title: Distinguishing between patients with pure psychogenic nonepileptic seizures and those with comorbid epilepsy by means of clinical data.
abstract: Patients with psychogenic nonepileptic seizures (PNESs) often have additional epileptic seizures (ESs). Distinguishing between those with ESs and those without ESs is difficult but mandatory. We hypothesize that these two patient groups differ in clinical data, which might be useful for establishing diagnosis. All patients with PNESs (n=114) from the Bethel Epilepsy Centre treated between 1/11/2010 and 1/11/2011 were included. Thirty-six percent had additional epilepsy. In contrast, 84 of the 114 patients with PNESs took antiepileptic drugs (AEDs) (AED treatment: patients with PNESs=44/73, patients with PNESs+ESs=40/41), most of them (65.5%) as polytherapy. Significant differences between both groups were as follows: patients with PNESs were older at disease onset, had a shorter duration from onset to inpatient visit, were less frequently on AEDs, were less frequently on antiepileptic polytherapy, and had a normal EEG compared with patients with PNESs+ESs. Multivariate stepwise logistic regression revealed age at seizure onset, number of AEDs, and difference between number of AEDs and psychiatric drugs as significant predictors of patients with ESs in PNESs (Nagelkerke's r2=0.59). Therefore, clinical data proved to be useful in the diagnostic process.
authors.affiliation: Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstraße 56, 44791 Bochum, Germany; Bethel Epilepsy Center, Mara Hospital, 33617 Bielefeld, Germany. Electronic address: roberthoepner@gmx.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoepner
authors.affiliation: Bethel Epilepsy Center, Mara Hospital, 33617 Bielefeld, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Labudda
authors.affiliation: Society for Epilepsy Research, 33617 Bielefeld, Germany.
authors.forename: Theodor W
authors.initials: TW
authors.lastname: May
authors.affiliation: Bethel Epilepsy Center, Mara Hospital, 33617 Bielefeld, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schöndienst
authors.affiliation: Bethel Epilepsy Center, Mara Hospital, 33617 Bielefeld, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Bien
authors.affiliation: Bethel Epilepsy Center, Mara Hospital, 33617 Bielefeld, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D015897:Comorbidity; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D013001:Somatoform Disorders / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Age at onset; Antiepileptic drugs; Differential diagnosis; Epilepsy; Psychogenic nonepileptic seizures