title: Long-term outcome of psychogenic nonepileptic seizures: the role of induction by suggestion.
abstract: OBJECTIVE
  The aims of our retrospective observational study were to evaluate the long-term outcome of PNESs after communication of the diagnosis and to define predictors of good outcome.
  
  
  METHODS
  Twenty-seven consecutive patients with a certain diagnosis of psychogenic nonepileptic seizures (PNESs) were included in the study. Follow-up information was obtained from each participant through a questionnaire designed for the study. Regarding seizure frequency, the patients were asked to report how many seizures they had experienced on average every month before the communication of the diagnosis and after it.
  
  
  RESULTS
  After the communication of the diagnosis, the median seizure frequency had dropped to 4 every month (p < 0.001). Seventeen participants (63%) were seizure-free at follow-up, and a further five (18.5%) showed a greater than 50% improvement in seizure frequency. Regarding the predictive value of clinical and sociodemographic variables for PNES global outcome, the factors gender, education, economic status, interval of time from onset, comorbidity with epilepsy, psychiatric history, mental retardation, psychological therapy, psychiatric therapy, and the presence of stressful and traumatic events were not related to prognosis; the only factor associated with a better outcome was the diagnosis made after the induction of PNESs by suggestion (p = 0.000, χ(2) = 4.654).
  
  
  CONCLUSIONS
  A substantial majority of our patients became seizure-free with communication of the diagnosis as the only intervention. The use of the induction by suggestion test was an important predictor of good outcome.
authors.affiliation: Cattedra di Psichiatria, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
authors.forename: Orsola
authors.initials: O
authors.lastname: Gambini
authors.affiliation: Cattedra di Psichiatria, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy. Electronic address: bennidemartini@hotmail.it.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Demartini
authors.affiliation: UO Neurologia 2, Centro Epilessia, A.O. San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via A. Di Rudinì, 8, 20142 Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.affiliation: UO Neurologia 2, Centro Epilessia, A.O. San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via A. Di Rudinì, 8, 20142 Milan, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Turner
authors.affiliation: Cattedra di Psichiatria, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Barbieri
authors.affiliation: UO Neurologia 2, Centro Epilessia, A.O. San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via A. Di Rudinì, 8, 20142 Milan, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
mesh_terms: D000328:Adult; D015897:Comorbidity; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012959:Socioeconomic Factors; D013404:Suggestion; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Induction by suggestion; Outcome; Prognosis; Psychogenic nonepileptic seizure