RESUMO
OBJECTIVE: Ictal injuries have long been considered typical signs of epileptic seizures. However, studies have shown that patients with functional seizures (FS)-also named psychogenic nonepileptic seizures-can also present these signs, misleading physicians and delaying a correct diagnosis. This systematic review aimed to assess the prevalence of injuries from FS. METHODS: A literature search was performed in PubMed, Embase, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Web of Science, PsycINFO, Google Scholar, OpenGrey, and ProQuest. Observational studies were included. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for studies reporting prevalence data. RStudio was used for meta-analyses. Cumulative evidence was evaluated according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: From the 2607 identified records, 41 studies were included in the qualitative synthesis, and 28 were included in meta-analyses. A meta-analysis of 13 studies, including 1673 individuals, resulted in an overall lifetime prevalence of injuries due to FS per person of 25% (95% confidence interval [CI] = 19%-32%, I2 = 88%). Considering a limited period (video-electroencephalographic [VEEG] monitoring days), a meta-analysis of 13 studies, including 848 individuals, resulted in an injury prevalence due to FS per person of .7% (95% CI = 0%-3%, I2 = 73%). Also, a meta-analysis of eight studies, including 1000 individuals, resulted in a prevalence of injuries per FS of .1% (95% CI = 0%-.98%, I2 = 49%). The certainty in cumulative evidence assessed by GRADE was rated "very low" for lifetime prevalence of injuries per person, "low" for prevalence per person during VEEG monitoring, and "moderate" for prevalence per number of FS. SIGNIFICANCE: Overall pooled lifetime prevalence of injuries due to FS per person was 25%. In comparison, the prevalence of injuries per person during VEEG monitoring and per functional seizure was .7% and .1%, respectively. [Correction added on 07 October 2023, after first online publication: In the preceding sentence, 'consecutively' was corrected to 'respectively'.] The evidence of the occurrence of injuries due to FS breaks the paradigm that epileptic seizures can cause injuries but FS cannot.
Assuntos
Transtorno Conversivo , Epilepsia , Humanos , Prevalência , Convulsões/diagnóstico , Convulsões/epidemiologia , Transtornos DissociativosRESUMO
PURPOSE: To explore patients' subjective experience when receiving a diagnosis of Dissociative Seizures (DS) in Buenos Aires, Argentina, and their explanatory models about DS. METHOD: A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 19 patients with DS. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS: Four main themes emerged: 1) Reactions to the Diagnosis; 2) Ways of Naming the Disease; 3) Own Explanatory Models; 4) External Explanatory Models. CONCLUSIONS: This information might help achieve an adequate knowledge of the local characteristics of patients with DS. Most patients could not express any emotions or considerations about being diagnosed with DS, and they related their seizures to a personal or social-emotional conflict and environmental stress; however, family members related patients' seizures to a biological cause. It is important to analyze cultural differences in patients with DS in order to develop appropriate interventions for this specific population.
Assuntos
Transtorno Conversivo , Convulsões Psicogênicas não Epilépticas , Humanos , Argentina , Transtorno Conversivo/complicações , Transtornos Dissociativos/complicações , Convulsões/etiologia , Pesquisa QualitativaRESUMO
PURPOSE: The purpose of this study was to explore how neurology specialists with interest in epilepsy depict psychogenic nonepileptic seizures (PNES) and their experience of diagnosing and treating the disorder. METHODS: An art project was organized as part of the curriculum of the 14th Latin American Summer School on Epilepsy (LASSE) in São Paulo (Brazil) from February 27th to March 6th, 2020. Willing neurologists were invited to draw or paint PNES and present their professional perspective of this disorder. Grouped by common themes, the artworks were analyzed in the context of the existing literature on PNES. RESULTS: The participants created 31 paintings and drawings, 13 of which were selected to represent the recurring themes. Throughout the artworks, neurologists often portrayed PNES as masking the underlying psychological issues, but there was little emphasis on the genesis of PNES itself. The manifestation of PNES was more attributed to just emotional suppression rather than to the influence of different situational factors on a pre-established seizure scaffold. Considering the management of PNES, neurology specialists used the symbol of a labyrinth to represent the difficulties of effectively providing diagnosis and multidisciplinary care for the patients. The general outlook on PNES was associated with darkness, possibly due to limited understanding of the disorder's nature and the unavailability of effective treatment options. CONCLUSION: Our study shows that art projects can be useful to better grasp neurology specialists' opinions about a certain disorder. Further research is needed to elucidate the mechanisms of PNES and help establish multidisciplinary care.