Papers by Barbara Dworetzky
Epilepsy & Behavior, 2022
BACKGROUND We previously reported on the efficacy of a manualized 12-session mindfulness-based th... more BACKGROUND We previously reported on the efficacy of a manualized 12-session mindfulness-based therapy (MBT) for psychogenic nonepileptic seizures (PNES). Completion of MBT provided improvements in weekly PNES frequency and self-rated intensity. OBJECTIVES In this study, we aimed to determine sustainability of improvement of seizure-related measures at 3- to 6-month follow-up after treatment completion. We also examined changes at treatment end and at follow-up on therapeutic targets of the MBT program. METHODS Patients with documented PNES were recruited from 2014 to 2018. Baseline measures were collected at time of diagnosis (T0) and at first follow-up post-diagnosis (T1). Outcomes are reported at MBT treatment completion (T3) and 3- to 6-month follow-up (T4). The Wilcoxon signed-rank test was used for pair-wise comparisons of PNES frequency; linear mixed models were used for other outcomes. RESULTS Fourteen of the 26 MBT completers (54%) attended follow-up (median 147.5 days between T3 and T4). PNES frequency, intensity, and number of days/week with PNES remained reduced at T4 (p < 0.01 for all; median frequency reduction 1.3/week from T1). Illness perception and feeling understood remained improved at T4 (p < 0.001 for both) as did worry about PNES (p < 0.05). Illness attribution (physical, mental or both) changed from T0 to T3 (p < 0.01), but not to T4. Psychological flexibility did not change over time. CONCLUSION Previously reported improvements in seizure-related measures with MBT at treatment conclusion were maintained at 3- to 6-month follow-up. There were sustained improvements in some underlying processes (illness perception, feeling understood, and symptom worry) over the course of treatment and at follow-up. Long-term benefits of MBT need to be established with randomized controlled trials.
Neurology, Sep 15, 2020
Neurologists are commonly consulted for patients with a functional neurologic disorder. Best prac... more Neurologists are commonly consulted for patients with a functional neurologic disorder. Best practices as to their diagnosis and treatment have been established, and multiple academic centers have programs in place for their treatment. However, given the number of patients suffering from this condition, a comprehensive model of care that can be broadly implemented needs to be developed and applied beyond specialized academic programs.
Neurology, Jan 21, 2015
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by ... more Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
Humana Press eBooks, Sep 25, 2007
... Barbara A. Dworetzky, Edward B. Bromfield, and Nanon E. Winslow ... was shown by Adams andLud... more ... Barbara A. Dworetzky, Edward B. Bromfield, and Nanon E. Winslow ... was shown by Adams andLuders to have a higher yield than 6 h of continuous EEG moni-toring, justifying continuation of this technique when no epileptiform discharges are noted at 3 min, particularly in ...
Oxford University Press eBooks, May 1, 2017
Patients with psychogenic nonepileptic seizures (PNES), a subtype of functional neurological symp... more Patients with psychogenic nonepileptic seizures (PNES), a subtype of functional neurological symptom disorder (FNSD), receive suboptimal care owing to a number of factors, including the poorly understood nature of the disorder, limited evidence-based treatments, limited education within training programs, and a divided healthcare system. This chapter reviews the impact that such factors have in the delivery of care and attitude toward patients with PNES and FNSD. The chapter constructively proposes how recent advances can be turned into therapeutic opportunities from the point of view of clinical care and education and training, by using an integrated care approach. The specific components and goals of the integrated care model are discussed. The ultimate goal is that all aspects of the patient’s life are aligned toward maximum recovery and optimized functioning. Finally, the positive impact that such a model can have in training programs is emphasized. A change in the delivery of care for FNSD patients represents an opportunity to integrate these disorders within the realm of modern medicine with a compassionate and empathic professional attitude.
DeckerMed Transitional Year Weekly Curriculum™, Apr 29, 2019
This work is published in two volumes with numerous illustrations and tables. The author has an e... more This work is published in two volumes with numerous illustrations and tables. The author has an engaging style, and the apostrophe, simile, and pathetic fallacy are woven into the text in an entertaining manner. It would make instructive reading for the stilted "subject-predicate" school of medical writers. The opening chapters deal with the early writings on epilepsy and explore the evolving concepts of causation. The various convulsive disorders are then classified and described. There is a chapter on the "Borderlands of Epilepsy" which includes migraine, syncope, carotid sinus syndrome, narcolepsy, hysteria, vertigo, and sleep disorders—the relationship of these to epilepsy it extremely tenuous. Other chapters consider sources of seizures, genetics of epilepsy, acquired epilepsy, electrobiology, and therapeutics. There is an interesting chapter on epileptics of worth and fame. The final chapters are a sympathetic look at the social, emotional, and legal problems of this disorder. The appraisal of the book
Journal of Epilepsy, Dec 1, 1995
... Neurology, University of Sheffield Medical School, Sheffield, England Thyroid Disease and the N... more ... Neurology, University of Sheffield Medical School, Sheffield, England Thyroid Disease and the Nervous System MICHAEL CAMILLERI, MD ... of Medicine, Indianapolis, Indiana Acute Bacterial Infections of the Central Nervous System ANDREW P. ROSE-INNES, MBChB Assistant ...
