Case series of functional non epileptic seizures (PNES) in patients with brain tumors

Functional (Psychogenic) non epileptic seizures (PNES) are events which mimic epileptic seizures without ictal electrical findings on the EEG recording during the events. Diagnosis of PNES is made by correlating the clinical presentation with the lack of ictal activity as diagnosed by video EEG (VEEG) and is crucial for proper decision-making regarding management. Patients with brain tumors have a high prevalence of epileptic seizures. However, clinician's awareness of PNES in those patients is often insufficient.

We collected data regarding 6 patients with brain tumors which were followed-up in the neuro-oncology unit in Sheba medical center and were diagnosed with epilepsy, along with PNES according to VEEG.

We describe data regarding 6 patients aged 20-68, four of them females, with different brain tumors and in various stages of the disease. PNES were mostly focal, and a clear trigger was identified in four patients. Improvement in PNES frequency alongside a reduction in anti-seizure medicaions followed diagnosis of PNES in 5 out of the 6 patients.

In our case series, PNES were usually focal, and patients did not have all the risk factors associated with PNES in the general population. PNES frequency was unrelated to oncological status. Diagnosis of PNES with open discussion reduced PNES frequency and dosages of anti-seizure medications in our patients.