NEAD Flashcards
What is the definition of NEAD?
Attacks that don’t appear to have a physiological explanation – biological research has not found a set anatomical or functional cause or explanation. No test or scan can be done to diagnose.
How has epilepsy been useful for understanding anatomy?
if the seizure moves from the finger to the arm then this means it is likely the area that control movement of these areas are closely linked in the brain too
How do the alternating contractions of agonistic and antagonistic muscles during an NEAD attack differ to epilepsy?
In epilepsy it is the alternation between complete contraction of all muscles (both agonistic and antagonistic) and relaxtion that causes the jerking like motions
What did NEAD used to be called?
hysteria
What can anxiety during pregnancy cause?
Epigenetic changes which are passed down to children and predispose to NEAD
What are the potential factors that could cause predisposition to NEAD?
Sexual abuse Childhood neglect Poor emotional regulation Poor attachment Problems trusting others Genetics
Essentially anything leading to vulnerability
What are some potential precipitants that may cause NEAD to manifest?
Car crash, trauma, losing job, losing independence, triggers from childhood abuse
What is the main cause for perpetuating NEAD?
Most cases are initially diagnosed as epilepsy so start antiepileptic drugs, that doesn’t help leading to stress and anxiety
Describe the seizures scaffold for NEAD
Hard-wired behavioural tendencies
Automatic motor movement have a ‘script’ in brain e.g. walking round a lampost when in deep conversation is automatic and unconscious
NEAD is thought to be similar
Seizure models from self, others, media etc. (sometimes first attack is epileptic and subsequent aren’t)
Prior physical illness and injury
Loss of consciousness
Anxiety causes muscle tension to increase- inherent generic response to emotions
Expectation has a strong role in the functioning of the seizure scaffold
Give some examples of how expectation has an affect on the brain and the seizure scaffold.
E.g. hemianopia post stroke – patients will eat only half the plate of food as the brain can only see the empty half (visual input of half an empty plate), thinks the plate is empty and fills the other half in as empty (expectation is that the whole plate is empty - perception is the expectation, rather than the sensory input)
McGurk effect: ‘bar’ vs ‘far’ changing when looking at someones lips despite the sound being the same – visual system trumps hearing, highlights the importance of expectation
What is perception?
perception= sensory input + expectation
How do patients often describe the triggers for NEAD?
Often out of the blue and not when feeling stressed
What is thought to be the triggers for NEAD? How do patients not feel these?
Thought that arousal triggers it – mostly emotional state, sometimes bodily state and some external factors
Rapid reflex – autonomously reacting to a state before you even feel it, thought to explain how patients don’t expect it
Our ability to attend to things is selective – senses pick up everything, brain only selects some things to feel → possibility for this reflex without patient knowing
What does Bakvis et al. (2009) demonstrate in their paper : Trauma, stress and preconscious threat processing in patients with psychogenic non-epileptic seizures?
To look at the levels of stress and hypervigilance in patients with NEAD
Low HR variability is a marker of stress (the heart is beating faster due to sympathetic stimulation and therefore rate is less variable)
At baseline NEAD patients have a higher level of stress than epilepsy patients and so are generally in a hypervigilant state
Stroop test - coloured eggs where the patient has to say the colour. Before eggs for 30ms (shorter than able to register) a face with either neutral, angry or happy expression is flashed. Found that patients with NEAD were slower to respond to the eggs post angry faces.
NEAD patients are hyperaware and more reactive to anger - respond to emotions differently
Patients with sexual abuse were the slowest to repsond
What did Reuber et al. (2012) demonstrate in their paper - comparison of heart rate variability parameters during complex partial seizures and psychogenic non epileptic seizures?
To look at autonomous nervous system during seizure
Lorenz plot found epileptic seizures to have very high sympathetic tone during seizure
NEAD patients had less sympathetic tone during seizures
i.e. NEAD patients are less stressed during attacks
