Clinical characteristics of psychogenic nonepileptic seizures across the lifespan: An international retrospective study

Purpose: Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. Methods: In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). Results: A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). Conclusion: While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.Fil: Sawchuk, Tyson. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; ChipreFil: Asadi Pooya, Ali A.. Shiraz University of Medical Sciences. Shiraz Medical School; Irán. Thomas Jefferson University. Jefferson Comprehensive Epilepsy Center. Department of Neurology; Estados UnidosFil: Myers, Lorna. Northeast Regional Epilepsy Group; Estados UnidosFil: Valente, Kette D.. Universidade de Sao Paulo; BrasilFil: Restrepo, Anilu Daza. Universidade de Sao Paulo; BrasilFil: D'Alessio, Luciana. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Homayoun, Maryam. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Bahrami, Zahra. Shiraz University of Medical Sciences. Shiraz Medical School; IránFil: Alessi, Rudá. Universidade de Sao Paulo; BrasilFil: Paytan, Angélica Aroni. La Trinidad Medical Center. Epilepsy Unit; VenezuelaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Taha, Firas. Northeast Regional Epilepsy Group; Estados UnidosFil: Lazar, Lorraine M.. Northeast Regional Epilepsy Group; Estados Unidos. Hackensack University Medical Center. Hackensack Meridian School of Medicine; Estados UnidosFil: Pick, Susannah. King's College London; Reino UnidoFil: Nicholson, Timothy R.. Kings' College London. Institute of Psychiatry, Psychology and Neuroscience. Section of Cognitive Neuropsychiatry; Reino UnidoFil: Buchhalter, Jeffrey. Alberta Children's Hospital. Children's Comprehensive Epilepsy Center; Canadá. University of Nicosia. School of Social Sciences. Department of Psychology; Chipre. University of Calgary; Canad