Epilepsy & Behavior 40 (2014) 97–98
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor Psychogenic nonepileptic seizures are Cinderella seizures, and Epilepsy & Behavior is their Prince Charming
To the Editor Definitive epidemiological data on the incidence and prevalence of psychogenic nonepileptic seizures (PNESs) are scarce. In studies of patients referred to tertiary neurological centers for diagnosis, the reported incidence rates are between 1.5 and 3 per 100,000, with an estimated prevalence of 2 to 33 per 100,000. Psychogenic nonepileptic seizures are commonly seen in specialist epilepsy centers, where about 20% of patients referred for epilepsy surgery evaluation and up to 50% of patients with intractable seizures are eventually diagnosed with PNESs [1]. Given the lack of data, it would be of interest to analyze the availability of information and number of searches about PNESs on the Internet. Millions of people worldwide use the Internet to source health information, and every day, patients and physicians use tools such as Google, Wikipedia, and PubMed to look for online health-related information [2]. An online analysis of PNES data reveals that there is a discrepancy between the disease burden (derived from epidemiological data) and the available disease-related information. A search performed with the key terms “psychogenic non-epileptic seizures” OR “psychogenic nonepileptic seizures” using the Google search engine retrieves 302,000 results compared with 1,890,000 results from a similar search using the term “epileptic seizures” [searches conducted on 26th July 2014]. Similarly, the overall search volume for the term “psychogenic nonepileptic seizures” is much smaller than that for the term “epileptic seizure” in searches conducted using Google Trends and Wiki Trends [searches conducted using http://www.google.com/trends/ and http:// www.wikipediatrends.com/ on 26th July 2014]. Compared with epileptic seizures, PNESs can rightly be considered “Cinderella seizures” because of the scarce amount of online information and little public knowledge or interest about these phenomena. Neurologists and epileptologists should be very well aware of PNESs so that they can promptly make the correct diagnosis and avoid unnecessary, inefficacious, and sometimes harmful antiepileptic treatment and plan the most appropriate management [3,4]. However, a survey of primary care and emergency physicians found that there were still ignorance and misperceptions surrounding PNESs [5]. There remains a need for ongoing education and outreach to referring physicians about PNESs, especially since early diagnosis of PNESs is associated with better outcomes [5]. Scientific societies and journals have a responsibility to increase and maintain knowledge and attitudes of epileptologists and general neurologists towards PNESs. In this regard, Epilepsy & Behavior (E&B) has historically contributed (and still does contribute) a body of literature that fills the gap between disease burden and disease-related information on PNESs. A search performed in MEDLINE (accessed via PubMed) by entering the terms “psychog*” and “seizur*” and filtered for the name of the journal
http://dx.doi.org/10.1016/j.yebeh.2014.08.129 1525-5050/© 2014 Elsevier Inc. All rights reserved.
Table 1 Number of results retrieved in MEDLINE (searched via PubMed) by entering the free terms “psychog*” AND “seizur*” and filtering the results by journal name (only journals devoted to epilepsy were considered in the search). Journal
Number of results
Clinical Nursing Practice in Epilepsy Epilepsia Epilepsy & Behavior Epilepsy & Behavior Case Reports Epilepsy Currents Epilepsy Research Epilepsy Research and Treatment Epileptic Disorders Journal of Epilepsy Journal of Epilepsy Research Journal of Pediatric Epilepsy Newsletter. American Epilepsy League Seizure
0 87 180 0 3 10 1 7 0 0 0 0 57
reveals that, of all the epileptological journals indexed in PubMed, E&B has published the highest number of articles devoted to PNESs (Table 1) [searches conducted on 26th July 2014]. This finding is really impressive if compared with the much lower number of articles in internationally renowned epileptological journals that have been publishing monthly for decades. Of note, 107 of the 180 articles published in E&B and devoted to PNESs have been published in the last five years, indicating that there is increasing interest and awareness about the condition. The educational role of E&B in maintaining interest about PNESs in the scientific community represents a great strength of the journal. It is now up to its contributors to preserve and further enhance its quality. If PNESs are Cinderella seizures, then there is no doubt that E&B is their Prince Charming.
Conflict of interest The authors declare that there are no conflicts of interest. References [1] Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 2003;4:205–16. [2] Brigo F, Igwe SC, Ausserer H, Nardone R, Tezzon F, Bongiovanni LG, et al. Why do people Google epilepsy? An infodemiological study of online behavior for epilepsyrelated search terms. Epilepsy Behav 2014;31:67–70. [3] Brigo F. An evidence-based approach to proper diagnostic use of the electroencephalogram for suspected seizures. Epilepsy Behav 2011;21:219–22. [4] Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav 2012;25:251–5. [5] Shneker BF, Elliott JO. Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells. Epilepsy Behav 2008;13: 243–7.
98
Letter to the Editor
Francesco Brigo Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy Department of Neurology, Franz Tappeiner Hospital, Meran/o, Italy Corresponding author at: Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Piazzale L.A. Scuro, 10-37134 Verona, Italy. Tel.: +39 458124174; fax: +39 458124873. E-mail address: [email protected].
