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Non-epileptic Convulsion


Presentation

  • The NCSE can have a variety of clinical presentations.[jneuropsychiatry.org]
  • The presentation of dacrystic seizures has common elements with PNES and it is possible that the patient has both types of crisis.[omicsonline.org]
  • ARVD is autosomal dominant and may present as sudden death.[jnnp.bmj.com]
  • NCSE can also present itself with speech problems. For example, SE that arises in the opercular region can present as speech difficulties due to dysarthria rather than aphasia.[clinicaladvisor.com]
Epilepsy
  • […] generalized convulsive Epilepsy, generalized idiopathic Epilepsy, generalized nonconvulsive Epilepsy, generalized tonic clonic Epilepsy, grand mal Epilepsy, primary generalized absence Epilepsy, progressive myoclonic Epileptic seizures - tonic Generalized[icd10data.com]
  • "Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)". Epilepsia. 46 (4): 470–2. doi : 10.1111/j.0013-9580.2005.66104.x. PMID 15816939.[en.wikipedia.org]
  • The global burden and stigma of epilepsy. Epilepsy. Behav 12(4), 540-546 (2008).[jneuropsychiatry.org]
  • IF IT'S NOT EPILEPSY...[jnnp.bmj.com]
Falling
  • Generally, seizures fall into the two categories: focal and generalized seizures. The difference between these types is how they begin.[epilepsyqueensland.com.au]
  • The resulting surge in vagus activity and reduced sympathetic tone, despite the falling blood pressure, set up a vicious cycle of bradycardia, falling peripheral resistance, and abrupt circulatory collapse.[jnnp.bmj.com]
  • This might mean you lose balance and fall over. Atonic seizures Atonic seizures cause all your muscles to suddenly relax, so you may fall to the ground. They tend to be very brief and you'll usually be able to get up again straight away.[nhs.uk]
  • According to the DSM-5 classification, neurological symptoms that are found, after appropriate neurological assessment, to be incompatible with neurological pathophysiology can fall under conversion disorder, factitious disorder, or malingering.[emedicine.medscape.com]
Crying
  • As the seizures progressed, the patient began to cry, and lacrimation was observed.[omicsonline.org]
  • […] main differences are: Symptom Epilepsy NEAs Duration 0.5 to 2 minutes Often longer than 2 minutes Pelvic thrusting rare Occasional Eyes / mouth Typically open Often closed Side-to-side head movement Rare More common Tongue biting Occasional Occasional Crying[nonepilepticattacks.info]
  • The child will begin crying after some form of upset and then stop breathing in expiration with what appears a silent cry or a series of expiratory grunts. With this prolonged expiratory apnoea the child's face becomes blue with deep cyanosis.[epilepsydiagnosis.org]
  • During the tonic phase, the diaphragm also contracts, which may elicit a characteristic ictal cry.[emedicine.medscape.com]
  • Tonic Clonic seizures (previously called grand mal seizures) During a tonic clonic seizure a person’s body stiffens, air being forced past the vocal cords causes a cry or groan and they fall to the ground (the tonic phase).[epilepsyqueensland.com.au]
Pallor
  • Characterised by autonomic features including vomiting, pallor and sweating followed by tonic eye deviation, impairment of consciousness with possible evolution into a secondarily generalised seizure.[nice.org.uk]
  • Pallor and autonomic symptoms such as flushing, sweating, feeling warm, nausea and abdominal discomfort may occur.[epilepsydiagnosis.org]
  • A witness may describe pallor, sweating, and cold skin. Muscle tone is flaccid sometimes with a few uncoordinated clonic jerks occurring after the fall.[jnnp.bmj.com]
Hyperpnea
  • Diagnosis Code R29.0 Tetany 2016 2017 2018 2019 Billable/Specific Code Applicable To Carpopedal spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) hysterical F44.5 hyperpnea[icd10data.com]
Hypotension
  • Moreover, barbiturates as well as phenytoin and phenytoin derivates cause significant hypotension and arrhythmias.[clinicaladvisor.com]
  • Continuous administration of iv barbiturates commonly causes pressor-requiring arterial hypotension, severe gastrioparesis and immunosuppression facilitating infections and sepsis[ Ropper, 2003 ].[ncbi.nlm.nih.gov]
Neonatal Tetany
  • […] hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) hysterical F44.5 hyperpnea R06.4 ICD-10-CM Diagnosis Code R06.4 Hyperventilation 2016 2017 2018 2019 Billable/Specific Code Type 1[icd10data.com]
Lacrimation
  • As the seizures progressed, the patient began to cry, and lacrimation was observed.[omicsonline.org]
Psychiatric Symptoms
  • The differentiation between dacrystic seizures and PNES can be very difficult from the point of view of symptomatology of psychiatric symptoms.[omicsonline.org]
Suicidal Ideation
