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. 2020 Oct 7;38(43):6714-6720.
doi: 10.1016/j.vaccine.2020.08.044. Epub 2020 Aug 30.

Immunization stress-related responses presenting as psychogenic non-epileptic seizures following HPV vaccination in Rio Branco, Brazil

Renato Luiz Marchetti  1 , Jose Gallucci-Neto  2 , Daniela Kurcgant  3 , Inah Carolina Galatro Faria Proença  3 , Leandro da Costa Lane Valiengo  3 , Lia Arno Fiore  4 , Lécio Figueira Pinto  4 , Ana Goretti Kalume Maranhão  5 , Maria Tereza da Costa Oliveira  6 , Lucia Helena de Oliveira  7
Affiliations

Immunization stress-related responses presenting as psychogenic non-epileptic seizures following HPV vaccination in Rio Branco, Brazil

Renato Luiz Marchetti et al. Vaccine. .

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.

Keywords: HPV immunization; HPV vaccination; Immunization anxiety-related reaction; Immunization stress-related response; Mass psychogenic illness; Psychogenic non-epileptic seizures.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Lucia Helena de Oliveira is a staff member of the Pan American Health Organization. The author alone is responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the Pan American Health Organization. Maria Tereza da Costa Oliveira is a consultant of Pan American Health Organization. The author alone is responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the Pan American Health Organization.

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