Abstracts

Rationale: There are few publications that examined the association of headache and chronic pain syndromes in patients with psychogenic non epileptic seizures (PNES). The frequently reported risk factors for PNES are depression, post traumatic stress disorder,and history of physical or sexual abuse. The aim of our study is to assess the frequency and the type of chronic pain syndromes in two patient groups; patients with PNES and epilepsy and identify if there is any difference in the reported frequency between the two groups. Methods: We identified all patients referred to the inpatient Epilepsy Monitoring unit (EMU) at Henry Ford Hospital with seizures or paroxysmal events in the years 2006 and 2007. Patient data including demographics, EMU diagnosis, MRI/CT findings, documentation of headache syndromes (including migraine, tension, cluster headaches and other headaches), chronic pain syndromes (neck pain, back pain, knee pain and fibromyalgia) were obtained by searching the Henry Ford Health System electronic database. We have excluded patients younger than 18 years of age, with both epileptic and PNES, with intracranial electrode placement and with neuroimaging studies (MRI/CT) that showed structural abnormalities with the exception of mesial temporal sclerosis and chronic periventricular ischemic changes. Results: We reviewed 497 patients electronic charts. We analyzed data in 177 patients who met the inclusion criteria. Eighty four of the 177 patients were diagnosed with PNES and 93 patients were diagnosed with epilepsy (localization related or generalized epilepsy). Out of 84 with PNES, 64 (76%) complained of pain. Of the 64 patients, 31(48%) had headache syndromes (migraine, tension, cluster and other headaches), 19 (30%) had headache and other chronic pain syndromes (back pain, knee pain, neck pain, hip pain, fibromyalgia), 10 (16%) had back pain or neck pain and 4 (6%) patients had fibromyalgia. Among the PNES group, only twenty (24%) had no pain symptoms reported. From the 93 patients with epilepsy, 29 (31%) complained of pain symptoms. Of the 29, 16 (55%) had headache syndromes (migraine, tension, type, cluster and other headaches), 5 (17%) had both headaches and other chronic pain syndromes (back pain, knee pain, neck pain, hip pain and fibromyalgia), 7 (24%) had back pain and neck pain and 1 (4%) had fibromyalgia. Among the epilepsy group, sixty four (69%) had no pain symptoms. Conclusions: Our study demonstrated that patients with PNES reported chronic headache and or other pain syndromes twice as frequently as patients with epilepsy. Patients with PNES reported not only headaches but also musculoskeletal pain and fibromyalgia. Diagnosis and effective treatment of the PNES along with the chronic pain has the potential to further improve the quality of life and overall outcome in this patient population.