Clinical features of Psychogenic Nonepileptic Seizures (PNES): analysis of a Brazilian series

Abstract

RATIONALE: An estimate of 3 million people present with the diagnosis of epilepsy in Brazil. Psychogenic Nonepileptic Seizures (PNES) are likely to occur in up to 2-33/100.000 people. Paradoxically, very few papers address this significant condition in the Brazilian literature. We describe a Brazilian PNES population and provide a review of the literature. METHODS: we reviewed the clinical history, vídeo-electroencephalographic (VEEG) data, psychiatric diagnosis and prognosis in a series of 45 PNES patients, with emphasis on the demographics, as well as, PNES major clinical presentations and classification. RESULTS: PNES represent 5.2% of the patients referred to the VEEG monitoring at our institution; patients were mostly young with a mean age of 27y/o and a clear predominance of the female gender (78%); the majority of PNES last between 1-5 minutes, but duration was highly variable; 28/45 patients were referred due to "intractable epilepsy" and 14/28 had MR defined mesial temporal sclerosis; about a third of the patients present with the classically described PNES clinical presentation; conversive and dissociative seizures prevail on PNES classification (80%). CONCLUSIONS: clinical and VEEG data on this Brazilian population matches descriptions coming from other series, suggesting potential cross-cultural similarities in the clinical expression of this condition.

Comparing standard medical care for nonepileptic seizures in Chile and the United States

“…Despite the prevalence of PNES, the literature in LA is fairly limited [25], and to the best of the authors' knowledge and literature review, country-specific literature for Chile does not yet exist. Reviewing existing literature in LA reveals that a few studies focused on the prevalence of ES in patients diagnosed with PNES [10,11,26], and some have reviewed retrospective data for PNES identification purposes [13,27].…”

“…Reviewing existing literature in LA reveals that a few studies focused on the prevalence of ES in patients diagnosed with PNES [10,11,26], and some have reviewed retrospective data for PNES identification purposes [13,27]. Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34]. Studies in LA have identified higher frequencies of psychiatric comorbid diagnoses, such as anxiety and dissociation, than studies in the US [11,15,25,27,35,36].…”

“…Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34]. Studies in LA have identified higher frequencies of psychiatric comorbid diagnoses, such as anxiety and dissociation, than studies in the US [11,15,25,27,35,36]. Moreover, reports in LA of trauma and abuse, such as physical or sexual abuse, reveal lower frequencies [13,25,35] than those reported in the US [14,37].…”

Neuropsychological aspects of psychogenic nonepileptic seizures

“…[4][5][6][7] Among these patients, about 75% are females in the 20-30 years age bracket. [8][9][10][11] The main psychiatric co-morbidity in patients with epilepsy is depression. 12 Blum 13 conducted a study in the USA and found that 29% of the patients with epilepsy presented a depressive state as against the 9% found for the general population.…”

Psychogenic nonepileptic seizures: an overview

“…The undisputed fact, however, is the prevalence of women with the diagnosis of PNES with a 1:4 proportion likely to represent an honest estimate. 7 Understanding (and accepting) the high prevalence of PNES is pivotal in its care. That makes one aware of the condition and may prevent at least two undesirable consequences of neglecting this diagnostic hypothesis.…”