Factors associated with comorbid epilepsy in patients with psychogenic nonepileptic seizures: A large cohort study, 2022, Massot-Tarrús et al

Highlights

• Demographic and clinical features help identifying patients with PNES + epilepsy.
• History of headaches, asthma, and long seizures support the presence of PNES-only.
• Febrile seizures, developmental deficits and brain lesions support PNES + epilepsy.
• The model performance shows an accuracy of 84.7% to classify patients correctly.
• Predictive models may help prioritize vEEGm in patients with likely PNES + epilepsy.

Abstract

Objective
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) occur in 12–22% of cases and the diagnosis of both simultaneous disorders is challenging. We aimed to identify baseline characteristics that may help distinguish patients with PNES-only from those with comorbid epilepsy.

Methods
We performed a longitudinal cohort study on those patients diagnosed with PNES in our epilepsy monitoring unit (EMU) between May 2001 and February 2011, prospectively followed up until September 2016. Patients were classified into PNES-only, PNES + possible or probable epilepsy, and PNES + definite epilepsy based on the clinical, vEEG, and neuroimaging data. Demographic and basal clinical data were obtained from chart review. Multiple regression models were performed to identify significant predictors of PNES + definite epilepsy, excluding patients with only possible or probable epilepsy for this specific analysis.

Results
One-hundred and ninety four patients with PNES-only, 30 with PNES + possible or probable epilepsy and 47 with PNES + definite epilepsy were included. 73.8% were female and the mean age at EMU admission was 37.4 ± standard deviation 13.5 years.
Patients with PNES + definite epilepsy most likely had never worked, had history of febrile seizures, structural brain lesions, developmental disabilities, and maximum reported seizure duration between 0.5 and 2 min.
Patients with PNES-only were on fewer anti-seizure medications (ASM), reported more frequently an initial minor head trauma, seizures longer than 10 min, and a higher number of neurological and medical illnesses – being migraine (18.1%), other types of headaches (18.5%), and asthma (15.5%) the most prevalent ones. All p < 0.05.
On the hierarchical regression analysis, history of febrile seizures, developmental disabilities, brain lesions, longest reported seizure duration between 0.5 and 2 min, and lack of neurological comorbidity, remained as significant predictors of PNES + epilepsy. The model's performance of a 5-fold cross-validation analysis showed an overall accuracy of 84.7% to classify patients correctly.

Conclusions
Some demographic and clinical characteristics may support the presence of comorbid epilepsy in patients with PNES, being unemployment, the presence of brain lesions, developmental disabilities, history of febrile seizures, seizure duration and lack of comorbid headaches the most relevant ones.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(22)00229-3/fulltext

 

The fact that they can maintain the framing of psychogenic despite this is horrifying. The lines between medicine and religion are blurring more and more each day. Prior theological writings have to be respected because eminence.

This again all points to immunological causes and mechanisms, but it's nowhere to be found, at least in the abstract, because taboo forbids it.

@Andy, by the way, link is broken.

 

Should work now.

 

This makes me wonder. What about their "rule-in" Hoover sign? If the epilepsy is organic it will be negative, if the seizure is psychogenic it will be positive but what about a patient who has both? There is a cat out there declaring prior rights!

There is no mention in any of the papers proudly declaring that FND is no longer a disease of exclusion that the signs can be present in organic disease as well.