Factors associated with comorbid epilepsy in patients with psychogenic nonepileptic seizures: A large cohort study.
Epilepsy Behav
; 134: 108780, 2022 09.
Article
em En
| MEDLINE
| ID: mdl-35753900
ABSTRACT
OBJECTIVE:
Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) occur in 12-22% of cases and the diagnosis of both simultaneous disorders is challenging. We aimed to identify baseline characteristics that may help distinguish patients with PNES-only from those with comorbid epilepsy.METHODS:
We performed a longitudinal cohort study on those patients diagnosed with PNES in our epilepsy monitoring unit (EMU) between May 2001 and February 2011, prospectively followed up until September 2016. Patients were classified into PNES-only, PNESâ¯+â¯possible or probable epilepsy, and PNESâ¯+â¯definite epilepsy based on the clinical, vEEG, and neuroimaging data. Demographic and basal clinical data were obtained from chart review. Multiple regression models were performed to identify significant predictors of PNESâ¯+â¯definite epilepsy, excluding patients with only possible or probable epilepsy for this specific analysis.RESULTS:
One-hundred and ninety four patients with PNES-only, 30 with PNESâ¯+â¯possible or probable epilepsy and 47 with PNESâ¯+â¯definite epilepsy were included. 73.8% were female and the mean age at EMU admission was 37.4⯱â¯standard deviation 13.5â¯years. Patients with PNESâ¯+â¯definite epilepsy most likely had never worked, had history of febrile seizures, structural brain lesions, developmental disabilities, and maximum reported seizure duration between 0.5 and 2â¯min. Patients with PNES-only were on fewer anti-seizure medications (ASM), reported more frequently an initial minor head trauma, seizures longer than 10â¯min, and a higher number of neurological and medical illnesses - being migraine (18.1%), other types of headaches (18.5%), and asthma (15.5%) the most prevalent ones. All pâ¯<â¯0.05. On the hierarchical regression analysis, history of febrile seizures, developmental disabilities, brain lesions, longest reported seizure duration between 0.5 and 2â¯min, and lack of neurological comorbidity, remained as significant predictors of PNESâ¯+â¯epilepsy. The model's performance of a 5-fold cross-validation analysis showed an overall accuracy of 84.7% to classify patients correctly.CONCLUSIONS:
Some demographic and clinical characteristics may support the presence of comorbid epilepsy in patients with PNES, being unemployment, the presence of brain lesions, developmental disabilities, history of febrile seizures, seizure duration and lack of comorbid headaches the most relevant ones.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Convulsões Febris
/
Epilepsia
Tipo de estudo:
Etiology_studies
/
Incidence_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article