Traumatic events and posttraumatic stress disorder in patients with psychogenic nonepileptic seizures: a critical review

Abstract

Although video-EEG monitoring has revolutionized the diagnosis of psychogenic nonepileptic seizure (PNES), the etiology of this condition remains poorly understood. This article is a critical review of studies on the prevalence of traumatic events, abuse, and/or posttraumatic stress disorder (PTSD) in patients with PNES. Searches carried out on MEDLINE (1966–2004) and Web of Science (1945–2004) identified 17 relevant studies. PNES samples showed very high rates of trauma (44–100%) and abuse (23–77%), which were 15–40% higher than those found in control groups. This suggests that traumatic experiences may be a potential risk factor for PNES. PNES samples also showed a higher prevalence of PTSD than control groups, raising the possibility that PNES may arise as a clinical expression of a hypothetical PTSD subtype the core symptoms of which are dissociative. Methodological limitations do not permit the confirmation of these hypotheses. Stronger research designs are needed, such as prospective and case–control studies in both hospital and community settings.