Summary Background Studies have linked epilepsy with an increased suicide risk, but the association might be modified by psychiatric, demographic, and socioeconomic factors. Methods Suicide cases were identified in the Cause of Death Register in Denmark from 1981 to 1997. Up to 20 controls, matched by sex, birth year, and calendar date, were assigned to each suicide case. Findings We identified 21 169 cases of suicide and 423 128 controls. 492 (2·32%) individuals who committed suicide had epilepsy compared with 3140 (0·74%) controls, corresponding to a three times higher risk (rate ratio [RR] 3·17 [95% CI 2·88–3·50]; p Interpretation Individuals with epilepsy have a higher risk of suicide, even if coexisting psychiatric disease, demographic differences, and socioeconomic factors are taken into account. Our study identifies people with newly diagnosed epilepsy as a vulnerable group that require special attention.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(07)70175-8.pdf

Epilepsy and risk of suicide: a population-based case–control study

In this review we systematically assess our currently available knowledge about psychogenic non-epileptic seizures (PNES) with an emphasis on the psychological mechanisms that underlie PNES, possibilities for psychological treatment as well as prognosis. Relevant studies were identified by searching the electronic databases. Case reports were not considered. 93 papers were identified; 65 of which were studies. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. A working definition for PNES is proposed. With respect to psychological etiology, a heterogeneous set of factors have been identified. Not all factors have a similar impact, though. On the basis of this review we propose a model with several factors that may interact in both the development and prolongation of PNES. These factors involve psychological etiology, vulnerability, shaping, as well as triggering and prolongation factors. A necessary first step of intervention in patients with PNES seems to be explaining the diagnosis with care. Although the evidence for the efficacy of additional treatment strategies is limited, variants of cognitive (behavioural) therapy showed to be the preferred type of treatment for most patients. The exact choice of treatment should be based on individual differences in the underlying factors. Outcome can be measured in terms of seizure occurrence (frequency, severity), but other measures might be of greater importance for the patient. Prognosis is unclear but studies consistently report that 1/3rd to 1/4th of the patients become chronic.

Psychogenic non-epileptic seizures--definition, etiology, treatment and prognostic issues: a critical review.

Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies

Psychogenic nonepileptic seizures: answers and questions.

https://www.neurologic.theclinics.com/article/S0733-8619(09)00047-4/pdf

The Etiology of Psychogenic Non-Epileptic Seizures: Toward a Biopsychosocial Model

Traumatic events and posttraumatic stress disorder in patients with psychogenic nonepileptic seizures: a critical review

<h3>Objective:</h3> Our aim was to compare seizure frequency reduction between traditional and t-VNS <h3>Background:</h3> Transcutaneous vagus nerve stimulation (t-VNS) aims to overcome the disadvantages of surgical implantation of traditional VNS, yet little is known about whether these modalities are equally effective in seizure frequency reduction. <h3>Design/Methods:</h3> We conducted a systematic review following the PRISMA guidelines. Included were clinical and/or randomized trial articles indexed by Embase and Pubmed, with the keywords: “drug-resistant epilepsy” or “refractory epilepsy” and “vagus nerve stimulator”. We performed a meta-analysis, considering treatment success as ≥ 50% of seizure frequency reduction. Statistical analyses were weighted for population size. We performed Mann-Whitney test for between-group and Wilcoxon test for within-group analyses. <h3>Results:</h3> Eighteen studies were included (13 traditional, 5 t-VNS), with a total of 1383 patients, with a mean age of 31.27 ± 8.71 years and median follow-up assessment of 12 months (range, 3.5–36). The median success rate for the traditional and t-VNS groups were 49.2% (range, 28–100) and 28% (range, 0–54), respectively (P &lt; 0.0001), with adherence &gt;70% to t-VNS. High variability was observed within the traditional VNS studies (P=0.002), but not in t-VNS. The most common reported side effects from t-VNS were ear pain, dizziness, and headache while traditional VNS was most associated with cough and dysphonia. <h3>Conclusions:</h3> Although t-VNS presents as a more convenient alternative to its traditionally implanted counterpart, its efficacy seems to be relatively low for refractory epilepsy. Furthermore, t-VNS has been associated with more frequently reported side effects than traditional VNS. <b>Disclosure:</b> Mr. Costa has nothing to disclose. Mr. Dos Santos Silva has nothing to disclose. Henrique Januzzelli has nothing to disclose. Isabella D’Andrea has nothing to disclose. 

Isabella D‘Andrea

Papers

Traumatic events and posttraumatic stress disorder in patients with psychogenic nonepileptic seizures: a critical review

Is there a difference in reduction of seizure frequency between transcutaneous and traditional VNS? (P5-1.009)