title: Medically unexplained symptoms in patients with PNES: Do they explain poor employment outcome in patients with good seizure outcomes?
abstract: Many patients with psychogenic nonepileptic seizures (PNES) have other medically unexplained symptoms (MUS). In order to assess their long-term contribution to ill-health and unemployment, we recorded MUS, employment, healthcare utilization, and seizure outcomes in a cohort of patients with PNES.
  
  
  
  We had complete computerized healthcare records and employment information in 120 patients with PNES, 5-10years postdiagnosis. We analyzed these data to assess the contribution of MUS to ill-health and to determine whether MUS could explain differences among seizure, employment, and healthcare utilization outcomes in PNES.
  
  
  
  At 5-10years, 41/120 patients (34.2%) were attending primary or secondary care for seizures, 42/120 patients (35.0%) had MUS other than PNES, and 36/120 patients (30.0%) were employed. Unemployment was predicted by age at presentation (OR: 0.90 (0.86-0.94), p<0.001), presenting to primary or secondary care with seizures (OR: 0.16 (0.05-0.52), p=0.003), and contact with psychiatric services at 5-10years (OR: 0.16 (0.05-0.58), p=0.005). No outcome measures were predicted by additional MUS, though MUS themselves were predicted by psychiatric contact (OR: 2.27 (1.01-5.01), p=0.048).
  
  
  
  Our data suggest that MUS do not contribute independently to unemployment in the population with PNES, whereas psychiatric morbidity appears to do so. Nonetheless, MUS and psychiatric morbidity persist in the long term in a substantial minority of patients with PNES. We found no evidence that seizures in patients whose PNES have resolved are replaced with other MUS.
authors.affiliation: Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland, United Kingdom.
authors.forename: Paul S
authors.initials: PS
authors.lastname: McKenzie
authors.affiliation: Scottish Epilepsy Centre, Glasgow G51 4QD, Scotland, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Oto
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, England, United Kingdom.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Graham
authors.affiliation: Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand. Electronic address: Roderick.Duncan@cdhb.health.nz.
authors.forename: Roderick
authors.initials: R
authors.lastname: Duncan
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D010342:Patient Acceptance of Health Care; D012640:Seizures / Q000523:psychology* / Q000628:therapy*; D013001:Somatoform Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: MUS; Medically unexplained symptoms; Nonepileptic seizures; PNES; Psychogenic; Psychogenic nonepileptic attacks