Psychogenic non-epileptic seizures in patients undergoing epilepsy surgery: experience from a tertiary referral...

The coexistence of psychogenic non-epileptic seizures (PNES) and drug-resistant epilepsy (DRE) presents significant challenges, particularly in the context of epilepsy surgery. This study aimed to investigate the clinical, demographic, and prognostic features of patients who underwent epilepsy surgery and had coexisting PNES.

This retrospective study was conducted at Hacettepe University Hospitals' Epilepsy Center between October 1996 and December 2019. Thirteen patients who underwent resective or non-resective epilepsy surgery and were diagnosed with PNES were included. Data were collected from outpatient clinic records, seizure charts, and video-EEG monitoring unit (VEMU) reports. Postoperative outcomes were evaluated using the Engel classification, and the presence of epileptic seizures and PNES was recorded.

Among 717 patients who underwent epilepsy surgery during the study period, 13 (1.8 %) had coexisting PNES. Of these, 11 had PNES in the presurgical period, and de novo PNES developed in two patients after surgery. Among the 10 patients with presurgical PNES who underwent resective surgery, 90 % achieved Engel Class I outcomes, while 10 % were classified as Engel Class III. No postoperative PNES recurrence was observed in these patients. However, in one patient who underwent corpus callosotomy, both epileptic seizures and PNES persisted. De novo PNES occurred in two cases, 1 and 7 years after surgery, despite Engel Class I outcomes.

PNES should not be seen as a reason for hesitation in referring patients for epilepsy surgery. Our findings suggest that good prognosis after epilepsy surgery can improve patients' quality of life and may indirectly lead to positive effects on PNES. However, the occurrence of de novo PNES underscores the importance of postoperative psychological follow-up for long-term success.