Clinical Neurology and Neurosurgery 120 (2014) 142–146
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Letters to the Editor Reply to letter to the Editor: Isolated transient myoclonus in the elderly
Psychogenic non-epileptic seizures – The age matters
We are pleased that Sethi found our report of interest and that he reported 3 additional cases of transient myoclonus (TM) from USA. We think that his letter is very important because to our knowledge, his report shows the ﬁrst TM cases from outside Japan. Sethi’s cases included toxic precipitating event for TM but drug can induce myoclonic movements (drug-induced myoclonus). With this one exception, the clinical features of his cases may be similar to previous reported cases and our cases. Previous and our reports demonstrated that TM shows normal or mildly abnormal electroencephalogram with nonspeciﬁc some slow activity or irregularity. We do not think that such electroencephalogram ﬁndings indicate encephalopathy. We agree with that subcortical myoclonus cannot be ruled out, because the asterixis and positive myoclonus can be originated from both the cortex and subcortex. However, previous electrophysiological ﬁndings about TM suggest that the cortical dysfunction is largely responsible for TM [1,2] although TM may be a heterogeneous entity and originated from different sites in the central nervous system. Further studies are necessary to resolve the precise mechanisms and generators of TM.
Conﬂict of interest statement We have no conﬂicts of interest. References
Psychogenic non-epileptic seizures Age Stressors
Dear Editor I read with interest the study by Asadi-Pooya et al. on psychogenic non-epileptic seizures (PNES) and the factors predisposing to it with great interest . That factors which potentially predispose to PNES differ in patients with juvenile as compared to adult-onset PNES intuitively makes sense for PNES occur in response to some triggering stressors which are likely to vary depending upon the age of the patient. So in a young patient; academic failure, bullying in school, physical or sexual abuse at the hands of a close relative or family member and failure in love are more likely to predispose to PNES as compared to medical comorbidities, a failed marriage or domestic abuse which is more likely to be an apparent trigger in the older adult patient population. It though needs to be emphasized that the triggering stressor or stressors may not be immediately apparent as the onset of PNES may postdate the triggering stressor by many years. Clinicians need to aware of this and take a detailed history going back to early childhood even in adult patients presenting with PNES.
 Hashimoto S, Kawamura J, Yamamoto T, Kinoshita A, Segawa Y, Harada Y, et al. Transient myoclonic state with asterixis in elderly patients: a new syndrome? J Neurol Sci 1992;109:132–9.  Hitomi T, Ikeda A, Inouchi M, Imamura H, Nakagawa T, Fumuro T, et al. Transient myoclonic state with asterixis: primary motor cortex hyperexcitability is correlated with myoclonus. Intern Med 2011;50:2303–9.
 Asadi-Pooya AA, Emami M. Juvenile and adult-onset psychogenic non-epileptic seizures. Clin Neurol Neurosurg 2013;115(September (9)):1697–700.
Akiyuki Hiraga ∗ Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
Nitin K. Sethi ∗ Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA
Satoshi Kuwabara Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan ∗ Corresponding
∗ Correspondence to: Comprehensive Epilepsy Center, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East, 68th Street, New York 10065, USA. Tel.: +1 212 746 2346; fax: +1 212 746 8845. E-mail address: [email protected]
We critically review the existing literature about the epidemiology (i.e., diagnosis, occurrence, age, gender, comorbidity with epilepsy, associated factors, prognosis, mortality, and cost) of psychogenic nonepileptic seizures (PNES) and provide sugg
Despite the long history of psychogenic nonepileptic seizures (PNES), relatively little is known about the mechanisms that cause and maintain this condition. Emerging research evidence suggests that patients with PNES might have difficulties in regul
Psychogenic nonepileptic seizures (PNES), a form of functional neurological symptom disorder (FNSD), are very rarely seen in genuine, electroencephalography (EEG)-confirmed sleep. However, they are more commonly reported as a nocturnal occurrence, li
Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are us
Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We con
Knowledge about health systems can promote implementation of more specific and strategic health practices for patients with psychogenic nonepileptic seizures (PNES). For this purpose, we surveyed the current management of PNES (standard medical care