ArticleJournal of neurology, neurosurgery, and psychiatry2021
Misdiagnosis of prolonged psychogenic non-epileptic seizures as status epilepticus: epidemiology and associated risks.
Article in Journal of neurology, neurosurgery, and psychiatry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 82 citations in OpenAlex.
- Incidence and prevalence of functional neurological disorder: a systematic review.Journal of neurology, neurosurgery, and psychiatry · 2025Pooled it
- Clinical features of adolescent-onset functional motor disorders in tertiary movement disorders centers.Journal of neurology · 2026Observational
- Beyond the spike: Functional (dissociative) seizures as a key to holistic attitudes in seizure disorders.Epilepsia · 2026Review
- Noninvasive Biomarkers for Assessing the Excitatory/Inhibitory Imbalance in Children with Epilepsy.The Journal of neuroscience : the official journal of the Society for Neuroscience · 2025Article
- Frequency and characteristics of functional neurological disorder in the emergency department.Journal of neurology · 2025Article
- Status non-epilepticus.Epileptic disorders : international epilepsy journal with videotape · 2025Article
- Acceptability and Utility of a Web-Based Patient-Completed Clinical Decision Aid for the Differential Diagnosis of Transient Loss of Consciousness: Qualitative Interview Study.JMIR formative research · 2025Article
- Iatrogenic harm in functional neurological disorder.Brain : a journal of neurology · 2025Review
- Somatic symptom and related disorders in the Arab world: a narrative review of clinical features and care implications.Frontiers in psychiatry · 2025Review
- Article
- Primum non nocere: Endotracheal Intubation for Prolonged Functional/Dissociative Seizures in an Adolescent.Journal of Brown hospital medicine · 2025Article
- Acute Onset of Impaired Consciousness.Deutsches Arzteblatt international · 2024Review
- Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors.Neurocritical care · 2024Article
- Cognition in pediatric patients with diagnosis of epilepsyRevista medica del Instituto Mexicano del Seguro Social · 2024Article
- Elevated Mortality Rate in Patients With Functional Seizures After Diagnosis and Referral.Neurology. Clinical practice · 2024Article
- Dissociative seizures in the emergency room: room for improvement.Journal of neurology, neurosurgery, and psychiatry · 2024Article
- Status epilepticus in the ICU.Intensive care medicine · 2024Review
- A complex case with generalized epilepsy, probable focal seizures, and functional seizures.Epilepsy & behavior reports · 2024Article
- The present and future of seizure detection, prediction, and forecasting with machine learning, including the future impact on clinical trials.Frontiers in neurology · 2024Review
- Benzodiazepine receipt in adults with psychogenic non-epileptic seizures in the USA.BMJ neurology open · 2024Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the epidemiology of prolonged psychogenic non-epileptic seizures (pPNES) misdiagnosed as status epilepticus, as well as the risks associated with non-indicated treatment.
methodsWe performed an individual patient data analysis from the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the Established Status Epilepticus Treatment Trial (ESETT) to assess incidence, patient characteristics and clinical course of misdiagnosed pPNES.
resultsAmong 980 patients aged 8 years or older diagnosed and treated for status epilepticus in RAMPART and ESETT, 79 (8.1%) were discharged with a final diagnosis of pPNES. The relative incidence was highest in adolescents and young adults (20.1%). The typical female preponderance seen in that age bracket was not evident in children and older adults. Adverse effects, including respiratory depression and intubation, were documented in 26% of patients with pPNES receiving benzodiazepines in RAMPART and 33% of patients receiving additional second-line medication in ESETT. In ESETT, patients who were treated with benzodiazepines before hospital admission had higher rates of unresponsiveness and severe adverse effects than those treated after admission, suggesting cumulative effects of accelerated treatment momentum. Across trials, one in five patients with pPNES were admitted to an intensive care unit.
conclusionsMisdiagnosis and treatment of pPNES as status epilepticus are a common and widespread problem with deleterious consequences. Mitigating it will require training of emergency staff in semiological diagnosis. Status epilepticus response protocols should incorporate appropriate diagnostic re-evaluations at each step of treatment escalation, especially in clinical trials.
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