Post-epilepsy surgery psychogenic nonepileptic seizures

Area of Science:

• Neurology
• Epileptology
• Psychiatry

Background:

• Drug-resistant epilepsy often necessitates surgical intervention.
• Post-epilepsy surgery seizures can present diagnostic challenges.
• Psychogenic nonepileptic seizures (PNES) are a recognized phenomenon in epilepsy management.

Purpose of the Study:

• To determine the prevalence of post-epilepsy surgery PNES.
• To identify risk factors associated with PNES after epilepsy surgery.

Main Methods:

• Retrospective analysis of 1,105 patients undergoing epilepsy surgery (1986-2016).
• Verification of PNES diagnosis using video-electroencephalography (EEG) ictal recordings.
• Comparison of factors between patients with and without postoperative PNES.

Main Results:

• PNES was documented in 3.9% (27/697) of patients with postoperative seizures.
• A low full-scale intelligence quotient (IQ <80) was significantly associated with post-epilepsy surgery PNES (OR 2.89).
• A preoperative psychiatric diagnosis was strongly associated with post-epilepsy surgery PNES (OR 4.67).

Conclusions:

• PNES should be considered in patients with recurrent seizures after epilepsy surgery.
• Factors like new ictal behaviors, preoperative psychiatric history, and low IQ warrant diagnostic suspicion.
• Early identification and appropriate diagnostic measures for PNES are crucial post-surgery.