Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

Abstract

Summary: Purpose: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). Methods: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow‐up, 38.1 years). The proportion of patients who were “unproductive” (receiving health‐related state benefits) at follow‐up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS‐2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients “unproductive;” and group 3, seizures stopped, patients “productive.” Results: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were “unproductive” (difference, NS). Ongoing psychopathology was related to the factor “group membership” with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. Conclusions: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.

Depression and symptoms affect quality of life in psychogenic nonepileptic seizures

“…For example, in one study, nearly half of the patients remained disabled because of psychiatric symptoms even though they no longer had PNES. 10 Depression contributes to poor QOL in patients with PNES and ES. In patients with epilepsy, depression symptomology is a strong predictor of a worse QOL.…”

“…However, studies have suggested seizure remission alone may not be an adequate outcome in PNES studies, as patients with reduced seizures may continue to have psychiatric symptoms and remain disabled. 10 The relationship between seizure frequency and quality of life (QOL) has been studied in patients with epilepsy, but not as extensively in patients with PNES. Gilliam 11 studied 195 patients with epilepsy to determine the relationship of neuropsychiatric function and QOL.…”

The Effect of Therapy Psychodynamic and Cognitive Behavioral Therapy on Quality of Life in Patients with PNES

“…According to Reuber et al [1] Psychogenic no epileptic seizures (PNES) can be defined as a form of paroxysmal behavior that mimics epileptic seizures and is characterized by a sudden and time-limited disturbance of motor, sensory, autonomic, cognitive and emotional functions, or a combination of these. However, the main feature is that these epileptic-like seizures are displayed without an abnormal Electroencephalographic (EEG) activity.…”

A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment

“…While short-term seizure cessation cannot be the only treatment goal in this patient group [35], it is clearly relevant and was achieved in one third of patients.…”