POPH8104 Issues in Public Health: Psychogenic Seizures

Choose a public health issue that is of interest to you and:

• Briefly describe what is currently known about this issue and thepopulation group(s) most likely affected
  
  
• Compare and contrast at least three interventions that have beenimplemented to produce change for your chosen issue and criticallyevaluate them in terms of effectiveness and ethical practice.
  
  
• Conclude which intervention was most effective and why
  
  
• Summarise your findings in an information leaflet/brochure/infographicthat could be understood by a lay person affected by the issue.

For any disease, it proper diagnosis is very important to treat it. However, for psychogenic seizures there have always been such evidences where misdiagnosis has happened. About 25 percent of the patients who were diagnosed previously, having recurrent episodes of epileptic seizure, were actually cases of psychogenic non-epileptic seizures (Baslet et al. 2015). Unfortunately, it has been seen in recent times that the neurologists have rejected the cases of psychogenic non-epileptic seizures and recommended it to the psychiatric team. The family members of these patients often think that they are faking the tremors and they are doing it just for seeking some sort of attention of the external environment. It is a type of somatoform disorders. Nevertheless, it is not a simple case of somatoform disorder it is complicated combination of conversion disorder and somatoform disorder. The target population around the globe who are going through this disease they find themselves helpless. The intensity of the seizures is less in case of psychogenic seizures. Therefore, the doctors somehow get confused and state these cases to be the initial stage of epilepsy. The doctors have access to the EEG video monitoring but in some cases, the EEG monitoring also fails for judging it. Therefore, the identification and treatment of psychogenic seizure is very important because these patients need help (Asadi-Pooya and Sperling 2015). Most of these cases are misdiagnosed and the patients cannot get back themselves in a normal structure of living. That is why, it is very important to take this issue as a public health issue of the contemporary society.

The clinicians are challenged on a daily basis on the episodes of seizures as a neurological basis. Another type of episodic behavior of psychogenic non-epileptic seizures are conceptualized for the hysteroepilepsy and they are oversimplified, failing to capture on a broad range. Out of every eighty-two patients, seventy-six percent of them were diagnosed with psychogenic non-epileptic seizures. The continuous diagnoses are done through the video monitoring of EEG reports (Pugh et al. 2015). The patients with pseudo seizures are not properly treated and due to this, there are signs of depressive episodes found in the suffered patients.

Causes of Psychogenic Non – epileptic Seizures

Some specific traumatic events like any physical and sexual abuses, divorce, lose of child, lose of family, death of loved one, sudden change in circumstances, depression to a severe level can trigger  psychogenic non epileptic seizures. Any psychological imbalance in the person can trigger this form of Somatoform disorders (Hendrickson et al. 2015). The attacks or the seizure acts as defense mechanisms for the patients when they face sort of similar situations again. This attack takes their mind and body away from any sense of past trauma. Somatoform disorders are certain condition that suggests some physical conditions that are not diagnosed in any examination. Conversion disorders are the form of somatoform disorders that are defined as a physical symptom that are affected by the psychological conflict of a person.  These problems tend to develop during adolescence and they are common in women population.

Review of Literature

In a recent study of Benbadis and his colleagues has studied and researched about the relationship between the fibromyalgia and psychogenic non-epileptic seizures. The experimenters designated two groups, one is the group of patients who were diagnosed with chronic pain and the other group was had incidence of seizures. Benbadis and his colleagues have derived the data from the records of the patients that were evaluated over five years in a clinic with EEG monitors. The experimenters recorded their span of seizures and all other aspects of the disease.  In the first group, there were twenty-eight patients and after the EEG monitoring, it was found that out of them twenty-seven were diagnosed with psychogenic non epileptic seizures. In the other group, thirteen patients were taken who had incidence of epileptic seizure. However, after EEG monitoring, it was found that ten of them had psychogenic non-epileptic seizures. These findings suggest that there are the incidences of chronic pain results in the diagnosis of the psychogenic non-epileptic seizure by observing the patients through the EEG monitoring. The neurologist all over the world does have the facility of EEG monitoring of the patients who are have the incidences of epileptic seizures. The neurotransmitter deregulations are found in patients who have the incidence rates of epilepsy. However, the there will be no deregulations for the patients who are suffering from pseudo seizures. The chronic pain or fibromyalgia are the incidence of psychogenic non-epileptic seizures is a very controversial statement. However, many medical representatives have argued that chronic pain is the etiology of the pseudo seizures but there are no evidence supporting this medical process. Therefore, the conflict with the actual diagnosis of the disease remains a question of concern (Myers et al. 2013).