Neurology, Nov 25, 2019
We read with great interest the article by Jalini et al., 1 which demonstrated a higher prevalenc... more We read with great interest the article by Jalini et al., 1 which demonstrated a higher prevalence of atrial cardiopathy in patients with embolic strokes of undetermined source (ESUS) compared with patients with large artery and small vessel disease strokes. We recently found that abnormally increased P-wave terminal force in lead V1 in patients with ESUS was inversely associated with paradoxical and artery-to-artery embolic sources, including patent foramen ovale (PFO) and vulnerable, unstable substenotic atherosclerotic plaques of aortic arch and neck arteries. 2 In patients with anterior circulation ESUS, internal carotid artery plaques with increased thickness, mobility, ulceration, and low or heterogeneous echo were more common when ipsilateral rather than contralateral to the stroke site. 3 Younger patients with Editors' note: Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies In the article "Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies," Jalini et al. reported atrial cardiopathy in 26.6% of patients meeting the criteria for embolic stroke of unknown source (ESUS) vs 12.1% of patients with large artery atherosclerosis and 16.9% of those with small vessel disease in a cross-sectional study of 846 consecutive patients with ischemic stroke. They also found that patients with ESUS were younger, less hypertensive, and had higher cholesterol and low-density protein levels but fewer left ventricular or atrial abnormalities compared with yet another group with cardioembolism. In response, Drs. Lattanzi and Silvestrini note that they recently found an inverse association between abnormally increased P-wave terminal force in lead V1 (a marker of atrial cardiopathy) and paradoxical or artery-to-artery embolic sources in patients with ESUS. Patients with anterior circulation ESUS more often had ipsilateral (vs contralateral) internal carotid artery plaques with more concerning atherosclerotic findings, whereas younger patients with ESUS had higher incidence of patent foramen ovale (PFO) and lower rates of other vascular risk factors or markers of cardiopathy or atherosclerosis. Stating that ESUS is thus a heterogeneous entity, they encourage the identification of such distinct phenotypes to help guide secondary prevention and potentially targeted interventions. In their reply, the authors agree that the ESUS definition seems too broad and that factors such as PFO, aortic arch, and nonstenotic carotid plaques that were not addressed in their study are important embolic sources in subgroups of patients with ESUS. They note that ongoing trials in subgroups of patients with ESUS will further inform secondary prevention in this population.
Clinical Eeg and Neuroscience, 2015
Epilepsy Currents, Nov 1, 2014
In Clinical Science Commentary Psychogenic nonepileptic seizures (PNES) represent the most common... more In Clinical Science Commentary Psychogenic nonepileptic seizures (PNES) represent the most common functional neurologic symptom disorder (FNSD) and the new terminology in DSM 5 for conversion disorder.
Epilepsy Currents, Nov 1, 2015
Clinical Eeg and Neuroscience, 2010
Nonconvulsive status epilepticus (NCSE) is a serious condition commonly considered when evaluatin... more Nonconvulsive status epilepticus (NCSE) is a serious condition commonly considered when evaluating a patient with altered mental status, and an electroencephalogram (EEG) is necessary for diagnosis. Neurology house staff often must make this diagnosis at times when no EEG technologist is available. We report our experience with abbreviated, emergency below-the-hairline EEGs (BTH-EEG) performed by neurology residents at our institution over a 1–1/2 year period. We analyzed demographic and clinical data in relation to whether or not an ictal or periodic pattern was identified, and these results were compared to follow up EEGs. Thirty-nine studies were identified, ranging in duration from 3 min-13 hrs. Mean and median age of patients included was 53 (range 25–81yrs); 21 were female. Seven of 39 BTH-EEGs showed at least one electrographic seizure, 9 more showed periodic discharges. Follow-up EEGs showed electrographic seizures in 6 of 39 patients, including 3 of the 7 with ictal BTH-EEG, and an additional 3 whose BTH-EEGs showed periodic lateralized discharges but no organized seizures. All 7 patients with ictal BTH-EEGs survived to discharge, vs. 23 of the remaining 32. We conclude that in selected cases, BTH-EEG is useful in detecting seizures and/or other epileptiform patterns. In our series, when NCSE was in question, the BTH-EEG showed these patterns 41% of the time. The BTH-EEG is a fast, non-invasive, inexpensive tool that may save valuable time, especially when no other viable option is immediately available. This technique may be applicable more broadly, not just limited to centers with neurology residents.
