Panic and Anxiety in Non-Epileptic Attack Disorder: Diagnostic and Mechanistic Implications

Abstract

This thesis explores the symptomology and experience of non-epileptic attack disorder (NEAD) and its implications for diagnosis and treatment. Three papers are presented. Paper 1 presents a meta-analysis of quantitative research that explored anxiety in NEAD compared to epilepsy and the healthy population. Forty-two studies were included involving a total of 1732 patients with NEAD and 3239 controls across ten countries, spanning fifty-seven years of research. The meta-analysis confirmed the common assumption that people with NEAD report higher anxiety compared to both healthy and illness controls. Compared to healthy participants, the effect size difference was very large. In contrast, epilepsy controls had higher anxiety scores than healthy controls, resulting in a small to moderate effect size difference between the NEAD and epilepsy groups that was still statistically significant. The analysis also highlighted high heterogeneity within the NEAD population. The results have implications regarding the theoretical understanding of NEAD which in turn has implications for assessment and diagnosis and treatment. Practitioners should be mindful of the variability of NEAD presentation and be cautious to not overgeneralise perceived causality for this. Paper 2 assessed the feasibility of conducting a study investigating a modified EEG with NEAD protocol and observing whether this modification results in an improvement in event yield amongst patients referred for diagnosis. The study comprised of a small-scale randomised control trial and assessed feasibility of implementing this within an NHS neurophysiology department. Results indicated research of this nature is feasible and acceptable to patients, however it also highlighted some challenges including recruitment and retention. Recommendations were made to improve recruitment and retention including the importance of a dedicated research team. Preliminary results indicate improved event yield for the modified EEG with NEAD protocol in comparison to standard clinical care. This showed a small to moderate effect size. Recommendations for further research in this area were made. Improving the diagnostic yield for NEAD has implications for patient safety and health, would improve outcomes and access to appropriate treatment. Paper 3 presents a critical reflection of the research process for Paper 1 and Paper 2, including the challenges faced, lessons learned and clinical and research implications.

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Brown (Supervisor)