Another study has found out that The International League against Epilepsy and its national level affiliates, the United Kingdom research funding agencies states that they have been increasingly paying attention to the seizures that are occurred due to epilepsy and as well as psychogenic non epileptic seizures. The absence of the treatment trial sessions for the psychogenic seizure patients forced the National Epilepsy foundation to provide funding for the development of several trial treatments for the psychogenic non-epileptic seizures. The consensus data given by the ILAE Neuropsychiatry of Epilepsy provide the diagnostic data and recommendations from the experts from the neurologists. The ILAE commissions of Neuropsychobiology have instructed the experts to produce a detailed analysis of the reports for the treatment of psychogenic non-epileptic seizure. The management and the treatment of psychogenic non-epileptic seizure is formulated in four distinct stages. The first step included the making of the diagnosis, the second step included the presentation of the diagnosis, the third step included gaining control over seizures and the last step included the management and life activities of seizure-inflected patients (Kaplan et al. 2013).

Intervention used

The intervention reviewed for the analysis of psychogenic non epileptic seizures include the several therapies like, psychodynamic therapy, cognitive behavior therapy, paradoxical intention therapy, mindfulness and psycho education interventions and meta analysis. The interventions used are mostly based on psychological interventions (Altalib et al. 2017).

Psychogenic non-epileptic seizures are not merely psychogenic disease it needs a proper assessment. Within the five axis of diagnostic approach the pseudo seizures does not fall under specific axis. The factors those are subjective to the tremors that are due to any past traumatic events. The skills that is required for handling such disclosures of the disease needs to be appropriately done. The therapist should be able to understand the turmoil of the patient. The patient can be unaware of the turmoil that is there in their unconscious mind. The turmoil can also be in form of childhood abuse or some of traumas from the past. The role of the family of the patients also plays a vital part in the identification of the problem or trauma that triggers the pseudo seizures in the patients. It is also very important for the family to understand that the patient is not faking their conditions. The attacks they get is triggered by their unconsciousness and they have zero role to control it. Based on the national surveys of the clinicians in the United States, United Kingdom and Chile, the standard of medical care and attention given to the patients suffering from psychogenic non-epileptic seizures includes neurological and psychological analysis, and includes the family members of the patients. This helps the family of the patients to realize about the various problems that are faced by the patients also makes them realize about the seriousness of the disease (Ding et al. 2014).

Several studies show the diverse nature and quality of the study. The findings done by the International and National community of Epilepsy highlights the need for psychological interventions of the treatment of the disease. The studies also infer that 82 percent of the population who are diagnosed with psychogenic seizures are cured up to 50 percent with the help several psychological assessment intervention (Diprose, Sundram and Menkes  2016).

Ethical Dilemmas

The ethical dilemmas are specified by the values that are conflicting to the resolutions, which satisfy the stakeholders. The stakeholder includes the primary health givers like the neurologists, psychiatrists, mental health practitioners, social workers and psychologists. In the ethical dilemma, the person who is struggling with the disease takes the decisions. The family, background, psychosocial background, societal conditions, applicable laws, stakeholder obligations and parents’ medical conditions are the elements that are to be taken into account for the administration of the ethical dilemmas that are faced by the pseudo seizure patients (Kumar et al. 2016).  

Conclusion

Epilepsy is any form is stigmatized in the society. Pseudo seizures are however, misdiagnosed by the neurologists. Nevertheless, the health professionals have the tendency to neglect the patients by stigmatizing them by calling the disorder as a mental illness. The family member also ignores the patients as they think that they are faking their seizures.

The report enumerates about the several aspect of psychogenic non-epileptic seizures. It includes the causes and intervention techniques used to treat the disease. Therefore, PNSE should be accepted as a public health issue and the government of the nation should intervene to improve the condition of the patients.

Information Brochure

Figure 1: The figure shows the neural activity of a normal human compared to a pseudo seizure patient.

Source: https://www.pinterest.com/pin/368310075749400133/ 

1. What are non-epileptic seizures?

Usually epileptic seizures are occurred due to the abnormal signals of the brain, but psychogenic non-epileptic seizures are caused due to certain stress or past traumatic conditions.

2. Signs and symptoms

• The patient might fall on the floor suddenly
• Shaking movements of limbs
• Bite in the tongue and can cut the tongue
• Loss of control on the bowel movements
• The patient becomes blank and absent minded and loses reality contact
• The patient do not remember anything at the time of the attack

3. Prevalence rate of psychogenic non-epileptic seizure

Around two to three people in every 10,000 of the population all over the world has PNSE.

