Heterogeneity in psychogenic nonepileptic seizures: understanding the role of psychiatric and neurological factors.

Multiple psychiatric and neurological factors in patients with psychogenic nonepileptic seizures (PNES) highlight the heterogeneity of this population. Forty-four individuals with PNES were evaluated and divided into groups based on psychiatric and neurological morbidity. Groups were then examined to determine how they differed in terms of clinical presentation, semiology, level of dysfunction, severity of psychopathology, and specific psychiatric and neurological conditions. Individuals with neurological morbidity more frequently displayed sound production during their events. Factors relevant to treatment planning such as psychiatric conditions, psychopathology severity, and dysfunction level did not differ between the group with neurological morbidity and the group without significant psychiatric or neurological morbidity. Patients with significant psychiatric impairment had more frequent dissociative experiences, higher levels of dysfunction, and more frequent trauma-related diagnoses. Dysfunction was positively associated with depression severity and stress. Subgroups of patients with PNES based on their neurological and psychiatric morbidity manifest differences that might inform treatment. (c) 2009 Elsevier Inc. All rights reserved.