Abstracts

RATIONALE: Psychogenic nonepileptic seizures (PNES) occur in both sexes, possibly for different reasons and with different semiologies. This study compares etiologies and semiologies in 144 consecutive patients with PNES. METHODS: From January 1998 to April 2000, we prospectively classified all video-EEG recorded events and seizures in an epilepsy monitoring unit and identified 144 cases with nonepileptic seizures of psychogenic origin. PNES were classified according to the epileptic seizure semiology mimicked: simple partial, complex partial, convulsive, status epilepticus, and myoclonic events. Age, gender, coexistence with epilepsy, past medical history, seizure semiology. 70% of the patients were interviewed by a psychiatrist to determine a DSM IV diagnosis. RESULTS: Patients included 99 females and 45 males. The mean age was 35.6 years old (range: 14-69) while 25/144 (17%) had both epileptic and nonepileptic seizures; there were no gender differences. Risk factors were identified in 81%. Mild concussions were the most frequent risk factor in both genders (19/99 women, 11/45 men), followed by physical and sexual abuse in the female group in 18/99 and drug and alcohol abuse in the male group in 15/45. Only the drug and alcohol abuse was significantly increased in men compared to women (p=0.0003 Fisher's exact test). 2 men and 12 women had multiple PNES semiologies; this was not significant. Simple partial semiology for PNES was statistically more common in men (15/45 men vs. 10/99 women, p=0.0015). In women, there was an insignificant trend for myoclonic semiologies. Depression was diagnosed more often in women than men (48/71 vs. 8/24 p = 0.0035). Conversion disorder was common in both sexes. CONCLUSIONS: Psychogenic nonepileptic seizures were most frequent in women under age 40. Mild head trauma is the most frequent antecedent risk factor seen in both genders. Compared to women, men were less likely to be diagnosed with depression and more likely to have a substance abuse history and a simple partial nonepileptic seizure semiology. Patients with PNNE have high rates of psychiatric disorders, especially major depression.