Abstracts

Rationale: Up to 30% of all cases referred to epilepsy centers due to presumed intractable epilepsy, in fact, have non-epileptic seizures (LÜders H, ed. Epilepsy Surgery. New York: Raven Press; 1991:83-90).Methods: In our study, we evaluated 249 patients with refractory seizures using video-EEG monitoring. In this sample, we identified 56 (22.5%) patients with psychogenic non-epileptic seizures – PNES only (mean age 29.6 + 10,1 years, females 69%, males 30,4%). Average duration of disease prior to PNES diagnosis was quite long ( 6.7 + 3.4 years). Results: Personality disorders were the most frequent psychiatric co-morbidity (in 44.6% of PNES patients), emotionally unstable (borderline) personality disorder was predominant (in 32.1% of PNES patients). Anxiety disorders (panic disorder, generalised anxiety disorder, post traumatic stress disorder) and depression were also frequent psychiatric co-morbidities in our sample. After two years of treatment, the overall effect of combined therapeutic procedures (pychopharmacotherapy and/or psychotherapy) was moderate; when evaluated for the last 12 months, 28.6% of patients in our sample were seizure free, 33.9% were responders (≥ 50% reduction in seizure frequency) and 32.1% patients did not respond to treatment (5.4% of patients were lost to follow up). These findings support previous data indicating poor prognosis of PNES patients; approximately one third of patients were seizure-free after two years (Conder and Zasler 1990, McDate and Brown 1992, Buchanan and Snars 1993Reuber et al. 2003, Reuber and Elger 2003). Delivery of the diagnosis, video-presentation of PNES seizures and education formed the first step of therapy. They were well-tolerated but effective in only a small proportion of PNES patients Conclusions: The best pharmacological treatment results were found in the subgroup of PNES patients suffering from co-morbid anxiety or depressive symptoms. The most problematic group to treat were the patients suffering from PNES with co-morbid personality disorders, predominantly emotionally unstable (borderline) disorder.