Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: A 5-year review
Cork University Hospital, Corcaigh, Munster, Ireland Epilepsy & Behavior
(Impact Factor: 2.26).
09/2007; 11(1):77-84. DOI: 10.1016/j.yebeh.2007.04.003
The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES).
We conducted a retrospective review of patients diagnosed with PNES in a 5-year period.
Fifty patients with PNES were identified, giving an estimated incidence of 0.91/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments.
PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.
Available from: Kette Valente
- "In the present study, a severe stressor family environment was reported and documented in a large number of patients, as previously reported  . An unfavorable family environment is often reported in children  and might be underinvestigated in adults. "
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ABSTRACT: Although psychogenic non-epileptic seizures (PNES) are a worldwide phenomenon, most of our knowledge addressing clinical characteristics is based on studies conducted in the USA, Europe, and Australia. There are scarce data about PNES in South American countries. This study provided a detailed analysis of the demographic, clinical, and psychosocial characteristics of 102 Brazilian patients with PNES. Seventy-eight patients (76.4%) were female with mean age of 35.27years. Mean age at onset was 27.85years; mean time to diagnosis was 7.89years; 87.25% lived with their families; 56.89% were single; and only 33 (39.75%) worked on a regular basis. Depression was diagnosed in 48.03%. Thirty-three patients misdiagnosed as having epilepsy were using antiepileptic drugs. Stress factors were identified in 57.84%. This is the first Brazilian study that involves a large sample of patients with video-EEG-documented PNES and corroborates the idea that PNES are a worldwide phenomenon sharing several similarities, despite cultural and socioeconomic differences.
Available from: Markus Reuber
- "Retrospective studies suggest that the long-term outcome of PNES is poor. Only about one-third of patients eventually become seizure-free   . Despite PNES being common and disabling, there are currently no evidence-based care pathways. "
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ABSTRACT: We previously described a communication strategy for the delivery of the diagnosis of psychogenic non-epileptic seizures (PNES) that was acceptable and effective at communicating the psychological cause of PNES. This prospective multicenter study describes the short-term seizure and psychosocial outcomes after the communication of the diagnosis and with no additional treatment. Participants completed self-report measures at baseline, two and six months after the diagnosis (seizure frequency, HRQoL, health care utilization, activity levels, symptom attributions and levels of functioning). Thirty-six participants completed the self-report questionnaires. A further eight provided seizure frequency data. After six months, the median seizure frequency had dropped from 10 to 7.5 per month (p=0.9), 7/44 participants (16%) were seizure-free, and an additional 10/44 (23%) showed greater than 50% improvement in seizure frequency. Baseline questionnaire measures demonstrated high levels of impairment, which had not improved at follow-up. The lack of change in self-report measures illustrates the need for further interventions in this patient group.
Available from: onlinelibrary.wiley.com
- "The ethical implications of leaving subjects with PNEA on AEDs for 9 months was an issue discussed extensively by the research team and the research ethics committee. We considered that, although it is intuitive that patients with PNEA (only) should not be prescribed AEDs, in practice a large proportion of patients are left on medication (Ettinger et al., 1999; Reuber et al., 2003; O'Sullivan et al., 2007, Hall-Patch et al., 2010), to the point that it could be said to constitute ''treatment as usual'' for many physicians. Furthermore , there is no published evidence that withdrawing AEDs improves outcome, or that maintaining them worsens it. "
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ABSTRACT: To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome.
Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months.
Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized. Fourteen patients were randomized to immediate withdrawal (IW) and 11 patients to delayed withdrawal (DW). There was a significant reduction in spell frequency from baseline to 9 months in the IW group but not in the DW group (p = 0.028). There was a significantly greater reduction in use of rescue medication in the IW group compared to the DW group between baseline and 9 months (p = 0.002). Emergency health care utilization dropped to zero in both groups by the end of the study. Psychological measures reflecting internal locus of control increased significantly more in the IW group (p = 0.005).
Stringent diagnostic criteria and an increasing tendency for patients to be referred before AED prescription limited the recruitment and the power of the study. Our data nonetheless provide evidence that some outcomes are improved by AED withdrawal in patients with PNEAs.
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