Psychogenic nonepileptic seizures in Latin America: A survey describing current practices

Lady Diana Ladino; Vanessa Benjumea-Cuartas; Yamile Calle-López; Juan Pablo Orozco-Hernández; Diana Marcela Castrillón-Velilla; Reydmar López-González; Anilu Daza-Restrepo; Mario Alberto Genel Castillo; Markus Reuber; Alyssa Denton; José F Tellez-Zenteno

doi:10.1016/j.yebeh.2020.107150

Psychogenic nonepileptic seizures in Latin America: A survey describing current practices

Epilepsy Behav. 2021 Jan;114(Pt A):107150. doi: 10.1016/j.yebeh.2020.107150. Epub 2020 Jun 2.

Affiliations

¹ Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia. Electronic address: lady.ladino@gmail.com.
² Neuromédica, Medellín, Colombia.
³ Epilepsy Program, Hospital Pablo Tobón Uribe, University of Antioquia, Medellín, Colombia.
⁴ Universidad Tecnológica de Pereira, Pereira, Colombia.
⁵ Epilepsy Unit, La Trinidad Medical Center, Caracas, Venezuela.
⁶ Unidad de Monitoreo de Epilepsia del Instituto de Ciencias Cardiovasculares del Hospital del Prado en Tijuana, Mexico.
⁷ Academic Neurology Unit, University of Sheffield, Sheffield, UK.
⁸ Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
⁹ Saskatchewan Epilepsy Program, Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Electronic address: jose.tellez@usask.ca.

PMID: 32507294
DOI: 10.1016/j.yebeh.2020.107150

Abstract

Objective: Psychogenic nonepileptic seizures (PNES) are one of the most common differential diagnoses of epilepsy. This study provides an overview of diagnostic and treatment services for patients with PNES across Latin America.

Methods: In 2017-2018, clinicians practicing in Latin America with responsibilities for patients with PNES were contacted to respond to a survey regarding the management of this disorder developed by the International League Against Epilepsy (ILAE) PNES Task Force.

Results: Three hundred and sixty responses from 17 Latin American countries were analyzed. Most respondents were neurologists (81%) under 40 years of age (61%). Fifty-seven percent of professionals stated that they personally diagnose PNES, but only 33% stated that they provide follow-up, and only 20% that they recommend treatment. Many participants (54%) characterized themselves as either unfamiliar with the diagnosis or inexperienced in arranging treatment. Most respondents reported having access to brain magnetic resonance imaging (MRI; 88%) and routine electroencephalogram (EEG; 71%), 64% have the access to video-EEG longer than 8 h, and 54% of professionals performed video-EEG to confirm PNES diagnoses. Although cognitive-behavioral therapy was recognized as the treatment of choice (by 82% of respondents), there was little access to it (60%). In contrast, a high proportion of respondents reported using antidepressant (67%), antiseizure (57%), and antipsychotic medications (54%) as treatments for PNES.

Significance: This study reveals several deficiencies in the diagnosis and treatment of patients with PNES in Latin America. The barriers are reinforced by lack of knowledge among the specialists and poor healthcare system support. There is inadequate access to prolonged video-EEG and psychotherapy. An inappropriate use of antiseizure medicines seems commonplace, and there are low follow-up rates by neurologists after the diagnosis. Multidisciplinary guidelines are required to improve the approach of patients with PNES.

Keywords: (MESH): Diagnosis; Barriers; Health services; Nonepileptic seizures; Psychotherapy; Treatment.

MeSH terms

Electroencephalography
Epilepsy* / diagnosis
Epilepsy* / epidemiology
Epilepsy* / therapy
Humans
Latin America / epidemiology
Psychophysiologic Disorders*
Seizures / diagnosis
Seizures / therapy
Surveys and Questionnaires