Can Treating Patients With PNES Lower the Risk of Sudden Unexpected Death?

Bermeo‐Ovalle, Adriana

doi:10.1177/1535759720988544

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Our study highlights the need to identify and implement effective risk prevention methods; strategies such as improving recognition and management of PNES are crucial 20. Confirming the diagnosis of PNES is a long process and a clinical challenge, and misdiagnosis of PNES as epilepsy is common 21.…”

Section: Discussionmentioning

confidence: 96%

“…Our study highlights the need to identify and implement effective risk prevention methods; strategies such as improving recognition and management of PNES are crucial. 20 Confirming the diagnosis of PNES is a long process and a clinical challenge, and misdiagnosis of PNES as epilepsy is common. 21 It is therefore essential to investigate cases where there is a suspicion for coexisting seizure types 6 and to acknowledge diagnostic uncertainty 22 ; failing to do so could lead to underestimation of risk in a population that is already at elevated risk of suicide, 2 and for whom prevention of premature mortality is a top priority.…”

Section: Discussionmentioning

confidence: 99%

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Increased suicide attempt risk in people with epilepsy in the presence of concurrent psychogenic nonepileptic seizures

Faiman

Hodsoll

Young

et al. 2022

J Neurol Neurosurg Psychiatry

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ObjectivesTo test the hypothesis that people with concurrent diagnosis of epilepsy and psychogenic nonepileptic seizures (PNES) are at increased risk of attempting suicide as compared to people with epilepsy or PNES alone. To report on suicide rates.MethodsRetrospective cohort study from the UK largest tertiary mental health care provider, with linked nationwide admission and mortality data from the Hospital Episode Statistics and Office for National Statistics. Participants were 2460 people with a primary or secondary diagnosis of epilepsy, PNES or concurrent epilepsy and PNES attending between 1 January 2007 and 18 June 2021. The primary outcome was a first hospital admission for suicide attempt (International Classification of Diseases, version 10 X60–X84).Results9% of participants had at least one suicide attempt-related hospital admission. For people with concurrent diagnosis of epilepsy and PNES, the odds for suicide attempt-related admissions were 2.52 times the odds of people with epilepsy alone (OR 0.40; 95% CI 0.21 to 0.79; p=0.01). Odds were comparable between people with concurrent diagnosis and people with PNES alone (OR 0.75; 95% CI 0.41 to 1.48; p=0.40). Post hoc analyses revealed that the odds of people with PNES alone were 1.93 times the odds of people with epilepsy alone (OR 0.52; 95% CI 0.38 to 0.70; p<0.001).ConclusionsPeople with concurrent diagnosis of epilepsy and PNES or PNES alone have significantly increased odds of hospitalisation due to suicide attempt as compared to people with epilepsy alone (152% and 93% increase, respectively). These findings have direct implications for the clinical management of suicide risk in people with epilepsy.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Increased suicide attempt risk in people with epilepsy in the presence of concurrent psychogenic nonepileptic seizures

Faiman

Hodsoll

Young

et al. 2022

J Neurol Neurosurg Psychiatry

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“…Investigators point out the gravity of the conversion disorder and the failure of neurologists and psychiatrists to effectively treat these patients [ 20 ]. They assert that PNES patients are no less important than patients with epilepsy [ 19 ] and that the elevated mortality rate makes a strong case for treating PNES at least as purposefully and aggressively as epilepsy [ 21 ]. They have called for further studies to shed light on the recent findings [ 1 ] but the relief they seek is already available.…”

Section: Introductionmentioning

confidence: 99%

Psychogenic Nonepileptic Seizures—High Mortality Rate Is a ‘Wake-Up Call’

Carlson¹

2023

JPM

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Patients with epilepsy have an elevated mortality rate compared to the general population and now studies are showing a comparable death ratio in patients diagnosed with psychogenic nonepileptic seizures. The latter is a top differential diagnosis for epilepsy and the unexpected mortality rate in these patients underscores the importance of an accurate diagnosis. Experts have called for more studies to elucidate this finding, but the explanation is already available, embedded in the existing data. To illustrate, a review of the diagnostic practice in epilepsy monitoring units, of the studies examining mortality in PNES and epilepsy patients, and of the general clinical literature on the two populations was conducted. The analysis reveals that the scalp EEG test result, which distinguishes a psychogenic from an epileptic seizure, is highly fallible; that the clinical profiles of the PNES and epilepsy patient populations are virtually identical; and that both are dying of natural and non-natural causes including sudden unexpected death associated with confirmed or suspected seizure activity. The recent data showing a similar mortality rate simply constitutes more confirmatory evidence that the PNES population consists largely of patients with drug-resistant scalp EEG-negative epileptic seizures. To reduce the morbidity and mortality in these patients, they must be given access to treatments for epilepsy.

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