What the patient’s history tells us about their nonepileptic seizures | Comment ce que disent les patients peut nous renseigner sur leurs crises non épileptiques psychogènes
Neurophysiologie Clinique/Clinical Neurophysiology. 2014-10-01; 44(4): 375-388
DOI: 10.1016/j.neucli.2013.09.002
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1. Neurophysiol Clin. 2014 Oct;44(4):375-88. doi: 10.1016/j.neucli.2013.09.002. Epub
2013 Oct 10.
[What the patient’s history tells us about their nonepileptic seizures].
[Article in French]
Reuber M(1), Micoulaud-Franchi JA(2), Gülich E(3), Bartolomei F(4), McGonigal
A(5).
Author information:
(1)Academic neurology unit, university of Sheffield, Royal Hallamshire hospital,
Glossop Road, Sheffield S10 2JF, Royaume-Uni. Electronic address:
.
(2)Solaris, pôle de psychiatrie universitaire, hôpital Sainte-Marguerite, 270,
boulevard de Sainte-Marguerite, 13009 Marseille, France; UMR CNRS 7291,
laboratoire de neurosciences cognitives (LNC), 31 Aix-Marseille université, site
Saint-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France. Electronic
address: .
(3)FakultätfürLinguistik und Literaturwissenschaft, Universität Bielefeld,
Postfach 10 01 31, 33501 Bielefeld, Allemagne. Electronic address:
.
(4)Inserm, U1106, institut de neuroscience des systèmes, 13005 Marseille, France;
Faculté de médecine, Aix-Marseille université, 13005 Marseille, France; Service
de neurophysiologie clinique, Assistance publique des Hôpitaux de Marseille, CHU
de la Timone, 13005 Marseille, France. Electronic address:
.
(5)Inserm, U1106, institut de neuroscience des systèmes, 13005 Marseille, France;
Faculté de médecine, Aix-Marseille université, 13005 Marseille, France; Service
de neurophysiologie clinique, Assistance publique des Hôpitaux de Marseille, CHU
de la Timone, 13005 Marseille, France. Electronic address: .
The aetiology of “psychogenic” non-epileptic seizures (NES) remains poorly
understood and the differentiation of NES from epilepsy can be a difficult. In
the first part of this review article we focus on recent insights into the
neurobiological underpinnings of NES. We summarise a number of studies
demonstrating the importance of abnormalities of emotion regulation in patients
with NES. Evidence for abnormal emotion regulation comes from both self-report
and experimental studies of pre-conscious cognitive processes. These studies show
that NES are not the only manifestation of abnormal mental processing in these
patients and that excessive social threat avoidance and emotional dysregulation
are also evident between seizures and may therefore contribute to disability
beyond the seizures themselves. In the second part of this review, we describe
the findings of a number of studies, which have examined differences between the
communication behaviour of patients with NES and those with epilepsy. We argue,
that, whilst these studies initially aimed to help clinicians with the
differential diagnosis of NES and epilepsy, close sociolinguistic analysis of
patient’s talk can also provide clues about the aetiology of NES. We conclude
that the interaction of patient with NES with the doctor can be interpreted as a
manifestation of avoidance and a demonstration of helplessness perhaps intended
to secure active support from the doctor. In the third part of this review, we
suggest that a close reading of a transcript of the interaction between a patient
with NES and her doctor (and perhaps attentive listening to how patients’ talk
about themselves and their disorder) can yield clues to the causes of NES in
individual cases.
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
DOI: 10.1016/j.neucli.2013.09.002
PMID: 25306078 [Indexed for MEDLINE]