title: Patients with psychogenic non-epileptic seizures referred to a tertiary epilepsy centre: patient characteristics in relation to diagnostic delay.
abstract: OBJECTIVE
  This clinical study examines patient and seizure characteristics of patients with psychogenic non-epileptic seizures (PNES) in a tertiary epilepsy centre. The main focus was whether a new subgroup of PNES patients emerged with a relatively short referral time and possible specific characteristics.
  
  
  METHODS
  All PNES patients referred to a specialist program in our centre between mid 2007 and mid 2009 were consecutively included. This yielded a study cohort of 90 patients.
  
  
  RESULTS
  The majority of the patients have a patient history with many medical symptoms and they were or had been in treatment by a medical specialist. Furthermore diffuse psychological/psychiatric symptoms and subsequent treatments are also remarkably common, in general without a clear psychological diagnosis. The average time between seizure onset and referral to an epilepsy centre is remarkably low (4.29 years). About 50% of the patients were referred within 2 years of seizure onset. This 'active high speed referral group' had significantly more previous psychological complaints, significantly more previous psychological/psychiatric treatments and a trend towards more previous medical investigations.
  
  
  CONCLUSIONS
  There seems to be a new subgroup of PNES patients with a short referral time, characterized by a more active attitude towards examination of the symptoms in combination with an active attitude to apply for treatment. However, the PNES cohort as a whole is characterized by having somatoform symptoms based on a process of somatization.
authors.affiliation: Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands. Bodden@kempenhaeghe.nl
authors.forename: N M G
authors.initials: NM
authors.lastname: Bodde
authors.forename: R H C
authors.initials: RH
authors.lastname: Lazeron
authors.forename: J M A
authors.initials: JM
authors.lastname: Wirken
authors.forename: S J
authors.initials: SJ
authors.lastname: van der Kruijs
authors.forename: A P
authors.initials: AP
authors.lastname: Aldenkamp
authors.forename: P A J M
authors.initials: PA
authors.lastname: Boon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D015331:Cohort Studies; D015897:Comorbidity; D057210:Delayed Diagnosis; D004522:Educational Status; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D012017:Referral and Consultation; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D012737:Sex Factors; D013001:Somatoform Disorders / Q000150:complications; D013997:Time Factors; D055815:Young Adult