A Comprehensive Profile of Clinical, Psychiatric, and Psychosocial Characteristics of Patients with Psychogenic Nonepileptic Seizures

• Published in: Epilepsia (Copenhagen) 1999-09, Vol.40 (9), p.1292-1298
• Main Authors: Ettinger, Alan B., Devinsky, Orrin, Weisbrot, Deborah M., Ramakrishna, Ravindra K., Goyal, Amit
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age of Onset; Anticonvulsants - therapeutic use; Attitude to Health; Biological and medical sciences; Child; Conversion Disorder - diagnosis; Conversion Disorder - psychology; Depression; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Disabled Persons - statistics & numerical data; Employment; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Health Status; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Nonepileptic seizures; Outcome; Outcome Assessment (Health Care); Personality Inventory - statistics & numerical data; Prognosis; Pseudoseizures; Psychiatric Status Rating Scales - statistics & numerical data; Seizures - diagnosis; Seizures - psychology; Social Adjustment; Suicide - psychology; Suicide, Attempted - psychology
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1157.1999.tb00860.x

Purpose: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome. Methods: We administered a telephone‐based structured questionnaire to 56 patients with NESs (16 male and 40 female patients; mean age, 35 years) at a mean follow‐up time of 18 months after making the diagnosis of NES. Results: Mean age of NES onset was 28 years with a mean duration of 8 years. Episodes resolved in 29 (51.8%) cases, decreased in 24 (42.9%), persisted unchanged in two (3.6%), and increased in frequency in one (1.8%). Thirty (53.6%) patients, including 13 (44.8%) of patients whose NESs resolved, were rehospitalized for NESs or for other symptoms. Twenty‐nine (51.8%) had significant depressive symptoms, 22 (39.3%) had suicidal ideation, and 11 (19.6%) attempted suicide [including 6 (21%) of the patients whose NESs resolved]. Believing the NES diagnosis was associated with resolution or improvement of NES frequency (p < 0.029), whereas anger in response to receiving the diagnosis did not predict a poorer outcome. Patients' perceptions of having good health (p < 0.02) and good occupational functioning (p < 0.04) were highly correlated with NES resolution. Only patients whose episodes resolved were employed at the time of follow‐up. Conclusions: At a mean of 1.5 years, NES outcome was poor, with resolution in only half the group and with frequent rehospitalizations after NES diagnosis, even among patients whose NES resolved. Depressive symptoms, suicidal ideation, and suicide attempts were common. Believing the NES diagnosis and patient perceptions of having good health and good occupational functioning correlated well with NES resolution.