  • ideation/homicidal ideation Previous psychiatric history/hospitalizations Neurology consult Birth history Congenital infections Ativan PRN for longer episodes while hospitalized Advise pts on their condition, prior to discharge and set up a follow-up[pedclerk.bsd.uchicago.edu]
Seizure
  • Keywords Dacrystic seizures; Lacrimation; Psychogenic non-epileptic seizures Introduction There are few reports in the literature informing the difficulty in making the differential diagnosis between dacrystic seizures and psychogenic non-epileptic seizures[omicsonline.org]
  • Distinguish psychogenic nonepileptic seizures from epileptic seizures and other paroxysmal nonepileptic events. Be aware of the comprehensive assessment needed to evaluate the child who has possible psychogenic nonepileptic seizures.[pedsinreview.aappublications.org]
  • seizure DS, dissociative seizure ES, epileptic seizure CBT, cognitive behavioural therapy non-epileptic seizures dissociative seizures diagnosis Up to one in five patients with apparently intractable epilepsy referred to specialist centres are found[pmj.bmj.com]
  • Clinical features Pseudoseizures differ from epileptic seizures in multiple ways.[pedclerk.bsd.uchicago.edu]
  • ( F44.5 ) epileptic convulsions and seizures ( G40.- ) newborn convulsions and seizures ( P90 ) ICD-10-CM Diagnosis Code G40 Epilepsy and recurrent seizures 2016 2017 2018 2019 Non-Billable/Non-Specific Code Note the following terms are to be considered[icd10data.com]
Seizure
  • Keywords Dacrystic seizures; Lacrimation; Psychogenic non-epileptic seizures Introduction There are few reports in the literature informing the difficulty in making the differential diagnosis between dacrystic seizures and psychogenic non-epileptic seizures[omicsonline.org]
  • Distinguish psychogenic nonepileptic seizures from epileptic seizures and other paroxysmal nonepileptic events. Be aware of the comprehensive assessment needed to evaluate the child who has possible psychogenic nonepileptic seizures.[pedsinreview.aappublications.org]
  • seizure DS, dissociative seizure ES, epileptic seizure CBT, cognitive behavioural therapy non-epileptic seizures dissociative seizures diagnosis Up to one in five patients with apparently intractable epilepsy referred to specialist centres are found[pmj.bmj.com]
  • Clinical features Pseudoseizures differ from epileptic seizures in multiple ways.[pedclerk.bsd.uchicago.edu]
  • ( F44.5 ) epileptic convulsions and seizures ( G40.- ) newborn convulsions and seizures ( P90 ) ICD-10-CM Diagnosis Code G40 Epilepsy and recurrent seizures 2016 2017 2018 2019 Non-Billable/Non-Specific Code Note the following terms are to be considered[icd10data.com]
Generalized Seizure
  • Generalized Seizures Expand 2. Generalized Seizures Section Generalized seizures occur when there is widespread seizure activity in the left and right hemispheres of the brain.[epilepsyontario.org]
  • Generally, seizures fall into the two categories: focal and generalized seizures. The difference between these types is how they begin.[epilepsyqueensland.com.au]
  • Generalized seizures occur across the entire surface of the brain rather than a specific location. These are less common and tend to be because of genetic factors.[share.upmc.com]
  • Such recordings can be extremely helpful to the doctor when determining a diagnosis. top of page Generally, seizures fall into two categories: primary generalised seizures and focal seizures .[epilepsyaustralia.net]
  • Provocation of nonepileptic seizures by suggestion in a general seizure population . Epilepsia 35 , 768–770 (1994). 18. Lesser, R. P. , Lueders, H. & Dinner, D. S. Evidence for epilepsy is rare in patients with psychogenic seizures .[nature.com]
Screaming
  • Video-EEG monitoring captured a prolonged seizure, which was accompanied by unmotivated screaming, clonic spasms of the upper right limb, lateral head movements (mostly to the left), and intermittent automatic movements of the upper left limb.[omicsonline.org]
  • Twitching in your arms or legs that lasts longer than 2 minutes Crying, screaming, or weeping Head, neck, and spine bent backwards Side to side head movements Strong or powerful pushing of the hips Thrashing or violent movements, such as striking at walls[drugs.com]
  • Children with night terrors may wake up in agitation, sit up in bed, scream, mumble, moan and sleepwalk, perspiring with a rapid heartbeat.[notes.childrenshospital.org]
  • There may screaming, swearing, aggression, damage to property and physical violence. Through the event it may seem that the individual is not normally responsive.[epilepsydiagnosis.org]
Personality Change
  • In non-comatose patients it may present as confusion, personality change or psychosis. Treatment should be considered as follows: Maintenance or reinstatement of usual oral anti-epileptic therapy.[patient.info]

