Psychogenic non-epileptic seizures with and without epilepsy: Exploring the influence of co-existing psychiatric disorders on clinical characteristics and outcomes.

Autor: ALKhaldi NA; Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia. Electronic address: nkhaldi@iau.edu.sa., Paredes-Aragón E; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neurological Emergencies Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico., Kim DD; Adult Neurodevelopmental and Geriatric Psychiatry Division, Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada., Yu YJ; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., ALKhateeb M; Neurology Section, Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia., Mirsattari SM; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Jazyk: angličtina
Zdroj: Epilepsy research [Epilepsy Res] 2024 Jan; Vol. 199, pp. 107279. Date of Electronic Publication: 2023 Dec 12.
DOI: 10.1016/j.eplepsyres.2023.107279
Abstrakt: Background and Objectives: Psychogenic non-epileptic seizures (PNES) are commonly associated with co-existing psychiatric disorders. The relationship between psychiatric factors and PNES episodes with and without epilepsy remains understudied. We reviewed co-existing psychiatric disorders in PNES-only, PNES with epilepsy aiming to examine whether these co-existing disorders associated with PNES clinical presentation and long-term outcomes.
Methods: We conducted a retrospective, longitudinal cohort study of patients with PNES diagnosed at our EMU from May 2000 to April 2008, with follow-up clinical data until September 2015. We categorized patients into three groups: PNES-only, PNES+ definite epilepsy, and PNES+ possible/probable epilepsy.
Results: In total, 271 patients with PNES were identified: 194 had PNES-only, 30 had PNES+ possible or probable epilepsy, and 47 had PNES+ definite epilepsy. No significant differences were observed in the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, or suicidal thoughts among the three groups. Similarly, no differences in co-existing psychiatric disorders characteristics were discovered among patients grouped by various durations and frequencies of PNES episodes. At EMU admission, for PNES-only patients total of 130/194 patients (67%) were on ASMs, and 64/194 (32.9%) were not. PNES-only not on ASM were the most likely to report at least two of the three main psychiatric disorders (depression, anxiety, and PTSD; p = 0.01). At the final follow-up, 68/130 (52.3%) and 92/130 (70.8%) patients were able to discontinue or reduce their ASM intake, respectively, with no significant differences in co-existing psychiatric disorders among them (p < 0.001). Overall, 51.6% or 31.3% of patients reported reduced or resolved PNES episodes, respectively. Further, this reduction and resolution of PNES episode were not affected by any psychological variable.
Conclusions: Co-existing psychiatric disorders prevalence did not differ between patients with PNES-only and those with coexisting epilepsy. Further, co-existing psychiatric disorders characteristics did not reliably predict PNES episode duration, frequency, reduction, or resolution. For patients with PNES-only, the presence of co-existing psychiatric disorders did not predict the rate at which ASMs could be reduced or discontinued.
Competing Interests: Declaration of Competing Interest S. M. Mirsattari serves on the advisory boards and speaker bureaus for UCB Canada Inc., Eisai Limited, and Sunovion Pharmaceuticals Canada, Inc. He has been involved in multiple multicenter clinical trials unrelated to PNESs. The other authors have no conflicts of interest or disclosures to report.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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