Information regarding outcome in patients with psychogenic nonepileptic seizures (PNES) is limited. We attempted to contact 72 consecutive patients with PNES confirmed by video-EEG monitoring: 51 of 72 (71%) were reached a mean of 15 months (range 12-27 months) after diagnosis and agreed to answer a structured telephone questionnaire. The questionnaire assessed the number of PNES in the last 6 months, antiepileptic drug (AED) use, occupational status, global self-rating, and extent of psychotherapeutic treatments. PNES had ceased in 18 of 51 (35%), decreased > 80% in 21 of 51 (41%), and decreased < 80% in 12 of 51 (24%). Thirty-three of 51 (65%) were not taking AEDs. Occupational status improved in 20% and did not change in 75%. Overall, 29 of 51 (57%) rated themselves markedly improved and 15 of 51 (29%) rated themselves unchanged or worse. Persisting PNES were associated with longer duration of PNES before diagnosis (p < 0.02) and presence of additional psychiatric disease (p < 0.01). Persisting PNES were not associated with gender, presence of epileptic seizures, or extent of psychotherapeutic treatments after diagnosis. Placebo saline infusion had been administered in some patients to help precipitate PNES. This did not affect the number of psychotherapy visits or outcome. We conclude that PNES cease or significantly decrease in most patients, but occupational status does not improve as often. Earlier diagnosis may improve outcome.

Placebo infusions are occasionally used to elicit psychogenic seizures. How frequently placebo infusions elicit patients' typical events, atypical and potentially confusing events, or even epileptic seizures is not known. We report the results of placebo infusions during video EEG in 68 patients who also had events recorded without placebo. A single investigator administered a saline placebo that was represented to the patient as an activating substance. We compared the events recorded without placebo with events recorded with placebo. Twenty patients had only epileptic seizures without placebo; with placebo, two of 20 (10%) had their typical epileptic seizures and three of 20 (15%) had atypical nonepileptic events. Forty patients had only psychogenic seizures without placebo; with placebo, 33 of 40 (82%) had their typical psychogenic seizures and three of 40 (8%) had atypical events. Eight patients had both psychogenic and epileptic seizures without placebo; with placebo, four of eight had their typical psychogenic seizures. Thus, placebo infusion elicits typical psychogenic events in most patients with psychogenic seizures, but atypical events or epileptic seizures may occur in a minority and lead to incorrect diagnosis.

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Violent behavior in psychiatric patients may result in long-term hospitalization. There is no FDA-approved psychopharmacologic treatment for aggression. In this study, 20 chronically aggressive hospitalized patients were administered 1 week of placebo followed by an open trial of increasing doses of propranolol. Patients who had an equivocal or definite clinical response were entered into an open add-on double-blind discontinuation study phase. Aggressive behavior was objectively documented throughout the study. After the open phase of the study, 7 patients had a greater than 50% decrease in aggressive behavior. Four patients entered the double-blind discontinuation phase. The clinical course of 3 of those patients was consistent with the positive response to propranolol. The results of this study are consistent with a therapeutic effect of propranolol in some patients with aggressive behavior. Further studies are indicated.

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