Psychogenic Non-Epileptic Attacks (PNEA)…in Africa

The epidemiology of PNEA in high income, western settings is fairly well described but little is known about this condition in Africa. At a referral hospital in Tanzania, Dekker and colleagues have recently made some interesting observations.1 In their 6-year retrospective chart review, they found that PNEA comprised 50% of the functional neurologic disorders seen but the PNEA presenting in their setting was almost exclusively a short-lived, self-limited condition in young women. This is in stark contrast to the more insidious and diverse presentations of the condition in the US and leaves this epileptologist wondering if the difference is due possibly to selection bias, the deterrence of chronicity due to stigmatization and/or possibly the relative absence of the medicalization of PNEA in the African setting where many, perhaps most self-limited ‘seizures’ are not brought to medical attention.2

  1. Dekker MCJ, Urasa SJ, Kellogg M, Howlett WP. Psychogenic non-epileptic seizures among patients with functional neurological disorder: A case series from a Tanzanian referral hospital and literature review. Epilepsia Open 2018; 3(1): 66-72.
  2. Asadi-Pooya AA, Sperling MR. Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 2015; 46: 60-5.

 

Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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