Psychogenic nonepileptic seizures in adults with epilepsy: a tertiary hospital-based study

Abstract

Objectives: Many studies describe and characterize psychogenic nonepileptic seizures (PNES) in high-income but few come from low/middle and low income countries.Design/methods: We aimed to determine the prevalence of PNES coexisted in adults with epilepsy and to characterize their semiology, comorbidities and predictors whether presented with epilepsy (n = 563) or alone (n = 73). Patients were recruited from a tertiary referral epilepsy clinic. Clinical suspicion and diagnosis were done by the neurologist based on histories and clinical cues. Psychiatric evaluation included structured psychiatric interviewing and assessment of symptoms of depression, anxiety and stress using Depression Anxiety Stress Scale (DASS 21).Results: The prevalence of PNES with epilepsy was 4.97% and diagnosed after a mean interval of 7.12yrs from onset of the first attack. Patients with PNES were predominantly females in their 2nd-3rd decades. Semiology of PNES included loss of consciousness, drop attacks, involuntary movements and speech arrest. Compared to patients with PNES coexisted with epilepsy, those with PNES alone were younger at presentation (p = 0.01) and age at onset (p = 0.002) and had frequent attacks (p = 0.001), psychosocial stressors and comorbid medical illnesses (p = 0.0001) and higher scores of depression, anxiety (p = 0.01) and stress (p = 0.001). In multivariate analysis, the significant predictors of high DASS scores with PNES were psychosocial stressors and comorbid medical conditions.Conclusions: The prevalence of PNES among adults with epilepsy is ∼5%. They are frequently misdiagnosed and treated as epilepsy. Specialist neurologists are more comfortable to diagnose patients with PNES. The multidisciplinary neurology and psychiatric assessments will help in the patient's therapeutic plan.