Mortality in patients with psychogenic nonepileptic seizures

Abstract

ObjectiveTo investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population.MethodsThis retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports.ResultsA total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0–3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4–19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and “epilepsy” was recorded as the cause of death in 24%.ConclusionsPatients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.

Clinical predictors of discordance between screening tests and psychiatric assessment for depressive and anxiety disorders among patients being evaluated for seizure disorders

“…Further research is warranted in this area, particularly as depression is a driving force for a higher mortality rate among pwPNES. [3][4][5] When the NDDI-E was developed and validated, subjects had to have a 4th grade reading level to minimize errors in the interpretation of the six items. 8 Although intelligence quotient testing was not one of the eight psychometric instruments administered to all patients, we did exclude any patients with a known intellectual disability or reading impairment.…”

“…3,4 Similarly, a large cohort study found that 20% of deaths in pwPNES younger than 50 years were attributable to suicide and pwPNES younger than 30 years had an eightfold increase in their standardized mortality rate. 5 Given the significant deleterious impact of depression and anxiety on the well-being of PWE, prompt diagnosis of these comorbidities is crucial and may be facilitated through validated screening instruments. 6,7 Brief screening instruments, such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder scale (GAD-7), have been validated for use in PWE and are widely used to screen for depression and anxiety.…”

Psychedelic‐assisted therapy for functional neurological disorders: A theoretical framework and review of prior reports

“…For example, two separate studies found patients with functional movement disorders to have similar or greater reductions in quality of life to patients with “organic” movement disorders 17,18 . A recent study also found that patients with PNES have a standardized mortality ratio that is 2.5 times higher than the general population, similar to that of patients with medically refractory epilepsy 19 …”

“…17,18 A recent study also found that patients with PNES have a standardized mortality ratio that is 2.5 times higher than the general population, similar to that of patients with medically refractory epilepsy. 19 Recent research into effective treatment practices may help reshape the prognosis of functional disorders. In the case of functional movement disorders, there is increasing evidence to support modified intensive physical rehabilitation programs.…”

Seizure‐related deaths in children: The expanding spectrum

“…22 Furthermore, some patients have seizures due to psychiatric disordersparoxysmal nonepileptic seizures-a group that also has a 2.5-fold elevated mortality rate. 23 2.1.2 | Bias toward attributing COD to a…”