Risk factors for comorbid epilepsy in patients with psychogenic non-epileptic seizures. Dataset of a large cohort study, 2022, Massot-Tarrús et al

Abstract
Psychogenic non-epileptic seizures (PNES) are the main differential diagnosis of pharmacorresistant epilepsy. Achieving the certainty in the diagnosis of PNES may be challenging, especially in the 10-22% of cases in which PNES and epilepsy co-exist. This difficulty hampers the management of these patients. Unfortunately, published series with this combined pathology are scarce and small in size.

This article presents the dataset of our article “Factors associated with comorbid epilepsy in patients with psychogenic non-epileptic seizures: a large cohort study” (Massot-Tarrús et al. 2022). It is composed by a detailed demographic and clinical data of 271 consecutive patients diagnosed with PNES in our epilepsy monitoring unit (EMU) between May 2001 and February 2011, and followed until September 2016. Based on the clinical, neuroimaging and vEEG findings, 47 of these patients were diagnosed with definite comorbid epilepsy, and 30 with possible or probable comorbid epilepsy. All data was collected retrospectively from chart review.

The cohort is depicted by means of demographic variables; age at PNES onset; years with PNES; frequency of PNES; duration of longest PNES seizure; self-reported history of minor head trauma (not associated with an increased risk of epilepsy) immediately preceding the first PNES; history of substance abuse; past or present history of active suicidal ideation; neuropsychological evaluation with the Minnesota Multiphasic Personality Inventory test; number and nature of risk factors for epilepsy; co-morbid degenerative brain disease or other neurological or psychiatric medical conditions; semiology of the seizures and triggers; EEG findings; type of epilepsy; number of past EMU admissions and epilepsy clinic visits and re-referrals; number of Anti-Seizure Medications (ASM) at EMU admission and discharge; and the outcome of the spells and ASM after the EMU discharge. Those ASM prescribed for reasons other than the treatment of the seizures (e.g., psychiatric disorders, migraine, pain syndromes, etc.) were not counted.

The presented baseline data can be used in studies evaluating the characteristics of patients with PNES and comorbid epilepsy, and in the creation of algorithms to identify them. It could facilitate the prioritization of this subgroup of patients for prolonged video-EEG monitorization to confirm the co-existence of both types of seizures and treat them accordingly.

Open access, https://www.sciencedirect.com/science/article/pii/S2352340922007752

 

At least they have a definition of why the patients were diagnosed as having psychogenic seizures but it also makes no sense. Even if the eeg is atypical that is not evidence for psychological causation.

I have seen this before in articles, particularly in a feature in the New Scientist, where the diagnosis was seen as important to prevent patients being given powerful drugs that won't help them. Since CBT has been shown (in the CODES trial) to not help them either this is not very compelling.

Nowadays, PNES is often used as a typical FND yet FND is meant to be a rule in diagnosis because of certain reflexes during neurological assessment (although why that should be caused by abnormal psychology is not explained either) but they haven't been used here.

There is obviously much to be learned about seizures, including the seizure like episodes we get with ME, but invoking psychological causes and hysteria/FND gets us no further forward.

 

It's amazing how this fact alone doesn't make them stop and rethink.