4. Causes of non epileptic attacks

• Emotional stress
• Death of loved ones
• Post traumatic events
• Physical and sexual abuse

5. Treatment of the disease

Several psychological assessment techniques are used to treat the disease.

6. Ethical issues and dilemmas are also associated with this disease.

References

Alsaadi, T. and Shahrour, T.M., 2014. Psychogenic Nonepileptic Seizures: What a Neurologist Should Know. Health, 2014.

Altalib, H.H., Elzamzamy, K., Pugh, M.J., Gonzalez, J.B., Cheung, K.H., Fenton, B.T., Kerns, R.D., Brandt, C.A. and LaFrance, W.C., 2017. Reply to “Psychogenic nonepileptic seizures: We know what they are not. But do we know what they are?”. Epilepsy & Behavior, 69, p.226.

Asadi-Pooya, A.A. and Sperling, M.R., 2015. Epidemiology of psychogenic nonepileptic seizures. Epilepsy & Behavior, 46, pp.60-65.

Baslet, G., Dworetzky, B., Perez, D.L. and Oser, M., 2015. Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clinical EEG and neuroscience, 46(1), pp.54-64.

Bello, F.A., Akinajo, O.R. and Olayemi, O., 2014. In-vitro fertilization, gamete donation and surrogacy: perceptions of women attending an infertility clinic in Ibadan, Nigeria: original research article. African journal of reproductive health, 18(2), pp.127-133.

Ding, J., An, D., Liao, W., Wu, G., Xu, Q., Zhou, D. and Chen, H., 2014. Abnormal functional connectivity density in psychogenic non-epileptic seizures. Epilepsy research, 108(7), pp.1184-1194.

Diprose, W., Sundram, F. and Menkes, D.B., 2016. Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy. Epilepsy & Behavior, 56, pp.123-130.

Hendrickson, R., Popescu, A., Dixit, R., Ghearing, G. and Bagic, A., 2014. Panic attack symptoms differentiate patients with epilepsy from those with psychogenic nonepileptic spells (PNES). Epilepsy & Behavior, 37, pp.210-214.

Kaplan, M.J., Dwivedi, A.K., Privitera, M.D., Isaacs, K., Hughes, C. and Bowman, M., 2013. Comparisons of childhood trauma, alexithymia, and defensive styles in patients with psychogenic non-epileptic seizures vs. epilepsy: implications for the etiology of conversion disorder. Journal of Psychosomatic Research, 75(2), pp.142-146.

Kerr, W.T., Janio, E.A., Le, J.M., Hori, J.M., Patel, A.B., Gallardo, N.L., Bauirjan, J., Chau, A.M., D’Ambrosio, S.R., Cho, A.Y. and Engel, J., 2016. Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. Seizure, 40, pp.123-126.

Kumar, U., 2016. Is Corporate Bailout Ethically Admissible?. PARIPEX-Indian Journal of Research, 4(6).

LaFrance, W.C. and Ranieri, R., 2014. Comments on Reuber et al. Psychogenic nonepileptic seizures: Review and update. Epilepsy & Behavior 2003; 4: 205-216. Epilepsy & Behavior, 40, pp.13-15.

LaFrance, W.C., Baker, G.A., Duncan, R., Goldstein, L.H. and Reuber, M., 2013. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach. Epilepsia, 54(11), pp.2005-2018.

Myers, L., Matzner, B., Lancman, M., Perrine, K. and Lancman, M., 2013. Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures. Epilepsy & Behavior, 26(2), pp.153-157.

Pugh, M.J.V., Orman, J.A., Jaramillo, C.A., Salinsky, M.C., Eapen, B.C., Towne, A.R., Amuan, M.E., Roman, G., McNamee, S.D., Kent, T.A. and McMillan, K.K., 2015. The prevalence of epilepsy and association with traumatic brain injury in veterans of the Afghanistan and Iraq wars. The Journal of head trauma rehabilitation, 30(1), pp.29-37.

Salinsky, M., Storzbach, D., Goy, E. and Evrard, C., 2015. Traumatic brain injury and psychogenic seizures in veterans. The Journal of head trauma rehabilitation, 30(1), pp.E65-E70.

Valente, K.D., Rzezak, P. and LaFrance, W.C., 2015. Standard medical care for psychogenic nonepileptic seizures in Brazil. Epilepsy & Behavior, 45, pp.128-135.