Stanley C. Igwe Department of Neuro-Psychiatry, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria 23 August 2014
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor Psychogenic nonepileptic seizures are Cinderella seizures, and Epilepsy & Behavior is their Prince Charming
To the Editor Definitive epidemiological data on the incidence and prevalence of psychogenic nonepileptic seizures (PNESs) are scarce. In studies of patients referred to tertiary neurological centers for diagnosis, the reported incidence rates are between 1.5 and 3 per 100,000, with an estimated prevalence of 2 to 33 per 100,000. Psychogenic nonepileptic seizures are commonly seen in specialist epilepsy centers, where about 20% of patients referred for epilepsy surgery evaluation and up to 50% of patients with intractable seizures are eventually diagnosed with PNESs [1]. Given the lack of data, it would be of interest to analyze the availability of information and number of searches about PNESs on the Internet. Millions of people worldwide use the Internet to source health information, and every day, patients and physicians use tools such as Google, Wikipedia, and PubMed to look for online health-related information [2]. An online analysis of PNES data reveals that there is a discrepancy between the disease burden (derived from epidemiological data) and the available disease-related information. A search performed with the key terms “psychogenic non-epileptic seizures” OR “psychogenic nonepileptic seizures” using the Google search engine retrieves 302,000 results compared with 1,890,000 results from a similar search using the term “epileptic seizures” [searches conducted on 26th July 2014]. Similarly, the overall search volume for the term “psychogenic nonepileptic seizures” is much smaller than that for the term “epileptic seizure” in searches conducted using Google Trends and Wiki Trends [searches conducted using http://www.google.com/trends/ and http:// www.wikipediatrends.com/ on 26th July 2014]. Compared with epileptic seizures, PNESs can rightly be considered “Cinderella seizures” because of the scarce amount of online information and little public knowledge or interest about these phenomena. Neurologists and epileptologists should be very well aware of PNESs so that they can promptly make the correct diagnosis and avoid unnecessary, inefficacious, and sometimes harmful antiepileptic treatment and plan the most appropriate management [3,4]. However, a survey of primary care and emergency physicians found that there were still ignorance and misperceptions surrounding PNESs [5]. There remains a need for ongoing education and outreach to referring physicians about PNESs, especially since early diagnosis of PNESs is associated with better outcomes [5]. Scientific societies and journals have a responsibility to increase and maintain knowledge and attitudes of epileptologists and general neurologists towards PNESs. In this regard, Epilepsy & Behavior (E&B) has historically contributed (and still does contribute) a body of literature that fills the gap between disease burden and disease-related information on PNESs. A search performed in MEDLINE (accessed via PubMed) by entering the terms “psychog*” and “seizur*” and filtered for the name of the journal
http://dx.doi.org/10.1016/j.yebeh.2014.08.129 1525-5050/© 2014 Elsevier Inc. All rights reserved.
Table 1 Number of results retrieved in MEDLINE (searched via PubMed) by entering the free terms “psychog*” AND “seizur*” and filtering the results by journal name (only journals devoted to epilepsy were considered in the search). Journal
Number of results
Clinical Nursing Practice in Epilepsy Epilepsia Epilepsy & Behavior Epilepsy & Behavior Case Reports Epilepsy Currents Epilepsy Research Epilepsy Research and Treatment Epileptic Disorders Journal of Epilepsy Journal of Epilepsy Research Journal of Pediatric Epilepsy Newsletter. American Epilepsy League Seizure
0 87 180 0 3 10 1 7 0 0 0 0 57
reveals that, of all the epileptological journals indexed in PubMed, E&B has published the highest number of articles devoted to PNESs (Table 1) [searches conducted on 26th July 2014]. This finding is really impressive if compared with the much lower number of articles in internationally renowned epileptological journals that have been publishing monthly for decades. Of note, 107 of the 180 articles published in E&B and devoted to PNESs have been published in the last five years, indicating that there is increasing interest and awareness about the condition. The educational role of E&B in maintaining interest about PNESs in the scientific community represents a great strength of the journal. It is now up to its contributors to preserve and further enhance its quality. If PNESs are Cinderella seizures, then there is no doubt that E&B is their Prince Charming.
Conflict of interest The authors declare that there are no conflicts of interest. References [1] Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 2003;4:205–16. [2] Brigo F, Igwe SC, Ausserer H, Nardone R, Tezzon F, Bongiovanni LG, et al. Why do people Google epilepsy? An infodemiological study of online behavior for epilepsyrelated search terms. Epilepsy Behav 2014;31:67–70. [3] Brigo F. An evidence-based approach to proper diagnostic use of the electroencephalogram for suspected seizures. Epilepsy Behav 2011;21:219–22. [4] Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav 2012;25:251–5. [5] Shneker BF, Elliott JO. Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells. Epilepsy Behav 2008;13: 243–7.
98
Letter to the Editor
Francesco Brigo Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy Department of Neurology, Franz Tappeiner Hospital, Meran/o, Italy Corresponding author at: Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Piazzale L.A. Scuro, 10-37134 Verona, Italy. Tel.: +39 458124174; fax: +39 458124873. E-mail address: [email protected].
Stanley C. Igwe Department of Neuro-Psychiatry, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria 23 August 2014
