Chapter 2: Emergency Department and Urgent Care Presentations
Daniel Weisholtz, MD and Barbara A. Dworetzky, MD

Section II: Etiologic Factors
Chapter 3: Psychiatric Factors
Kim Bullock, MD and John Barry, MD
Chapter 4: Neurologic and Medical Factors
Victoria S. S. Wong, MD and Martin Salinsky, MD
Chapter 5: Mechanisms of Possible Neurocognitive Dysfunction
Daniel L. Drane, PhD and Dona E. C. Locke, PhD
Chapter 6: The Neurobiology of PNES and Other Functional Neurological Symptoms
David L. Perez, MD and Valerie Voon MD, PhD

Section III: Diagnostic Procedures
Chapter 7: Diagnostic Challenges for the Neurologist
Jigar Rathod, MD and Selim R. Benbadis, MD
Chapter 8: Diagnostic Challenges for the Mental Health Team and Psychiatrist
Lorna Myers, PhD and John Barry, MD
Chapter 9: Practical and Diagnostic Challenges for the Neuropsychologist
Kim Willment, PhD and David Loring, PhD

Section IV: Principles of Treatment
Chapter 10: Communicating the Diagnosis
Markus Reuber, MD, PhD
Chapter 11: Clinicians' Response to the Diagnosis
Sigita Pliopys, MD, Shan Abbas, MD, and Brien Smith, MD
Chapter 12: Models of Care
Tyson Sawchuk MSc, RPsych, Joan K Austin, PhD, RN, FAAN, and Debbie Terry, MS, CNP
Chapter 13: Readiness to Start Treatment and Obstacles to Adherence
Benjamin Tolchin, MD and Gaston Baslet, MD

Section V: Treatment Interventions
Chapter 14: Evidence-Based Treatments
W. Curt LaFrance Jr., MD, MPH and Laura H. Goldstein, PhD, MPhil
Chapter 15: The Role of the Neurologist after Diagnosis
Adriana Bermeo-Ovalle, MD and Andres M. Kanner, MD, FANA
Chapter 16: The Roles of the Patient and Family
Julia L. Doss, PsyD, LP and Jeffrey Mark Robbins, MSW

Section VI: Long-Term Outcomes and Prognosis
Chapter 17: Long-Term Outcomes
Roderick Duncan, MD, PhD
Chapter 18: An Integrated Approach to other Functional Neurological Symptoms and Related Disorders
Jon Stone, MB, ChB, FRCP, PhD and Alan Carson, MD
Chapter 19: Towards the Integration of Care
Gaston Baslet, MD and Barbara A. Dworetzky, MD

Psychogenic Nonepileptic Seizures

Toward the Integration of Care

Edited by Barbara A. Dworetzky and Gaston Baslet

Author Information

Dr. Dworetzky is the Chief of Epilepsy at the Brigham and Women's Hospital and Associate Professor at Harvard Medical School. She leads the large multidisciplinary Bromfield Epilepsy Program and directs the EEG laboratory and the clinical training fellowships in her field. Dr. Dworetzky is the Chair of the Clinical Council of Activities for the American Epilepsy Society and is a leading expert in psychogenic nonepileptic seizures. Together with Dr. Baslet, she sees patients in a shared clinical setting to enhance patient engagement in treatment.

Dr. Gaston Baslet is an Associate Psychiatrist at Brigham and Women's Hospital and Assistant Professor at Harvard Medical School. He specializes in the neuropsychiatric aspects of epilepsy and functional neurological symptom disorder, including psychogenic non-epileptic seizures. His particular focus is in the development of therapeutic strategies for short-term and long-term management of PNES.

Contributors:

Shan Abbas, MD
Department of Neurology
Spectrum Health
Grand Rapids, MI

Joan K. Austin, PhD, RN, FAAN
Indiana University School of Nursing
Indianapolis, IN

John Barry, MD
Department of Psychiatry and Behavioral Sciences
Stanford University Medical Center
Stanford, CA

Gaston Baslet, MD
Associate Psychiatrist
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Selim R. Benbadis, MD
Director, Comprehensive Epilepsy Program
Departments of Neurology and Neurosurgery
University of South Florida College of Medicine
Tampa, FL

Adriana Bermeo-Ovalle, MD
Department of Neurological Sciences
Rush Medical College
Director, EEG Laboratory
Rush University Medical Center
Chicago, IL

Kim Bullock, MD
Department of Psychiatry and Behavioral Science
Stanford School of Medicine
Stanford, CA

Rochelle Caplan, MD
Semel Institute for Neuroscience and Human Behavior
University of California Los Angeles
Los Angeles, CA

Alan Carson, MD
Department of Clinical Neurosciences
Centre for Clinical Brain Sciences
University of Edinburgh
Western General Hospital
Department of Rehabilitation Medicine
University of Edinburgh
Edinburgh, UK

Julia L. Doss, PsyD, LP
Minnesota Epilepsy Group P.A.
St. Paul, MN

Daniel L. Drane, PhD
Departments of Neurology and Pediatrics
Emory University School of Medicine
Atlanta, GA
Department of Neurology
University of Washington School of Medicine
Seattle, WA

Roderick Duncan, PhD
Department of Neurology
Christchurch Hospital
Christchurch, New Zealand

