Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case-control study.

Academic Article

Abstract

  • OBJECTIVE: We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. METHODS: Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect. RESULTS: In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073). CONCLUSIONS: Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
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    Keywords

  • Epilepsy, Epileptic seizures, Functional disorders, Psychogenic nonepileptic seizures, Adult, Anxiety, Case-Control Studies, Cohort Studies, Depression, Electroencephalography, Epilepsy, Epilepsy, Temporal Lobe, Female, Humans, Male, Middle Aged, Risk Assessment, Seizures, Somatoform Disorders
  • Digital Object Identifier (doi)

    Author List

  • Wissel BD; Dwivedi AK; Gaston TE; Rodriguez-Porcel FJ; Aljaafari D; Hopp JL; Krumholz A; van der Salm SMA; Andrade DM; Borlot F
  • Start Page

  • 180
  • End Page

  • 184
  • Volume

  • 61