QLIF-04. BRAIN TUMORS ASSOCIATED WITH PSYCHOGENIC NON EPILEPTIC SPELLS: CASE SERIES

Abstract

Epileptic seizures (ES) are considered a main focus in assessing brain tumor treatment, yet, the role of psychogenic non epileptic spells (PNES) is known to be highly prevalent and is under-reported. In the neuro-oncology literature no cases have been well described having PNES. We present a series of five patients and identify risk factors, discuss the association of PNES with brain tumors and describe their role in brain tumor treatment. Patients were identified retrospectively from our practice with diagnosis of PNES and medical history of primary or secondary brain tumors. The diagnosis of psychogenic spells was based on history, seizure observation, routine EEG, and video-EEG. The mean age of presentation was 38 years, with a female gender predominance. The initial diagnosis of brain tumor was associated with a new onset seizure prior to diagnosis in the majority of the patients. Only one patient presented PNES alone, the rest of the patients presented both ES and PNES during the course of their disease. Most of the patients in this case series presented with mixed PNES and were treated with multiple anti-epileptic drugs (AED) prior and after PNES diagnosis. The most commonly used AED was gabapentin. All of the patients received a form of combination therapy. The preferred treatment modality was chemotherapy, followed by surgical resection. The patients manifested several distressing spells that affected their overall quality of life and required multiple medical consultations. None of these patients presented clinical evidence of tumor progression at the time of PNES presentation on imaging studies. Our findings offer a new perspective in PNES diagnosis and their involvement in brain tumor treatment along with possible prognosis implications. Further studies to analyze tumor localization or tumor behavioral patterns in association with PNES are warranted.