Barbara A. Dworetzky, MD
Chief, Epilepsy
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Laura H. Goldstein, PhD, MPhil
Department of Psychology
Institute of Psychiatry, Psychology and Neuroscience
King's College London
London, UK

Andres M. Kanner, MD, FANA
Department of Clinical Neurology
Director, Comprehensive Epilepsy Center
Chief, Epilepsy Section
Miller School of Medicine
University of Miami
Miami, FL

W. Curt LaFrance Jr, MD, MPH
Rhode Island Hospital
Brown University
Providence, RI

Dona E. C. Locke, PhD
Division of Psychology
Mayo Clinic
Scottsdale, AZ

David Loring, PhD
Departments of Neurology and Pediatrics
Director, Neuropsychology
Emory University
Atlanta, GA

Lorna Myers, PhD
Northeast Regional Epilepsy Group
New York, NY

Mary Angela O'Neal, MD
Director of Women's Neurology
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

David L. Perez, MD
Department of Neurology, Cognitive Behavioral Neurology Unit
Department of Psychiatry, Neuropsychiatry Unit
Massachusetts General Hospital
Harvard Medical School
Boston, MA

Sigita Pliopys, MD
Head, Pediatric Neuropsychiatry Program
Department of Psychiatry and Behavioral Sciences
Northwestern University Feinberg School of Medicine
Ann & Robert H. Lurie Childrens Hospital of Chicago
Chicago, IL

Jigar Rathod, MD
Department of Clinical Neurophysiology
University of South Florida College of Medicine
Tampa, FL

Markus Reuber, MD, PhD
Academic Neurology Unit
University of Sheffield
Royal Hallamshire Hospital
Sheffield, UK

Jeffrey Mark Robbins, MSW
Department of Neurology
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Martin Salinsky, MD
Department of Neurology
Oregon Health & Sciences University
VA Portland Health Care System
Portland, OR

Tyson Sawchuk, MSc, RPsych
Pediatric Neurosciences, Alberta Children's Hospital
Brain & Behavior, Alberta Children's Hospital Research Institute
Calgary, AB, Canada
Debbie Terry, MS CNP
Division of Neurology
Nationwide Children's Hospital
Columbus, OH

Brien Smith, MD
Department of Neurology
Spectrum Health
Grand Rapids, MI

Jon Stone, PhD
Department of Clinical Neurosciences
Centre for Clinical Brain Sciences
University of Edinburgh
Western General Hospital
Edinburgh, UK

Benjamin Tolchin, MD
Department of Neurology
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Valerie Voon, MD, PhD
Department of Psychiatry
Behavioural and Clinical Neurosciences Institute
Cambridgeshire and Peterborough NHS Foundation Trust
Cambridge University
Cambridge, UK

Daniel Weisholtz, MD
Department of Neurology
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Kim Willmet, PhD
Departments of Neurology and Psychiatry
Brigham and Women's Hospital
Harvard Medical School
Boston, MA

Victoria S. S. Wong, MD
Department of Neurology
Oregon Health & Sciences University
VA Portland Health Care System
Portland, OR

Psychogenic Nonepileptic Seizures

Toward the Integration of Care

Edited by Barbara A. Dworetzky and Gaston Baslet

Reviews and Awards

"Psychogenic nonepileptic seizures are the most common subtype of functional neurologic disorder and it is important for the medical community to know how to help these patients. Unfortunately, functional neurologic disorders have fallen into a black hole between neurologists and psychiatrists, and it has been difficult to find appropriate care. This excellent book points a way forward. Not only does it summarize the current literature on diagnosis, pathophysiology, and therapy, but it emphasizes the need for a multidisciplinary approach. The book gives guidance for how neurologists, psychiatrists and other healthcare professionals can work together." --Mark Hallett, MD, National Institute of Health, Bethesda, MD

"Drs. Dworetzky and Blaset, together with their team of experts, have provided a concise and thorough review of psychogenic nonepileptic seizures. This book provides insight on diagnosis, mechanisms, and therapy and is a must read for all neurologists, psychiatrists, and psychologists involved in this underserved, large population." --Orrin Devinsky, MD, Chief of Service, NYU Epilepsy Service, NYU School of Medicine, New York, NY

"Psychogenic non-epileptic seizures are the most common subtype of functional neurologic disorder, and, since these are not rare and the patients have significant disability, it is important for the medical community to know how to help these patients. Unfortunately, functional neurologic disorders have fallen into a black hole between neurologists and psychiatrists, and it has been difficult to find appropriate care. This excellent book points a way forward. Not only does it summarize the current literature on diagnosis, pathophysiology, and therapy, but it emphasizes the need for a multidisciplinary approach, an integrated model of care. The disorder is complex, and a single magic bullet is not going to make the patients better. The book gives guidance for how neurologists, psychiatrists and other healthcare professionals can work together." --Mark Hallett, MD, National Institute of Health, Bethesda, MD

"Drs Dworetzky and Blaset, together with their team of international experts, have provided a concise and thorough review of psychogenic non epileptic seizures. This book provides insightful pearls on diagnosis, mechanisms, and therapy and is a must read for all neurologists, psychiatrists, and psychologists involved in this underserved, large population." -Orrin Devinsky, MD, Chief of Service, NYU Epilepsy Service, Department of Neurology, NYU School of Medicine, New York, NY