Outcome in psychogenic nonepileptic seizures: 1 to 10‐year follow‐up in 164 patients

Abstract

Our knowledge of longer term outcome in psychogenic nonepileptic seizures (PNESs) patients is limited; we know less still about factors predicting prognosis. This study was intended to describe outcome in a large cohort and to identify predictive clinical and psychological factors to generate new ideas for treatment. One hundred sixty-four adult patients with PNESs (66.7%) responded to outcome, personality, and psychosymptomatology questionnaires (Dimensional Assessment of Personality Pathology-Basic Questionnaire [DAPP-BQ], Dissociative Experiences Scale, and Screening Test for Somatoform Symptoms) a mean of 11.9 years after manifestation and 4.1 years after diagnosis of PNES. Additional clinical data were retrieved from hospital records. The responses showed that 71.2% of patients continued to have seizures and 56.4% were dependent on social security. Dependence increased with follow-up. Outcome was better in patients with greater educational attainments, younger onset and diagnosis, attacks with less dramatic features, fewer additional somatoform complaints, and lower dissociation scores. Better outcome was associated with lower scores of the higher order personality dimensions "inhibitedness," "emotional dysregulation," and "compulsivity" but not "dissocial behavior" (DAPP-BQ). Outcome in PNESs is poor but variable. Clinical and personality factors can be used to provide an individualized prognosis. By generating a patient-specific profile, they show particular maladaptive traits or tendencies that can identify goals for psychological therapy.

Nonepileptic seizures treatment workshop summary

“…For example, the Goldstein et al trial employed measures assessing clinical outcome (seizure frequency diary), psychosocial outcome (work and social adjustment), psychopathology outcome (fear, depression), as well as several secondary outcome measures of health perceptions and locus of control [34]. Reuber et al [35] examined long-term NES outcomes from the standpoint of seizure outcome and government disability status and found that several clinical and psychological factors were associated with better prognosis. However, they pointed out that some variables are not conducive to intervention, such as history of better education and less violent seizures.…”

“…Similarly, changing maladaptive personality characteristics may also prove difficult. Targeting personality characteristic change may also prove difficult, but they suggested that it may be possible to "concentrate on the identification and management of stressors or triggers in the (social) environment that interact with personality vulnerability" [35].…”

Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

“…5 Patients with PNES experience long-term economic and social dependence, have frequent emergency department visits and hospital admissions, and incur high medical care costs. [6][7][8] The prognosis for the untreated illness is poor, with 71% of patients having ongoing psychogenic seizures and 56% of patients on disability at 1-to 10-year follow-up. 7 Psychotherapy has been shown to reduce psychogenic seizure frequency and improve quality of life.…”

“…[6][7][8] The prognosis for the untreated illness is poor, with 71% of patients having ongoing psychogenic seizures and 56% of patients on disability at 1-to 10-year follow-up. 7 Psychotherapy has been shown to reduce psychogenic seizure frequency and improve quality of life. The strongest evidence basis, including two randomized trials, demonstrates the efficacy of cognitive behavioral therapy.…”

The diagnostic and prognostic value of induction methods in patients with psychogenic nonepileptic seizures

“…NEPN'si olan hastaların tedavi sürecinin; tanıyı hastaya deklare etme sürecinde başladığı ve bu aşamada kullanılan etkin bir iletişimin hastanın tedavisine büyük katkı sağlayacağı bildirilmiştir. [22] Reuber ve ark.nın [23] çalışmalarında, 164 NEPN hastasının tanı sonrası 1-10 yıllık takiplerinde %70'inde nöbetlerin sürdüğü belirtilmiştir. Son yıllarda yapılan bir çalışmada ise NEPN'si olan 260 hastanın, tanı sonrası 6-12 ay süre ile takip edildiği ve sadece %38'inde nöbetlerin izlenmediği bildirilmiştir.…”