Workup

  • […] auras, vegetative disturbances or reduced or altered consciousness, but without major convulsive movements. [3] This definition implicitly includes the presence of epileptiform discharges on the EEG, which proves therefore essential in the diagnostic workup[neurologyindia.com]
  • History Part I: Pattern Recognition: There are many specific questions that should be asked prior to the workup in order to facilitate treatment and discover the etiology. The following questions should be considered: a.[clinicaladvisor.com]

Treatment

  • Administer a maximum of two doses of the first-line treatment (including pre-hospital treatment). If seizures continue, administer IV phenobarbital or phenytoin as second-line treatment.[patient.info]
  • […] are essential to optimize response to treatment and to prevent neurological (for which there is little evidence base) and systemic sequelae Overdiagnosis and aggressive use of anticonvulsants can contribute to morbidity and mortality Treatment is poorly[litfl.com]
  • […] auricular acupuncture as a treatment for NES.[clinicaltrials.gov]
  • The etiology, diagnosis, treatment, and prognosis remain controversial [ 9, 10 ].[jneuropsychiatry.org]
  • But what happens to an individual who is given this diagnosis but is not corresponding to the medicinal treatment? Up to 25% of individuals who are given the diagnosis of epilepsy that are not responding to the medicinal treatment are misdiagnosed.[skepticink.com]

Prognosis

  • In these common cases, the prognosis for full recovery is good.[pharmacytimes.com]
  • Good prognosis is associated with a low rate of undesirable outcomes; poor prognosis is associated with a high rate of undesirable outcomes.[nice.org.uk]
  • A poor prognosis is predicted by a long delay in diagnosis and the presence of psychiatric comorbidity, including personality disorder.[patient.info]
  • Complications : NCSE is associated with poor prognosis (8, 12). Studies have shown that surrogate markers of neuron damage such as enolase are elevated (13).[emdocs.net]
  • The prognosis for the majority of patients with PNES appears to be poor, despite a wider recognition of the problem. Well conducted studies are needed to test the different treatment options.[annalsofian.org]

Etiology

  • Determining the etiology of the seizures will often guide further diagnostics and management.[clinicaladvisor.com]
  • Etiology, diagnosis, and treatment of nonepileptic seizures. Curr Neurol Neurosci Rep. 2001;1:381–9. 10. Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4:205–16. 11.[aafp.org]
  • The etiology, diagnosis, treatment, and prognosis remain controversial [ 9, 10 ].[jneuropsychiatry.org]
  • If the etiology is one listed in Table 2, prognosis is directly correlated with the condition. More rapid diagnosis and better treatments have decreased mortality over the past 50 years.[pharmacytimes.com]
  • References Blumberg J,Fernández IS, Vendrame M, Oehl B, Tatum WO, et al. (2012) Dacrystic seizures: demographic, semiologic, and etiologic insights from a multicenter study in long-term video-EEG monitoring units. Epilepsia 53: 1810-1819.[omicsonline.org]

Epidemiology

  • Epidemiology of status epilepticus. J Clin Neurophysiol . 1995;12:316-325. DeLorenzo RJ, Hauser WA, Towne AR. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology . 1996;46:1029-1035.[pharmacytimes.com]
  • Non-convulsive status epilepticus is uncommon and management is less urgent. [ 1 ] Epidemiology Estimated incidence is between 10 and 60 cases per 100,000 person/years. [ 2 ] The incidence is higher in poorer populations.[patient.info]
  • “Ictal epileptic headache”: Beyond the epidemiological evidence. Epilepsy Behav. 2012; 25 :9–10. doi: 10.1016/j.yebeh.2012.07.002. [ PubMed ] [ CrossRef ] [ Google Scholar ] 7.[ncbi.nlm.nih.gov]
  • Epilepsia 53:e67–e70 View Article PubMed Google Scholar Belcastro V, Striano P, Parisi P (2012) “Ictal epileptic headache”: Beyond the epidemiological evidence.[thejournalofheadacheandpain.springeropen.com]
Sex distribution
Age distribution

Pathophysiology

  • To date, indeed, IEH remains an extremely rare phenomenon and thus the exact pathophysiological point of connection between headache and epilepsy remains enigmatic.[ncbi.nlm.nih.gov]
  • According to the DSM-5 classification, neurological symptoms that are found, after appropriate neurological assessment, to be incompatible with neurological pathophysiology can fall under conversion disorder, factitious disorder, or malingering.[emedicine.medscape.com]
  • Leach JP,Mohanraj R, Borland W (2012) Alcohol and drugs in epilepsy: pathophysiology, presentation, possibilities, and prevention. Epilepsia 53 Suppl 4: 48-57.[omicsonline.org]

Prevention

  • And if it’s early enough, prevent them. Whether it’s through the most-advanced technology, like brain imaging, or the most-foundational health habits, like rest and exercise, no matter your age, stage, or issue, there’s always hope here.[floridahospital.com]
  • If you or someone you know needs help, see our suicide prevention resources. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.[themighty.com]
  • In all cases, prompt treatment is the key to preventing serious outcomes. The goal of treatment is to stop the seizure activity as quickly as possible and treat any underlying precipitant.[epilepsychicago.org]
  • At follow-up they should be checked if symptoms recur in order to prevent a relapse of CSE or NCSE.[clinicaladvisor.com]

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