Epilepsy & Behavior, Feb 1, 2011
The interictal EEG is a noninvasive and useful test for selecting candidates for resective epilep... more The interictal EEG is a noninvasive and useful test for selecting candidates for resective epilepsy surgery, although it has many pitfalls. It is an essential test for the most common drug-resistant epilepsy, mesial temporal sclerosis, and predicts good outcome when interictal epileptiform discharges are concordant with unilateral hippocampal atrophy or sclerosis, and predicts poor outcome when interictal epileptic discharges are discordant with the lesion. Its role in other types of epilepsy surgery, including nonlesional cases and corpus callosotomy, is less clear. Future research gathering large multicenter prospective data is needed to maximize the role of this classic neurophysiological test in the evaluation of candidates for epilepsy surgery.
Epilepsy & Behavior, 2011
We investigated the safety, tolerability, and effectiveness of lacosamide (LCM) in patients with ... more We investigated the safety, tolerability, and effectiveness of lacosamide (LCM) in patients with acute recurrent seizures or with periodic epileptiform activity captured during continuous EEG monitoring. A total of 17 patients received LCM; 12 patients received LCM as a second or third antiepileptic drug (AED), one patient as a fourth AED, and one patient as a fifth AED. No additional AEDs were introduced after LCM in 15 patients. Twelve patients responded to LCM with improvement in the seizures or periodic epileptiform activity. Two patients required further AED management or burst suppression. No adverse effects, including symptomatic bradycardia and allergic reactions, were seen for intravenous infusion dosages up to 300 mg. Eleven patients were eventually discharged on LCM. LCM is an important new AED in the add-on treatment of acute recurrent seizures and periodic epileptiform activity in critically ill patients.
Epilepsia, Dec 7, 2017
We conducted a prospective cohort study, examining long-term adherence with psychiatric treatment... more We conducted a prospective cohort study, examining long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures (PNES). Subjects diagnosed with documented PNES were scheduled for 4 psychiatric visits. Survival analysis was performed, and covariates were assessed for association with time to nonadherence using Cox proportional hazard regression analysis. One hundred twenty-three subjects were recruited and followed for up to 17 months. Eighty percent of subjects attended the first outpatient visit, 42% attended the second, 24% attended the third, and only 14% remained adherent through the fourth visit. Two covariates were associated with nonadherence: (1) a prior diagnosis of PNES (hazard ratio 1.57, P-value .046); (2) a lower score on the Brief Illness Perception Questionnaire (BIPQ), signifying lower concern about one's illness (hazard ratio 0.77 for every 10-point increment on the 80-point scale, P-value .008). Adherence with psychiatric treatment among patients with PNES is initially reasonably good but worsens rapidly over visits 2-4. Risk factors for nonadherence include a history of a prior diagnosis of PNES, and a lower level of concern about the illness as assessed by a lower score on the BIPQ.
Lancet Neurology, Oct 1, 2013
Background Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people wi... more Background Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide.
Neurology, Feb 12, 2013
OBJECTIVE: To compare major respiratory and cardiac parameters in association with epileptic (ES)... more OBJECTIVE: To compare major respiratory and cardiac parameters in association with epileptic (ES) versus non-epileptic seizures (NES). BACKGROUND: Respiratory dysfunction is frequently seen in association with epileptic-seizures and may be a contributing factor to the higher risk of unexpected death. However, the presence of abnormal respiration associated with non-epileptic events has not been examined. DESIGN/METHODS: We prospectively enrolled patients admitted in the epilepsy monitoring unit for seizure evaluation. Breathing disturbances (central versus obstructive events, tachypneas versus bradypnea), oxygenation and heart-rate before, during and after seizures and relationship to seizure activity were evaluated by respiratory inductance plethysmography (RIP), pulse-oximetry and EKG. Type of seizure (non-epileptic versus epileptic) was determined on the basis of EEG and video analysis. Statistical analyses were performed to compare minimal oxygen saturation (two group mean comparison test), as well as proportions of apnea, tachycardia, and desaturation in ES versus NES (two groups comparison of proportions). RESULTS: Forty-three adult-patients were enrolled from October 2010 to August 2011. Subjects9 age ranged from 22 to 62 years. Fifty-five definite epileptic and 22 non-epileptic events were recorded. Significant desaturation was noted in 54% of the ES and none of the NES. Minimal oxygen saturation associated with an event was significantly lower in the ES compared with the NES (p=.03). Apnea (central or obstructive) was noted in 35% of the ES and none of the NES (p=.001). Tachycardia occurred in 67% of the ES 71% of the NES (n/s). CONCLUSIONS: Our findings complement prior reports of cardiorespiratory abnormalities in epileptic events, in comparison with non-epileptic events. Tachycardia was similar in ES and NES. In contrast, respiratory abnormalities were seen primarily in the epileptic events. This suggests that respiratory dysfunction has a unique importance in the evaluation of epileptic seizures. Supported by: Harvard CATALYST pilot project grant. Disclosure: Dr. Kothare has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Dworetzky has received personal compensation for activities with Sleep Health/Digitrace Company, and Best Doctors. Dr. Abdenadder has nothing to disclose. Dr. Pavlova has received personal compensation for activities with Takeda.
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Papers by Barbara Dworetzky