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Dramatic presentations in psychogenic nonepileptic seizures.
Ali A Asadi-Pooya1, Zahra Bahrami2
1Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA.
Seizure
|January 29, 2019
Summary
Psychogenic nonepileptic seizures (PNES) often present dramatically with urinary incontinence or injury. Early recognition of these features is crucial to avoid misdiagnosis and inappropriate treatments for PNES patients.
Area of Science:
- Neurology
- Psychiatry
- Epileptology
Background:
- Psychogenic nonepileptic seizures (PNES) are often misdiagnosed as epileptic seizures.
- Dramatic presentations of PNES can complicate diagnosis and treatment.
- Understanding the frequency of dramatic PNES features is essential for clinical practice.
Purpose of the Study:
- To determine the incidence of dramatic presentations in psychogenic nonepileptic seizures (PNES), specifically urinary incontinence and ictal injury.
- To identify historical risk factors associated with these dramatic PNES manifestations.
Main Methods:
- Retrospective analysis of a database.
- Inclusion of all patients diagnosed with PNES at Shiraz Comprehensive Epilepsy Center from 2008 to 2018.
- Data collection on seizure characteristics, including urinary incontinence and bodily injuries.
Main Results:
- Out of 259 patients with PNES, 12% reported urinary incontinence and 29% reported bodily injury.
- Common injuries included lacerations (13.5%), tongue biting (12%), and fractures (2%).
- A significant difference was observed in antiepileptic drug use between patients with and without dramatic features (p=0.03).
Conclusions:
- Dramatic features such as ictal injury and urinary incontinence are common in PNES.
- These presentations pose a significant risk for misdiagnosis and unnecessary treatments.
- Increased awareness and accurate diagnosis of PNES are critical to prevent patient harm.
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