Tyson Sawchuk1, Ali A Asadi-Pooya2, Lorna Myers3, Kette D Valente4, Anilu Daza Restrepo5, Luciana D' Alessio6, Maryam Homayoun7, Zahra Bahrami7, Rudá Alessi5, Angélica Aroni Paytan6, Silvia Kochen8, Firas Taha9, Lorraine M Lazar10, Susannah Pick11, Timothy R Nicholson12, Jeffrey Buchhalter13. 1. Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus. Electronic address: tyson.sawchuk@albertahealthservices.ca. 2. Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA. 3. Northeast Regional Epilepsy Group, New York, USA. Electronic address: lmyers@epilepsygroup.com. 4. Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil. Electronic address: kette.valente@hc.fm.usp.br. 5. Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil. 6. Epilepsy Unit, La Trinidad Medical Center, Caracas, Venezuela. 7. Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. 8. Buenos Aires University, Epilepsy Center, Ramos Mejía and el Cruce Hospitals, ENyS-IBCN-CONICET, Buenos Aires, Argentina. 9. Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA. Electronic address: ftaha@epilepsygroup.com. 10. Northeast Regional Epilepsy Group, New York, USA; Hackensack University Medical Center, Hackensack Meridian School of Medicine, NJ, USA. Electronic address: llazar@epilepsygroup.com. 11. Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK. Electronic address: susannah.pick@kcl.ac.uk. 12. Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, London, UK. Electronic address: timothy.nicholson@kcl.ac.uk. 13. Children's Comprehensive Epilepsy Center, Alberta Children's Hospital, Calgary, Canada; University of Nicosia, School of Social Sciences, Department of Psychology, Cyprus; University of Calgary, Cumming School of Medicine, Departments of Pediatrics, Canada.
Abstract
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.
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.
Authors: Mathilde Salmon; Jordan Sibeoni; Aurélie Harf; Marie Rose Moro; Maude Ludot-Grégoire Journal: Front Psychiatry Date: 2022-07-25 Impact factor: 5.435
Authors: Wesley T Kerr; Xingruo Zhang; Emily A Janio; Amir H Karimi; Corinne H Allas; Ishita Dubey; Siddhika S Sreenivasan; Janar Bauirjan; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Jerome Engel; Mark S Cohen; Jamie D Feusner; John M Stern Journal: Epilepsy Behav Date: 2021-01-01 Impact factor: 2.937