Psychogenic nonepileptic seizures: clinical characteristics and outcome

Volbers B, Walther K, Kurzbuch K, Erdmann L, Gollwitzer S, Lang J, Onugoren MD, Schwarz M, Schwab S, Hamer H (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Abstract

Background: Clinical characteristics, outpatient situation, and outcome in patients with psychogenic nonepileptic seizures (PNES) remain to be elucidated. Methods: Patients diagnosed with PNES after video-electroencephalography (EEG) monitoring (VEM) 03/2000–01/2016 at the Erlangen Epilepsy Center were surveyed between June 2016 and February 2017. Primary outcome was PNES cessation defined as no PNES episodes within > = 12 months prior to the interview. Secondary outcome variables included quality of life (QoL) and dependency. Sensitivity analysis included patients with proven PNES during VEM without comorbid epilepsy. Results: Ninety-nine patients were included (median age 38 (interquartile range (IQR 29–52)) years; 68 (69%) females, follow-up 4 (IQR 2.1–7.7) years). Twenty-eight (28%) patients suffered from comorbid epilepsy. Twenty-five (25%) patients reported PNES cessation. Older age at symptom onset (odds ratio (OR) related to PNES cessation: 0.95 (95% CI 0.90–0.99)), comorbid epilepsy (OR 0.16 (95% CI 0.03–0.83)), anxiety disorder (OR 0.15 (95% CI 0.04–0.61)), and tongue biting (OR 0.22 (95% CI 0.03–0.91)) remained independently associated with ongoing PNES activity after adjustment. Sensitivity analysis (n = 63) revealed depressive disorder (OR 0.03 (95% CI 0.003–0.34)) instead of anxiety as independent predictor, while this seemed relevant only in patients older than 26 years at onset (OR 0.04 (95% CI 0.002–0.78) versus OR 0.21 (95% CI 0.02–1.84) in patients younger than 26 years). PNES cessation was associated with increased median QoL (8 (IQR 7–9) versus 5.5 (IQR 4–7); p <.001) and an increased frequency of financial independency (14 (56%) versus 21 (28%); p =.01). Conclusions: We found poor outcomes in PNES especially in older patients at onset with comorbid depressive disorder. Comorbid epilepsy also seems to be a major risk factor of ongoing PNES activity, which in turn affects patients’ daily living.

Authors with CRIS profile

Bastian Volbers Department of Neurology Katrin Kurzbuch Medizinische Fakultät Laura Erdmann Professur für Epileptologie Johannes Lang Department of Psychiatry and Psychotherapy Michael Schwarz Department of Neurology Stefan Schwab Lehrstuhl für Neurologie Hajo Hamer Professur für Epileptologie

How to cite

APA:

Volbers, B., Walther, K., Kurzbuch, K., Erdmann, L., Gollwitzer, S., Lang, J.,... Hamer, H. (2022). Psychogenic nonepileptic seizures: clinical characteristics and outcome. Brain and Behavior. https://doi.org/10.1002/brb3.2567

MLA:

Volbers, Bastian, et al. "Psychogenic nonepileptic seizures: clinical characteristics and outcome." Brain and Behavior (2022).

BibTeX: Download