Clinical Study
The spectrum of psychogenic non-epileptic seizures and comorbidities seen in an epilepsy monitoring unit

https://doi.org/10.1016/j.jocn.2010.07.120Get rights and content

Abstract

We sought to study characteristics of patients presenting with psychogenic non-epileptic seizures (PNES), with and without major psychiatric comorbidity. A total of 39 patients who were diagnosed with PNES in a tertiary care setting were studied, and those patients with and without axis I psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) were compared. The mean time in confirming the diagnosis was 9 years. More than half the patients were taking anti-epileptic medications when they presented for video–electroencephalographic monitoring. The mean monitoring time required to capture a PNES was 0.6 days. Comorbid chronic medical conditions were found in 38.5% and axis I-psychiatric diagnoses in 48.7%. There were no significant differences in characteristics between those with and without major psychiatric comorbidities.

Introduction

Psychogenic non-epileptic seizures (PNES) pose a diagnostic challenge to clinicians. The underlying aetiopathogenesis and psychodynamics remain equally complex. This condition may coexist with epilepsy in about 10% of patients.1, 2 Antecedent traumatic experiences, particularly sexual abuse, are reported by the majority.3 Several studies have shown a high prevalence of psychiatric comorbidities in patients with PNES.4, 5, 6 Patients with PNES with psychiatric comorbidity have a poor outcome.7

We sought to study the characteristics of patients presenting with PNES, including their comorbidities and the differences in characteristics of PNES patients with and without major psychiatric comorbidity.

Section snippets

Participants and methods

We retrospectively reviewed medical records of all patients who underwent video–electroencephalographic (EEG) monitoring (VEM) from January 2002 to June 2007 in the epilepsy monitoring unit (EMU) of the Alfred Hospital, Melbourne, a tertiary referral hospital. This study was approved by the Human Research Ethics Committee of the institution.

Patients with a confirmed diagnosis of PNES with or without a background of epilepsy were studied. Most patients were admitted for VEM on an elective basis

Demographic and clinical characteristics

There were 39 patients (29 females and 10 males) diagnosed with PNES, with an age range of 15–83 years (mean age, 39 years). The age of onset ranged from 9 years to 80 years (mean, 30 years). Four patients (10%) had late-onset PNES, defined as onset after the age of 55 years. Three patients (8%) presented with acute onset multiple PNES. The longest duration of the condition was 56 years and the mean was 9.2 years. A total of 82% of patients had an MRI brain scan performed prior to admission.

Anti-epileptic drug usage

Prior to

Discussion

This study demonstrates the spectrum of adult patients with PNES seen in an EMU in the tertiary care setting. PNES is more prevalent in young females, and most patients with PNES are taking AED therapy. There is a long delay before the diagnosis is established. Although numbers are small, an axis I psychiatric diagnosis does not appear to be associated with significant differences in the clinical and demographic characteristics of PNES. Over 25% of our patients with PNES had a history of

References (21)

There are more references available in the full text version of this article.

Cited by (33)

View all citing articles on Scopus
View full text