Authors :
Presenting Author: Ozgu Kizek, MD – Istanbul Faculty of Medicine, Istanbul University
Ayse Deniz Elmali, MD – Istanbul Faculty of Medicine, Istanbul University
Ferda Uslu, MD – Istanbul Faculty of Medicine, Istanbul University
Nerses Bebek, MD, PhD – Istanbul Faculty of Medicine, Istanbul University
Rationale:
Prolonged psychogenic nonepileptic seizures (PNES) are reported in up to 78% of individuals with PNES and account for intensive care unit (ICU) admissions in approximately 18%–27% of patients experiencing nonepileptic psychogenic status (NEPS). Endotracheal intubation is required in about 15% of these cases. This study aims to highlight the significant burden NEPS places on healthcare systems and elucidate its clinical characteristics.
Methods:
A total of 146 patients diagnosed with PNES at a tertiary epilepsy center were retrospectively reviewed. Eleven patients who experienced seizure episodes lasting longer than 20 minutes, resulting in multiple emergency department visits and ICU admissions were included.
Results:
Three male and eight female patients were identified, with a median age of 29 years (IQR: 15, 25-40). Four patients (36%) were additionally diagnosed with epilepsy. Ten patients were receiving antiseizure medications. Electroencephalography revealed interictal epileptiform discharges in four patients. Only two patients had a prior documented diagnosis of PNES. Five individuals (45.4%) had recurrent ICU admissions. Seven patients (63.6%) underwent intubation; three of them due to tachycardia and respiratory depression. In these cases, intravenous antibiotic therapy was initiated in the ICU for suspected infections. One patient had a known allergy to diazepam. Neuroimaging findings were unremarkable. Two patients had a prior history of psychiatric treatment. Among patients with recurrent NEPS, two had a history of suicide attempts, one of whom died by suicide.
Conclusions:
The recognition and management of NEPS require enhanced interdisciplinary education. Early identification of NEPS may reduce ICU admissions and prevent iatrogenic complications. Accurate diagnosis and appropriate psychiatric care can prevent serious outcomes, including suicide. It is essential to approach this patient population not as occupying a theoretical boundary between epileptology and psychiatry, but rather as a distinct clinical entity requiring integrated care.
Funding: No