Benjamin D Wissel1, Alok K Dwivedi2, Tyler E Gaston3, Federico J Rodriguez-Porcel1, Danah Aljaafari4, Jennifer L Hopp5, Allan Krumholz5, Sandra M A van der Salm6, Danielle M Andrade7, Felippe Borlot7, Brian D Moseley1, Jennifer L Cavitt1, Stevie Williams8, Jon Stone8, W Curt LaFrance9, Jerzy P Szaflarski3, Alberto J Espay10. 1. Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA. 2. Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA. 3. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Division of Neurology, University of Toronto, Toronto, ON, Canada; Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia. 5. Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. 6. Department of Neurology, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands. 7. Division of Neurology, University of Toronto, Toronto, ON, Canada. 8. Department of Clinical Neurosciences, The University of Edinburgh, Edinburgh, Scotland, United Kingdom. 9. Department of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA. 10. Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: alberto.espay@uc.edu.
Abstract
OBJECTIVE: We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. METHODS: Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect. RESULTS: In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073). CONCLUSIONS: Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
OBJECTIVE: We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. METHODS: Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect. RESULTS: In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073). CONCLUSIONS: Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
Authors: Alberto J Espay; Selma Aybek; Alan Carson; Mark J Edwards; Laura H Goldstein; Mark Hallett; Kathrin LaFaver; W Curt LaFrance; Anthony E Lang; Tim Nicholson; Glenn Nielsen; Markus Reuber; Valerie Voon; Jon Stone; Francesca Morgante Journal: JAMA Neurol Date: 2018-09-01 Impact factor: 18.302