Thus, the etiology and psychopathology of FS are the same as the larger category where biopsychosocial factors play a major role. 7 Etiology & PsychopathologyĬontrary to what is commonly implied in the literature, FS are not a unique disorder, but rather are a specific subtype of the larger group of somatic symptom and related disorders or, previously, somatoform disorders. About 80% to 90% of people with FS have additional psychiatric diagnoses (eg, posttraumatic stress disorder, anxiety, or depression). 9 There is higher prevalence of FS in women, and sexual trauma may be a mediating factor in the association between female sex/gender and FS. 8 Concurrent epilepsy occurs in 10% to 15% of persons with FS. Epidemiology & PrevalenceįS have an estimated prevalence rate of 2 to 33 per 100,000 annually 7 25% of patients evaluated in an epilepsy center and 16% of those evaluated in neurology clinics have a diagnosis of FS and FND. 6 “Attacks or seizures” is classified under conversion disorder (also termed functional neurologic symptom disorder ) along with other neurologic symptoms. In the DSM-5, this category includes somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder and other related conditions. 4įS are a specific subtype of a larger group of psychiatric conditions, previously defined in the American Psychiatric Association’s Diagnostic and Statistical Manual, 4th edition (DSM-IV) as somatoform disorders 5 and in the 5th edition (DSM-5), as somatic symptom and related disorders. 2,3 A good argument can be made that the term seizures, in the English language, may imply an epileptic nature. Other terms considered include nonepileptic seizures, which we consider too broad because that would include nonepileptic nonpsychogenic events (eg, syncope, migraines, transient ischemic attacks, movement disorders, and sleep disorders) PNES nonepileptic attacks, which is also overly broad psychogenic nonepileptic attacks, psychogenic nonepileptic events, psychogenic seizures, and dissociative seizures. 1Īlthough terminology has been evolving toward the term functional seizures, there is still debate within the field about what terminology is most appropriate. Further testing of the reliability of the FLEP scale items appears to be needed.Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are paroxysmal attacks that may resemble an epileptic seizure but are not caused by abnormal brain electric activity and have a psychologic etiology. The items about "recall" and "clustering" of the events throughout the night may increase the likelihood of mistaking RBD for seizures. The item investigating wandering, as presently formulated, may be unable to distinguish nocturnal wandering from sleepwalking. ![]() ![]() Our investigation highlights the inadequacy of some of the items in the scale. However, the scale is associated with a real risk of misdiagnosis in some patients and gives uncertain indications in about one-third of cases, mainly RBD. The FLEP scale shows high positive and negative predictive values in diagnosing NFLE versus arousal parasomnias and RBD. ![]() The FLEP scale gave an incorrect diagnosis in 4/71 (5.6%) of the cases, namely NFLE patients with episodes of nocturnal wandering, and uncertain diagnostic indications in 22/71 subjects (30.9%). The sensitivity of the scale as a diagnostic test for NFLE was 71.4%, the specificity 100%, the positive predictive value 100%, and the negative predictive value 91.1%. The FLEP scale was applied to 71 subjects (60 male 11 female aged 54 +/- 21) referred to an outpatient's sleep and epilepsy unit for diagnostic assessment of nocturnal motor-behavioral episodes, which turned to be arousal parasomnias (11 subjects), NFLE (14 subjects), or idiopathic RBD (46 subjects), based on the findings of in-lab full night video polysomnography with extended EEG montages. To test the usefulness of the FLEP scale in diagnosing nocturnal frontal lobe epilepsy (NFLE), arousal parasomnias, and REM sleep behavior disorder (RBD).
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