Psychogenic nonepileptic seizures (PNES) represent a heterogeneous entity associated with poor long-term outcome in terms of PNES cessation.
PNES cessation is associated with improved quality of life and financial independency.
Older age at onset, depressive disorders (especially in late-onset PNES), anxiety, and comorbid epilepsy are associated with PNES activity and seem to represent distinct etiological mechanisms.
Outpatient care is poor in general.
“Natural” course of disease activity after diagnosis in patients with PNES cessation (figure):
Clinical characteristics, outpatient situation, and outcome in patients with psychogenic nonepileptic seizures (PNES) remain to be elucidated.
Patients diagnosed with PNES after video-electroencephalography (EEG) monitoring (VEM) 03/2000–01/2016 at the Erlangen Epilepsy Center were surveyed between June 2016 and February 2017. Primary outcome was PNES cessation defined as no PNES episodes within > = 12 months prior to the interview. Secondary outcome variables included quality of life (QoL) and dependency. Sensitivity analysis included patients with proven PNES during VEM without comorbid epilepsy.
Ninety-nine patients were included (median age 38 (interquartile range (IQR 29–52)) years; 68 (69%) females, follow-up 4 (IQR 2.1–7.7) years). Twenty-eight (28%) patients suffered from comorbid epilepsy. Twenty-five (25%) patients reported PNES cessation. Older age at symptom onset (odds ratio (OR) related to PNES cessation: 0.95 (95% CI 0.90–0.99)), comorbid epilepsy (OR 0.16 (95% CI 0.03–0.83)), anxiety disorder (OR 0.15 (95% CI 0.04–0.61)), and tongue biting (OR 0.22 (95% CI 0.03–0.91)) remained independently associated with ongoing PNES activity after adjustment. Sensitivity analysis (n = 63) revealed depressive disorder (OR 0.03 (95% CI 0.003–0.34)) instead of anxiety as independent predictor, while this seemed relevant only in patients older than 26 years at onset (OR 0.04 (95% CI 0.002–0.78) versus OR 0.21 (95% CI 0.02–1.84) in patients younger than 26 years). PNES cessation was associated with increased median QoL (8 (IQR 7–9) versus 5.5 (IQR 4–7); p < .001) and an increased frequency of financial independency (14 (56%) versus 21 (28%); p = .01).
We found poor outcomes in PNES especially in older patients at onset with comorbid depressive disorder. Comorbid epilepsy also seems to be a major risk factor of ongoing PNES activity, which in turn affects patients’ daily living.