Pseudosleep events in patients with psychogenic non-epileptic seizures: prevalence and associations

Abstract

Objectives: To determine the prevalence and clinical associations of a history of events during sleep in patients with psychogenic non-epileptic seizures (PNES, pseudoseizures), and to compare the prevalence of a history of sleep events with that in poorly controlled epilepsy. Methods: Prospective study by semistructured interview of the history of event patterns and their clinical associations in 142 patients with video EEG confirmed PNES, and 100 patients with poorly controlled epilepsy. Results: 84/142 patients with PNES (59%) and 47/100 with epilepsy (47%) gave a history of events during sleep (p = 0.062). In patients with PNES, significant associations were found between a history of sleep events and: convulsive clinical semiology, antiepileptic drug treatment, fatigue, suicide attempts, mood disorder, and physical abuse. A particularly strong association with social security benefit was also found (odds ratio 4.0, p,0.001). Conclusions:The prevalence of a history of sleep events is similar in PNES and epilepsy, and is of no value in discriminating between the two, although a history of events occurring exclusively during sleep does suggest epileptic seizures. The clinical associations found indicate that a combination of psychopathological and external influences may be important in determining whether or not a patient with PNES gives a history of events during sleep.

An 18-Year-Old Woman with Prolonged Eyes Closed Unresponsiveness during Multiple Sleep Latency Testing

“…This form of malingering or conversion disorder has been well described in long-term video EEG assessment in epilepsy monitoring units in patients with pseudoseizures/psychogenic non-epileptic attacks. [1][2][3] Video-EEG monitoring is a powerful tool that allows for the electrophysiologic confirmation of wakefulness, despite apparent eyes closed motionless unresponsiveness.…”

The dark night

“…Psychogenic non-epileptic seizures arise from wakefulness but evidence suggests they also can arise from apparent sleep or ‘pseudosleep’ in up to 58% of patients 4. However, these patients are very unlikely to walk as part of their episodes, and almost all experience episodes from wakefulness as well.…”

Making the diagnosis in patients with blackouts: it’s all in the history

“…Although doctors may notice and even use other verbal and non-verbal clues, most research looking for items which could be useful in the differentiation of epileptic seizures from other paroxysmal neurological disorders has focussed on factual information such as the duration of attacks,29 whether they happen from sleep,30 whether they cause injury,31 and whether the eyes are open or closed 32. Clusters of such factual items distinguish between patients with generalised tonic clonic seizures and syncope with an accuracy of over 90% (table 2).…”

“…One study in which two experienced epileptologists, unaware of any other clinical information, were asked to rate detailed written seizure descriptions from patients with temporal lobe epilepsy or non-epileptic seizures found that the sensitivity of this approach for the detection of epileptic seizures was very good at 96%, but the specificity was only 50% 36. Isolated factual items traditionally deemed helpful (such as reported seizures from sleep,30 or descriptions of pelvic thrusting)37 do not have any discriminating value. Although the postictal examination finding of a severe lateral laceration of the tongue is probably a reliable pointer to the diagnosis of epilepsy, the same cannot be said for the answer to the question “Have you bitten your tongue in your seizures?”.…”