title: Clinical characteristics of psychogenic nonepileptic seizure status in the long-term monitoring unit.
abstract: Patients with psychogenic nonepileptic seizures (PNES) mimicking status epilepticus (PNES-status) are at risk of iatrogenic complications. Our aim was to assess whether the population of patients with PNES who develop PNES-status are distinguishable. Retrospectively, we identified patients with PNES-status and compared them with patients with PNES without status and with patients with electroclinical status epilepticus (SE). Of 49 patients with PNES, 9 had PNES-status (18.2%) and 40 had PNES only. Compared with patients with PNES, subjects with PNES-status had taken fewer than three antiepileptic medications (P=0.016), had more than one event per week (P=0.026), were more likely to be admitted emergently to the monitoring unit (P=0.007), had shorter long-term monitoring (LTM) stays (P=0.003), and tended to be diagnosed sooner after initial presentation (P=0.058). Use of fewer than three antiepileptic drugs and emergent admission were independent predictors of PNES-status classification on logistic regression. Of 154 patients with epilepsy, 8 had SE during LTM (5.2%), significantly fewer than the proportion with PNES-status relative to PNES (P=0.008); the only clinical variable distinguishing these two groups was a baseline lower seizure frequency among the patients with epileptic seizures (P=0.045). Our results suggest that patients with PNES-status have features that differentiate them from patients with PNES without status and, to a lesser extent, from patients with epileptic seizures.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. bdworetzky@partners.org
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dworetzky
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Mortati
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Bernardino
authors.initials: B
authors.lastname: Vaccaro
authors.forename: Aaron
authors.initials: A
authors.lastname: Nelson
authors.forename: Edward B
authors.initials: EB
authors.lastname: Bromfield
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology; D013226:Status Epilepticus / Q000175:diagnosis*; D014741:Video Recording
chemical_list: D000927:Anticonvulsants