Abstracts

RATIONALE: It is estimated that between 10-40% of patients seen at epilepsy centers have psychogenic nonepileptic seizures (PNES). Traditional treatment recommendations have focused on emotional stressors/psychiatric issues and treatment with psychotherapy or behavioral therapy, although resolution of symptoms is often difficult to achieve. This patient population has been well documented to have a high incidence of somatic complaints although treatment recommendations for PNES have rarely specifically addressed these comorbidities as an important part of the treatment plan. Personal clinical observation has suggested a high comorbidity and often precursor of inadequately addressed chronic pain syndromes.
METHODS: Thirty patients (9 male and 21 female) with a diagnosis of non-electrographic seizures(NES) as ascertained by typical seizures captured on ambulatory EEG monitoring between 1992 and 2000 were randomly selected and asked to complete a brief, confidential, IRB approved survey via mail and then follow-up telephone contact. Patients with a diagnosis of electrographic seizures (epilepsy) as well were not excluded.
RESULTS: 28 (93%) of those surveyed reported problems with headaches or pain. Only 2 had other pain issues (fibromyalgia). 18 (60%) of these had chronic ongoing pain issues, of which 15 (50%) reported disability from the pain. 26 (87%) also reported refractory seizures while only 11 (37%) of these reported a knowledge of having NES. 17 (57%) were on an anti-epileptic drug (AED) and 8 (27%) were on two or more AEDs. 21 (70%) reported nonrestful sleep and 24 (80%) reported depression/anxiety symptoms. 19 (63%) had a history of being abused and 18 (60%) a clear association between their headache/pain and seizure provocation. In 12 (40%) cases the pain syndrome preceded seizure onset. Only 5 (17%) of those surveyed reported traumatic brain injury or prior neurosurgical procedure. 10 (33%) are curently employed.
CONCLUSIONS: Chronic pain syndromes are a significant comorbidity in patients with a diagnosis of NES and often precede the onset of seizure events. Prior studies that show poor outcomes in this patient population may be partially due to lack of awareness and treatment of this comorbid symptom. Patients who are unwilling or unable to address any underlying psychiatric precipitators may have improvement of symptoms with treatment of their pain issues and other comorbid symptoms. Additional significant comorbidities that remained true as compared to prior studies included depression, nonrestful sleep and a history of being abused.