Psychogenic Nonepileptic Seizures:integrating cognitive and neurobiological aspects

Publish Year: 1397
نوع سند: مقاله کنفرانسی
زبان: English
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EPILEPSEMED15_117

تاریخ نمایه سازی: 29 اردیبهشت 1398

Abstract:

Psychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but have a different cause. It is clear that PNES are not associated with epileptic discharges in the brain, but it remains uncertain what the neurobiological underpinnings of seizures are when they are nonepileptic. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on our current understanding of the literature on aetiology, associated neurobiological changes and phenomenology of PNES, I will demonstrate that an Integrative Cognitive Model (ICM) can provide an explanation which transcends a traditional dualistic interpretation dividing symptoms or disorders into psychological or physiological . The ICM suggests that the central feature of PNES is the automatic activation of a mental representation of seizures (the seizure scaffold ) in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual’s awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated. It also facilitates the explanation of the disorder to patients (as a psycho-physiological reflex-like response triggered by internal or external triggers perceived as threatening) and it can provide a structural basis for psycho- and pharmacotherapeutic treatment formulations.

Authors

Markus Reuber,

University of Sheffield, United Kingdom