Authors :
Presenting Author: Francisco Arruda, MD, PhD – Instituto de Neurologia de Goiânia
Paulo Oliveira, Psychiatrist – Head, Psychiatry, Instituto de Neurologia de Goiânia
Rationale:
Non-Epileptic Seizures (NES) are relatively common and at times surprising in the epilepsy monitoring unit setting. Their occurrence depends largely on patient selection and population served, accounting for a great variability of incidence. We present the findings of such cases in our epilepsy monitoring unit between 2004 and 2022.
Methods:
A total of 2872 adult and pediatric patients were referred for surgical evaluation for refractory epilepsies. All patients were submitted to a standard protocol including 24 channel scalp video-EEG, MRI, neuropsychological and neuropsychiatric evaluations. Retrospective analysis identified all cases where NES were recorded and the clinical/demographic findings are presented.
Results:
Two hundred and twenty six cases (7,87%) were diagnosed with NES. Average age was 35 years; 61 males (27%) and 165 females (73%). Annual incidence varied from 0% to 17%, peaking in most recent years. Eighty seven patients (38,7%) had “pure” psychogenic NES (PNES), whereas 125 (54,7%) had NES in probable or definitive association with epilepsy. Only 14 patients had other non-epileptic events (parasomnias, psychomotor agitation, panic attacks, self gratification, etc). Seven patients developed PNES after epilepsy surgery. From the 87 patients with “pure” PNES, 67 (77%) had normal MRIs (or inespecific findings, such as microangiopathy), in contrast with 19 (21,8%) in the group with epilepsy. The yield of the blinded psychiatric interview alone in diagnosing NES was 31,9%.
Conclusions:
In the setting of refractory epilepsy evaluation, NES comprise a miscelanea of clinical conditions beyond “pure” psychogenic cases. Comorbidity of NES and epilepsy is surprisingly high. Female sex and normal MRI are more common in “pure” PNES cases. A steady increase in the prevalence of NES is observable throughout the years. Neuropsychiatric interview adds to the identification of NES and should be a part of the standard preoperative assessment for every patient.
Funding: None