Renato Luiz Marchetti1, Jose Gallucci-Neto2, Daniela Kurcgant3, Inah Carolina Galatro Faria Proença3, Leandro da Costa Lane Valiengo3, Lia Arno Fiore4, Lécio Figueira Pinto4, Ana Goretti Kalume Maranhão5, Maria Tereza da Costa Oliveira6, Lucia Helena de Oliveira7. 1. Neuropsychiatry Program, Department and Institute of Psychiatry, University of São Paulo Faculty of Medicine, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP CEP 05403-903, Brazil. Electronic address: renato.marchetti@hc.fm.usp.br. 2. Neuropsychiatry Program, Department and Institute of Psychiatry, University of São Paulo Faculty of Medicine, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP CEP 05403-903, Brazil; VEEG Unit, Department and Institute of Psychiatry, University of São Paulo Faculty of Medicine, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP CEP 05403-903, Brazil. 3. Neuropsychiatry Program, Department and Institute of Psychiatry, University of São Paulo Faculty of Medicine, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP CEP 05403-903, Brazil. 4. VEEG Unit, Department and Institute of Psychiatry, University of São Paulo Faculty of Medicine, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP CEP 05403-903, Brazil. 5. National Immunization Program, Health Surveillance Secretariat, Brazilian Ministry of Health, SRTVN, Quadra 701, Lote 3, Edifício PO 700, 6° andar, CGPNI, Asa Norte, Brasília, DF CEP: 70.719-040, Brazil. Electronic address: ana.goretti@saude.gov.br. 6. Immunization Unit/Family, Health Promotion and Life Course, Pan American Health Organization, 525 Twenty-third Street, NW Washington DC, USA. Electronic address: dacostmar@paho.org. 7. Immunization Unit/Family, Health Promotion and Life Course, Pan American Health Organization, 525 Twenty-third Street, NW Washington DC, USA. Electronic address: oliveirl@paho.org.
Abstract
IMPORTANCE: The absence of a positive diagnosis of psychogenic non-epileptic seizures (PNES) in immunization stress-related response (ISRR) clusters may have not only a direct impact on affected patients' health but may also reduce compliance to national vaccination programs. It is therefore crucial to develop efficient diagnostic tools and a feasible proposal for proper communication and treatment of ISRR. PURPOSE: To explore the psychogenic nature of patients' convulsive seizures in a suspected outbreak of an ISRR cluster following human papillomavirus vaccination in Rio Branco, Brazil. METHODS: Twelve patients with convulsive seizures were submitted to prolonged intensive video-electroencephalography monitoring, brain magnetic resonance imaging, cerebrospinal fluid diagnostic testing, laboratory subsidiary examinations, and complete neurological and psychiatric evaluations. RESULTS: Ten patients received the positive diagnosis of PNES, and two patients received the diagnosis of idiopathic generalized epilepsy. No biological association was found between the HPV vaccine and the clinical problems presented by the patients. CONCLUSIONS: Prolonged VEEG monitoring can contribute significantly to the positive diagnosis of PNES in ISRR clusters and to avoid hesitancy to vaccinate.
IMPORTANCE: The absence of a positive diagnosis of psychogenic non-epileptic seizures (PNES) in immunization stress-related response (ISRR) clusters may have not only a direct impact on affected patients' health but may also reduce compliance to national vaccination programs. It is therefore crucial to develop efficient diagnostic tools and a feasible proposal for proper communication and treatment of ISRR. PURPOSE: To explore the psychogenic nature of patients' convulsive seizures in a suspected outbreak of an ISRR cluster following human papillomavirus vaccination in Rio Branco, Brazil. METHODS: Twelve patients with convulsive seizures were submitted to prolonged intensive video-electroencephalography monitoring, brain magnetic resonance imaging, cerebrospinal fluid diagnostic testing, laboratory subsidiary examinations, and complete neurological and psychiatric evaluations. RESULTS: Ten patients received the positive diagnosis of PNES, and two patients received the diagnosis of idiopathic generalized epilepsy. No biological association was found between the HPV vaccine and the clinical problems presented by the patients. CONCLUSIONS: Prolonged VEEG monitoring can contribute significantly to the positive diagnosis of PNES in ISRR clusters and to avoid hesitancy to vaccinate.
Authors: Matthew Butler; Jan Coebergh; Farinaz Safavi; Alan Carson; Mark Hallett; Benedict Michael; Thomas A Pollak; Tom Solomon; Jon Stone; Timothy R Nicholson Journal: J Neuropsychiatry Clin Neurosci Date: 2021-07-15 Impact factor: 2.891