Russell Nightscales1, Lara McCartney1, Clarissa Auvrez1, Gerard Tao1, Sarah Barnard1, Charles B Malpas1, Piero Perucca1, Anne McIntosh1, Zhibin Chen1, Shobi Sivathamboo1, Sophia Ignatiadis1, Simon Jones1, Sophia Adams1, Mark J Cook1, Patrick Kwan1, Dennis Velakoulis1, Wendyl D'Souza1, Samuel F Berkovic1, Terence J O'Brien2. 1. From the Department of Neuroscience, Central Clinical School (R.N., S.B., C.B.M., P.P., Z.C., S.S., P.K., T.J.O.), and Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C.), Monash University, Melbourne; Departments of Medicine (R.N., C.A., G.T., C.B.M., P.P., A.M., Z.C., S.S., P.K., T.J.O.) and Neurology (R.N., C.A., G.T., C.B.M., P.P., S.S., P.K., T.J.O.) and Neuropsychiatry Unit (L.M., S.J., S.A., D.V.), The Royal Melbourne Hospital, and The Melbourne School of Psychological Sciences (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (R.N.) and Epilepsy Research Centre, Department of Medicine (A.M., S.F.B.), Austin Health, The University of Melbourne, Heidelberg; Department of Neurology (C.B.M., P.P., A.M., S.S., P.K., T.J.O.), The Alfred Hospital, Melbourne; and Department of Medicine (S.I., M.J.C., W.D.), St. Vincent's Hospital, The University of Melbourne, Fitzroy, Australia. 2. From the Department of Neuroscience, Central Clinical School (R.N., S.B., C.B.M., P.P., Z.C., S.S., P.K., T.J.O.), and Clinical Epidemiology, School of Public Health and Preventive Medicine (Z.C.), Monash University, Melbourne; Departments of Medicine (R.N., C.A., G.T., C.B.M., P.P., A.M., Z.C., S.S., P.K., T.J.O.) and Neurology (R.N., C.A., G.T., C.B.M., P.P., S.S., P.K., T.J.O.) and Neuropsychiatry Unit (L.M., S.J., S.A., D.V.), The Royal Melbourne Hospital, and The Melbourne School of Psychological Sciences (C.B.M.), The University of Melbourne, Parkville; Department of Medicine (R.N.) and Epilepsy Research Centre, Department of Medicine (A.M., S.F.B.), Austin Health, The University of Melbourne, Heidelberg; Department of Neurology (C.B.M., P.P., A.M., S.S., P.K., T.J.O.), The Alfred Hospital, Melbourne; and Department of Medicine (S.I., M.J.C., W.D.), St. Vincent's Hospital, The University of Melbourne, Fitzroy, Australia. terence.obrien@monash.edu.
Abstract
OBJECTIVE: To investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population. METHODS: This retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports. RESULTS: A total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0-3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4-19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and "epilepsy" was recorded as the cause of death in 24%. CONCLUSIONS: Patients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.
OBJECTIVE: To investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population. METHODS: This retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports. RESULTS: A total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0-3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4-19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and "epilepsy" was recorded as the cause of death in 24%. CONCLUSIONS:Patients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.
Authors: Lara Jehi; Nathalie Jette; Churl-Su Kwon; Colin B Josephson; Jorge G Burneo; Fernando Cendes; Michael R Sperling; Sallie Baxendale; Robyn M Busch; Chahnez Charfi Triki; J Helen Cross; Dana Ekstein; Dario J Englot; Guoming Luan; Andre Palmini; Loreto Rios; Xiongfei Wang; Karl Roessler; Bertil Rydenhag; Georgia Ramantani; Stephan Schuele; Jo M Wilmshurst; Sarah Wilson; Samuel Wiebe Journal: Epilepsia Date: 2022-07-17 Impact factor: 6.740
Authors: Mark Hallett; Selma Aybek; Barbara A Dworetzky; Laura McWhirter; Jeffrey P Staab; Jon Stone Journal: Lancet Neurol Date: 2022-04-14 Impact factor: 59.935
Authors: Wesley T Kerr; Xingruo Zhang; Chloe E Hill; Emily A Janio; Andrea M Chau; Chelsea T Braesch; Justine M Le; Jessica M Hori; Akash B Patel; Corinne H Allas; Amir H Karimi; Ishita Dubey; Siddhika S Sreenivasan; Norma L Gallardo; Janar Bauirjan; Eric S Hwang; Emily C Davis; Shannon R D'Ambrosio; Mona Al Banna; Andrew Y Cho; Sandra R Dewar; Jerome Engel; Jamie D Feusner; John M Stern Journal: Seizure Date: 2021-02-09 Impact factor: 3.184
Authors: Steven Lenio; Wesley T Kerr; Meagan Watson; Sarah Baker; Chad Bush; Alex Rajic; Laura Strom Journal: Epilepsy Behav Date: 2021-02-02 Impact factor: 2.937
Authors: Benjamin Stewart; Jon G Dean; Adriana Koek; Jason Chua; Rafael Wabl; Kayla Martin; Naveed Davoodian; Christopher Becker; Mai Himedan; Amanda Kim; Roger Albin; Kelvin L Chou; Vikas Kotagal Journal: Pharmacol Res Perspect Date: 2020-12
Authors: T A Milligan; A Yun; W C LaFrance; G Baslet; B Tolchin; J Szaflarski; V S S Wong; S Plioplys; B A Dworetzky Journal: Epilepsy Behav Rep Date: 2021-12-16
Authors: Christina van der Feltz-Cornelis; Sally Brabyn; Jonathan Ratcliff; Danielle Varley; Victoria Allgar; Simon Gilbody; Chris Clarke; Dimitris Lagos Journal: Brain Behav Immun Health Date: 2021-02-24