Epilepsy and Functional Neurological Disorders

epilepsy

affects the brain and causes seizures (electrical activity in the brain that temporarily affect how it works)

seizures can cause a wide range of symptoms and can affect people in different ways depending which part of the brain is involved

usually lifelong condition, can live normal lives if seizures are well controlled

seizures include zoning out but remaining aware but unable to explain at the time

can have surgery and other forms of medical treatment

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Non-Epileptic Attack Disorder (NEAD)

episodes of temporary loss of control and/or awareness

symptoms affect

movement - shaking, falls, poor movement control

senses - changes to hearing, sight, taste, smell or touch, feeling numb

awareness/thinking skills - feeling confused, distant, disorientated, black black out

range of comorbid MUS, more common in women, young people, low socioeconomic status

present similarly to epilepsy so hard to tell apart, not caused by electrical activity

functional neurological disorder

neurological symptoms that cannot be accounted for by physical damage to the neurvous system

NEAD is the most common FND presenting to neurology

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journey to diagnosis

engagement is important

fairclough et al. (2013) reasons for lack of engagement and droup-out

disagree with diagnosis

diagnosis has lack of person relevance

deny psychological factors in their life

impairment due to condition - physical not psychological

shame and isolation

NEAD explanatory models

physical manifestation of emotional distress

freudian concept of convesion and later psychodynamic ideas about somatisation

people with NEAD have higher rates of MHP compared with general population and people diagnosed with epilepsy (diprose, 2016)

authors suggest that NEAD is the expression of psycho,ogical distress and thus diagnoses are not distinct conditions

clinical expression of the dissociative type of PTSD

when dissociated, thoughts, feelings and/or memories relating to traumatic events enters the awareness

NEAD is also present in individuals without a known history of trauma (hingray et al., 2011)

NEAD is a hard-wired intrinsic stress response

episode is a physiological reaction to stress much like the fight-flight response that has benefits for survival

NEAD is a learned behaviour

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