Quality of Life in Psychogenic Nonepileptic Seizures

Abstract

Summary:Purpose: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs.Methods: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n ‫ס‬ 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs.Results: In our sample, 45 patients had PNESs, and 40 hadESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP.Conclusions: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.

Crise não epiléptica psicogênica: história e crítica de um conceito

“…Segundo os autores, apesar de a doença continuar sendo predominantemente feminina, teria havido um aumento no número de homens acometidos pela mesma. Chodoff (1982), por sua vez, defendia que a histeria era marcada por pressões históricas e culturais. Para esse autor, o distúrbio de personalidade histérica nada mais era do que uma caricatura do feminino.…”

“…A partir da década de 1990 perpetua-se a preocupação com a padronização dos diagnósticos psiquiátricos relacionados à crise, e os pacientes passam a receber múltiplos diagnósticos psiquiátricos; inicia-se, assim, a era da 'comorbidade psiquiátrica' (Jawad et al, 1995;Bowman, Markand, 1996;Lesser, 1996;Krumholz, 1999;Devinsky, 1998;Ettinger et al, 1999;Silva et al, 2001;Mökleby et al, 2002;Szaflarski et al, 2003;Binzer, Stone, Sharpe, 2004;D'Alessio et al, 2006;Testa et al, 2007).…”

“…Do ponto de vista médico, os pacientes ficam expostos a procedimentos iatrogênicos, como o uso de doses elevadas de drogas antiepilépticas (Niedermeyer, 1990), e invasivos, como punções venosas e entubação endotraqueal (Arnold, Privitera, 1996). Além disso, a comorbidade com transtornos depressivos e ansiosos é alta (Ettinger et al,1999;Kurcgant et al, 2000), e a qualidade de vida desses pacientes é pior quando comparada àquela dos portadores de epilepsia de difícil controle (Szaflarski et al, 2003).…”

Psychogenic non-epileptic seizures and psychoanalytical treatment: results

“…As a result, the quality of life of patients with PNES and the unemployment index (22-23%) are worse than those encountered for patients with epilepsy. 8,9 These conditions experienced over the years of treatment and without therapeutic results lead the patient to seek out government programs for financial assistance, such as disability benefit and even disability retirement. Thus, the economic impact of PNES is immeasurable.…”

Evaluation of the quality of life of patients with epilepsy and patients with physchogenic non-epileptic seizures

“…Скор квалитета живота код болесника са ПНЕН (41 ± 15,6) је био статистички значајно лошији него у групи са епилепсијом (57,6 ± 18,2) која се састојала од 2/3 болесника са ФРЕ и 1/3 са ФСЕ. Пацијенти са ПНЕН су имали чешће и теже психијатријске поремећаје (пре свега депресију), као и израженија нежељена дејства антиепилептичких лекова, чије укидање само по себи може да поправи ква-литет живота (362). Ова разлика са нашим резултатима је највероватније груписања болесника са ФРЕ и ФСЕ у заједничку групу са епилепсијама.…”