Autonomic and subjective responsivity to emotional images in people with dissociative seizures

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self‐reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non‐responders’, differences in subjective responses were observed for some conditions, compared to control ‘non‐responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non‐responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.     

MODIFICATION OF SEIZURE DISORDERS: THE INTERRUPTION OF BEHAVIORAL CHAINS1

This study investigated the effects of interruption and differential reinforcement on seizures in children. Seizures were conceptualized as the terminal link in a behavioral chain, resulting in a strategy aimed at identifying and modifying behaviors that reliably preceded the seizure climax. Seizure frequency was reduced in four of five subjects, whereas the frequency of preseizure behavior was reduced in only three subjects. Parents and school personnel were successfully used as change agents.     

Pilocarpine seizures cause age-dependent impairment in auditory location discrimination

Children who have status epilepticus have continuous or rapidly repeating seizures that may be life-threatening and may cause life-long changes in brain and behavior. The extent to which status epilepticus causes deficits in auditory discrimination is unknown. A naturalistic auditory location discrimination method was used to evaluate this question using an animal model of status epilepticus. Male Sprague-Dawley rats were injected with saline on postnatal day (P) 20, or a convulsant dose of pilocarpine on P20 or P45. Pilocarpine on either day induced status epilepticus; status epilepticus at P45 resulted in CA3 cell loss and spontaneous seizures, whereas P20 rats had no cell loss or spontaneous seizures. Mature rats were trained with sound-source location and sound-silence discriminations. Control (saline P20) rats acquired both discriminations immediately. In status epilepticus (P20) rats, acquisition of the sound-source location discrimination was moderately impaired. Status epilepticus (P45) rats failed to acquire either sound-source location or sound-silence discriminations. Status epilepticus in rat causes an age-dependent, long-term impairment in auditory discrimination. This impairment may explain one cause of impaired auditory location discrimination in humans.     

Interictal and postictal performances on dichotic listening test in children with focal epilepsy

Dichotic listening test (DL) is an important tool to disclose speech dominance in healthy subjects and in clinical cases. The aim of this study was to probe if focal epilepsy in children reveals a corresponding suppression of the ear reports contralateral to seizure onset site. Thus, 15 children and adolescents with clinically and electroencephalographically diagnosed focal epilepsy selected for left-hemisphere speech dominance without mental retardation were compared to matched controls according to age, gender, IQ and handedness. All children were assessed with DL for three times: Interictally (t(0)), postictally 5' (t(1)) and 1h (t(2)). At t(0), all groups revealed a right ear advantage (REA), indicating a left-hemisphere speech dominance. There was a continuous increase in right correct score (REC) over the trials for normal controls. Five minutes postictally, there was an abrupt decrease in REC with a sustained left ear correct score (LEC) for children with epilepsy, independent of which side suffered from seizures. This effect was maintained even after 1h. Thus, in children with left-hemisphere speech dominance the epileptic discharges caused a suppression of REC regardless of origin. The seizures may have a prolonged impact on attention and auditory perception for a considerable time after consciousness has been regained.     

A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures

Objective: We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures.

Methods: Individuals were randomised to write about potentially ‘therapeutic’ topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions.

Results: Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the ‘therapeutic’ condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures.

Conclusions: A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.     

Psychogenic Nonepileptic Seizures

Neurological, neurodiagnostic, and neuropsychological aspects of psychogenic nonepileptic seizures (PNES) are reviewed, including psychosocial, psychiatric, cognitive, and MMPI-2 findings.     

Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.     

Scatter as an index of organicity: A comparison of mentally retarded individuals experiencing and not experiencing concomitant convulsive disorders

This study examined the validity of Wechsler subtest scatter as an index of organicity and convulsive disorders in a mentally retarded sample. Four different indices of scatter were studied. Only the Selz and Reitan (Journal of Consulting and Clinical Psychology, 1979, 47, 258–264) index was related to organicity. However, after the contribution of Full-Scale IQ was partialed out, no significant relationship remained. It was concluded that scatter has only minimal diagnostic utility in detecting organicity.Woodhaven Center is operated and funded under a contract between Temple University and the Pennsylvania Department of Public Welfare.     

A Review of Diagnostic Techniques in the Differential Diagnosis of Epileptic and Nonepileptic Seizures

The diagnosis of psychogenic nonepileptic seizures (PNES) is complex. Long-term electroencephalogram monitoring with video recording (video EEG) is the most common method of differential diagnosis of epilepsy and PNES. However, video EEG is complex, costly, and unavailable in some areas. Thus, alternative diagnostic techniques have been studied in the search for a diagnostic method that is as accurate as video EEG, but more cost effective, convenient, and readily available. This paper reviews the literature regarding possible diagnostic alternatives and organizes findings into 7 areas of study: demographic and medical history variables, seizure semiology, provocative testing, prolactin levels, single photon emission computed tomography, psychological testing, and neuropsychological testing. For each area, the literature is summarized, and conclusions about the accuracy of the technique as a diagnostic tool are drawn. Overall, it appears unlikely that any of the reviewed alternative techniques will replace video EEG monitoring; rather they may be more successful as complementary diagnostic tools. An important focus for further investigations involves combinations of diagnostic techniques for the differential diagnosis of epilepsy and PNES.