Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures.
OBJECTIVE
To examine baseline clinical features of psychogenic nonepileptic seizures (PNES) in a large cohort and to investigate outcome over a period of up to 10 years. Studies investigating PNES have been limited by differences in diagnostic criteria, short follow-up periods, and the use of limited outcome measures.


METHODS
Patients with PNES were identified, using strict diagnostic criteria. Baseline neurological, neuropsychiatric, and neuroimaging data were obtained from medical records. Long-term outcome was assessed with ratings of seizures, psychopathology, and quality of life in a subset of the patients.


RESULTS
Patients with PNES (n = 221) experienced long delays in diagnosis (mu, 5.6 years; standard deviation, 7.7 years) and high rates (>60%) of prolonged treatment with antiepileptic drugs. Compared with previous studies, a relatively low proportion (8.1% to 17.9%, depending on diagnostic criteria) had comorbid epilepsy. An unexpected finding was that 22.6% of PNES patients had magnetic resonance imaging abnormalities. Patients assessed at follow-up (n = 61) exhibited poor long-term outcomes with ongoing PNES, high rates of psychopathology, low rates of specialist follow-up, poor quality of life, and poor overall levels of functioning.


CONCLUSIONS
These results demonstrate the need for earlier diagnosis of PNES and comorbidities and highlight the need for diagnostic and therapeutic approaches that combine neurological and psychiatric perspectives.
Jones
Simon G
SG
Department of Medicine, The University of Melbourne and Royal Melbourne Hospital, Victoria, Australia. simex_jones@hotmail.com
O' Brien
Terence J
TJ
Adams
Sophia J
SJ
Mocellin
Ramon
R
Kilpatrick
Christine J
CJ
Yerra
Raju
R
Lloyd
John H
JH
Velakoulis
Dennis
D
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D015897:Comorbidity; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000188:drug therapy; D011788:Quality of Life; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014741:Video Recording
D000927:Anticonvulsants