TY  - JOUR
PY  - 2018//
TI  - Psychogenic non-epileptic seizures in children and adolescents. Part I: diagnostic formulations
JO  - Clinical child psychology and psychiatry
A1  - Kozlowska, Kasia
A1  - Chudleigh, Catherine
A1  - Cruz, Catherine
A1  - Lim, Melissa
A1  - McClure, Georgia
A1  - Savage, Blanche
A1  - Shah, Ubaid
A1  - Cook, Averil
A1  - Scher, Stephen
A1  - Carrive, Pascal
A1  - Gill, Deepak
SP  - 140
EP  - 159
VL  - 23
IS  - 1
N2  - Psychogenic non-epileptic seizures (PNES) are a nonspecific, umbrella category that is used to collect together a range of atypical neurophysiological responses to emotional distress, physiological stressors and danger. Because PNES mimic epileptic seizures, children and adolescents with PNES usually present to neurologists or to epilepsy monitoring units. After a comprehensive neurological evaluation and a diagnosis of PNES, the patient is referred to mental health services for treatment. This study documents the diagnostic formulations - the clinical formulations about the probable neurophysiological mechanisms - that were constructed for 60 consecutive children and adolescents with PNES who were referred to our Mind-Body Rehabilitation Programme for treatment. As a heuristic framework, we used a contemporary reworking of Janet's dissociation model: PNES occur in the context of a destabilized neural system and reflect a release of prewired motor programmes following a functional failure in cognitive-emotional executive control circuitry. Using this framework, we clustered the 60 patients into six different subgroups: (1) dissociative PNES (23/60; 38%), (2) dissociative PNES triggered by hyperventilation (32/60; 53%), (3) innate defence responses presenting as PNES (6/60; 10%), (4) PNES triggered by vocal cord adduction (1/60; 2%), (5) PNES triggered by activation of the valsalva manoeuvre (1/60; 1.5%) and (6) PNES triggered by reflex activation of the vagus (2/60; 3%). As described in the companion article, these diagnostic formulations were used, in turn, both to inform the explanations of PNES that we gave to families and to design clinical interventions for helping the children and adolescents gain control of their PNES.<p />  <p>Language: en</p>
LA  - en
SN  - 1359-1045
UR  - http://dx.doi.org/10.1177/1359104517732118
ID  - ref1
ER  -