Clinical characteristics of psychogenic nonepileptic seizures across the lifespan: An international retrospective study

SAWCHUK, TYSON, ASADI-POOYA, ALI A,MYERS, LORNA, D' ALESSIO, LUCIANA, ET AL.

EPILEPSY & BEHAVIOR (PRINT)

ACADEMIC PRESS INC ELSEVIER SCIENCE

Año: 2020 vol. 102

1525-5050

Purpose: Previous studies from a few countries have reported semiological differences in younger children comparedwith adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesisthat semiological, demographic, and historical risk factors vary with different ages of PNES onset in a largecohort from different countries.Methods: In this retrospective study, we investigated patients consecutively referred for PNES, who were admittedto epilepsymonitoring units in Iran, Brazil, Venezuela, Canada,Argentina, and USA. Age, gender, age at seizureonset, seizure semiology, and factors predisposing to PNES (abuse, stressors)were documented according to routinediagnostic practices at each center. Participantswere grouped according to their age at onset (i.e., childhood,adolescence, or adulthood).Results: A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122,70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p=0.011). Event frequencyin the month preceding the diagnosis was higher in the childhood- [x = 50, standard deviation (sd) = 82, p =0.025] versus adolescent- (x=24, sd=36) or adult-onset groups (x=29, sd=61). Significant between-groupdifferences were observed for generalized body movements (p=0.0001) and ictal injury (p=0.027), suggestingmoresevere ictal presentations in adult-onset PNES comparedwith younger ages. Adult-onset patientswerealso more likely to be taking an unnecessary antiepileptic medication (p= 0.010).Conclusion: While PNES may present at any age, there appear to be notable differences across the lifespan withrespect to some of the clinical characteristics. Further international and cross-cultural studies may reveal otherinteresting characteristics of PNES.