Abstracts

Rationale: Most of our knowledge on Psychogenic Non-Epileptic Seizures (PNES) is based on studies conducted with populations from United States or Europe. The authors believe that socioeconomic and cultural background affect the characteristics of PNES. However, there is scarce data on PNES on South-American countries, usually with small sample sizes and without video-EEG. The aim of the present study was to describe the demographics and clinical characteristics considering stress factors, psychiatric diagnosis and social functioning in a large Brazilian series with PNES. Methods: We reviewed videos and medical records of 102 patients (mean age 35.27 years; 76.4% female) with PNES, documented by video- EEG (mean 7.82 days) from 2006 to 2011. All patients evaluated were over 18 years of age. Patients with epilepsy were not excluded. Diagnosis of malingering (with clear panic attacks) was a criterion of exclusion. Patients who presented PNES, during video-EEG, that were not recognized by their families as typical of those presented at home were also excluded. We collected data on age; gender; years of schooling; marital status; living situation; employment; psychiatric diagnoses or other acute or chronic somatic illnesses; concomitant epilepsy and stress factors. Previous use of antiepileptic drugs (AEDs), use of medical services and side effects were also documented. Results: Mean age at PNES onset was 27.85 years; mean time to diagnosis was 7.89 years; 89 patients (87.25%) lived with their families; 58 (56.86%) were single; 41 (40.19%) had finished high school; and 33 (39.75%) worked on regular basis. Eighteen patients (21.68%) were on permanent disability, seven (38.88%) out of these with the diagnosis of refractory epilepsy. Depression was diagnosed in 49 patients (48.03%), anxiety in 28 (27.45%) and 32 (31.37%) had somatic symptoms. Thirty-three patients misdiagnosed with epilepsy (49.25%) were using antiepileptic drugs. Fifteen patients (14.70 %) had previous hospitalization (ER/ICU). All patients had performed ancillary diagnostic testing and had frequent physician visits. Stress factors were identified in 59 patients (57.84%), the most commons being family related (15.68%). Physical abuse was reported by 17.64% and sexual abuse by 5.88%. Conclusions: Most of our findings are in line with those of studies conducted in the United States and Western Europe. However, we observed major differences in comparison with studies conducted in China and Eastern Europe. These findings indicate that cultural and socioeconomic differences may affect the characteristics of PNES.