title: Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes.
abstract: OBJECTIVE
  To investigate the relationship between traumatic brain injury (TBI) and psychogenic nonepileptic seizures (PNES). We hypothesized that PNES with TBI would be associated with more psychiatric comorbidities and disability than PNES without TBI.
  
  
  METHODS
  In this cross-sectional study comparing patients with PNES with TBI to patients with PNES without TBI, medical records from 255 consecutive patients with electroencephalography (EEG)-confirmed PNES were reviewed to assess variables including demographic, head injury, neurologic, psychiatry, social variables, and quality of life and symptoms scales. Parametric, analysis of covariance (ANCOVA), and logistic regression analyses were performed, to compare psychiatric and function variables between the two study groups while controlling for age and sex.
  
  
  RESULTS
  Of the 92 patients with PNES who fulfilled inclusion/exclusion criteria, 41 (44.6%) had a history of TBI. Of the 41 patients with TBI, 30 (73%) met criteria for mild TBI (mTBI). Patients with TBI had more mood disorder diagnoses, were more likely to receive disability, and had lower global functioning than non-TBI patients with PNES, after adjusting for age and sex. Patients with TBI and PNES had significantly increased odds for having major depression, behavioral impulsivity, posttraumatic stress disorder diagnosis, and a trauma/abuse history.
  
  
  CONCLUSIONS
  TBI is a significant risk factor in patients with PNES, being associated with increased psychiatric diagnostic comorbidity, symptoms severity, poorer functioning, and increased disability. This study reveals the importance of identifying and addressing the impact of TBI in patients with seizure disorders. Addressing the sequelae of TBI in PNES may be a target to improve functioning.
authors.affiliation: Departments of Neurology Psychiatry, Rhode Island Hospital, Providence, RI 02903, USA. william_lafrance_jr@brown.edu
authors.forename: W Curt
authors.initials: WC
authors.lastname: LaFrance
authors.forename: Marie
authors.initials: M
authors.lastname: Deluca
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fava
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D003291:Conversion Disorder / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003863:Depression / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D011788:Quality of Life; D012640:Seizures / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000150:complications / Q000523:psychology; D016896:Treatment Outcome