Delay in diagnosis of psychogenic nonepileptic seizures in adults: A post hoc study

The aim of the current post hoc study was to investigate factors associated with delay in diagnosis of adult patients with psychogenic nonepileptic seizures (PNES).

We retrospectively investigated all patients with PNES admitted to the epilepsy-monitoring unit at the Jefferson Comprehensive Epilepsy Center from 2012 through 2016. We identified the median time to diagnosis of PNES and divided the patients into two groups. We studied factors associated with delay in diagnosis of PNES.

In all, 49 patients (39 women and 10 men) were studied. Mean age at the time of admission was 40±16years and at the onset of the seizures was 34±16years. Disease duration was 5.6±8.2years. The median for time to diagnosis was 3years. Patients with early diagnosis (before 3years after seizure onset) (21 patients) and patients with late diagnosis (delay of 3years or more from onset) (28 patients) were compared. Only history of head trauma had significant association with the delay in diagnosis: 2 of 19 patients (7%) with an early diagnosis and 11 of 28 patients (39%) with a late diagnosis reported head trauma (P=0.02).

Delay in diagnosis of PNES is common, and some factors (e.g., history of head trauma) may contribute to this delay. It is important that physicians involved in the management of seizures appreciate the importance of making an early and definitive diagnosis of PNES.