Psychogenic non-epileptic seizures in neurosurgical patients with pharmacoresistant epilepsy: epidemiology

Background. Psychogenic non-epileptic seizures (PNES) are common in pharmacoresistant epilepsy (PRE), especially in neurosurgical patients. Objective. To assess the epidemiology and classify variants of PNES in neurosurgical patients with PRE. Design and Methods. A single-centre uncontrolled open observational study was conducted (2017–2023) at Polenov Neurosurgical Institute within the framework of state assignment No. 123021000127-7. An epidemiological analysis was performed and a classification of PNES was developed. The study was approved by the LEC (protocol No.: 2304-22 of 18/04/2022). Descriptive statistics were used (SPSS 29.0.10; p = 0.05). Results. The study included 369 neurosurgical patients with PRE (cohort 1); PNES were identified in 29 patients (cohort 2). The PNES rate was 8 %. Preoperative PNES occurred in 5.4 % of cohort 1 and 70 % of cohort 2; postoperative PNES — in 2.4 % and 30 %, respectively. The proposed PNES classification includes four variants: isolated PNES, PNES during epilepsy remission, comorbidity of seizures and PNES, and de novo PNES. Conclusion. Psychogenic non-epileptic seizures are reported in about one in thirteen neurosurgical patients with pharmacoresistant epilepsy. De novo psychogenic non-epileptic seizures as psychopathological complications after surgery occur in 2.8 % of patients with epilepsy. The classification of psychogenic non-epileptic seizures includes 4 variants of the combination with epilepsy. The practical applica tion of the data on the epidemiology of psychogenic non-epileptic seizures in pharmacoresistant epilepsy will help to avoid irrational use of antiepileptic drugs and surgical treatment methods.

1. Kanemoto K, LaFrance WC, Duncan R, et al. PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps — an ILAE PNES Task Force report. Epilepsia Open. 2017;2(3):307–316. DOI:10.1002/EPI4.12060.

2. Kustov GV, Zinchuk MS, Rider FK, et al. Psychogenic non-epileptic seizures. Zhurnal nevrologii i psixiatrii im. S. S. Korsakova=S. S. Korsakov Journal of Neurology and Psychiatry. 2021;121(8):112–118. In Russian. DOI:10.17116/jnevro2021121081112.

3. Tolchin B, Altalib H. Addressing Psychogenic Nonepileptic Seizures: Clinical Challenges. Psychiatric times. 2019;36(7):16–17.

4. Asadi-Pooya AA, Asadollahi M, Tinker J, et al. Post-epilepsy surgery psychogenic nonepileptic seizures. Epilepsia. 2016;57(10):1691–1696. DOI:10.1111/epi.13513.

5. Huff JS, Murr N. Psychogenic Nonepileptic Seizures. In: StatPearls. Treasure Island (FL): StatPearls Publishing. May 8, 2022.

6. Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: The effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62–65. DOI:10.1016/j.yebeh.2016.06.018.

7. Shova NI, Alekseeva DV, Mikhailov VA. Psychogenic nonepileptic seizures: to the issue of diagnosis and patient management (with a case report). Epilepsy and paroxysmal conditions. 2021;13(2):147–156. In Russian. DOI:10.17749/2077-8333/epi.par.con.2021.056.

8. González Otárula KA, Tan YL, Dubeau F, et al. Psychogenic nonepileptic seizures in patients with surgically treated temporal lobe epilepsy: Presurgical and de novo postsurgical occurrence. Epilepsy Behav. 2017;75:252–255. DOI:10.1016/j.yebeh.2017.08.015.

9. Furlan AER, da Silva SC Junior, Marques LHN, de Araujo Filho GM. Are psychogenic nonepileptic seizures risk factors for a worse outcome in patients with refractory mesial temporal epilepsy submitted to surgery? Results of a retrospective cohort study. Epilepsy Behav. 2019;93:12–15. DOI:10.1016/j.yebeh.2019.01.036.

10. Qiao L, Yu T, Li Y. Surgical outcome of a female patient with comorbid epilepsy and psychogenic non epileptic seizures confirmed with video-EEG monitoring. Ann Transl Med. 2021;9(3):273. DOI:10.21037/atm-205423.

11. Musick ST, Farooqi A, Hudson MC, et al. Immediate serial postoperative de novo psychogenic nonepileptic seizures after Interdisciplinary selective amygdalohippocampectomy. Neurosurgery. 2021; 25:101202. DOI:10.1016/J.INAT.2021.101202.

12. Parra J, Iriarte J, Kanner AM, Bergen DC. De novo psychogenic nonepileptic seizures after epilepsy surgery. Epilepsia. 1998;39(5):474–477. DOI:10.1111/j.1528-1157.1998.tb01408.x.

13. Krahn LE, Rummans TA, Sharbrough FW, et al. Pseudoseizures after epilepsy surgery. Psychosomatics. 1995;36(5):487–493. DOI:10.1016/S0033-3182(95)71630-9.

14. Glosser G, Roberts D, Glosser DS. Nonepileptic seizures after resective epilepsy surgery. Epilepsia. 1999;40(12):1750–1754. DOI:10.1111/j.1528-1157.1999. tb01593.x.

15. Operto FF, Coppola G, Mazza R, et al. Psychogenic nonepileptic seizures in pediatric population: A review. Brain Behav. 2019;9(12):e01406. DOI:10.1002/brb3.1406.

16. Karlov VA, Iliushenko SV. Psychogenic pseudoseizures as psychoneurological problem. Zhurnal Nevrologii i Psikhiatrii im. S. S. Korsakova=S. S. Korsakov Journal of Neurology and Psychiatry. 2020;120(6):162–166. In Russian. DOI:10.17116/jnevro2020120061162.

17. Markoula S, Liampas A, Rubboli G, et al. A European questionnaire survey on epilepsy monitoring units’ current practice for postoperative psychogenic nonepileptic seizures’ detection. Epilepsy Behav. 2020;112:107355. DOI:10.1016/j.yebeh.2020.107355.

18. Popkirov S, Asadi-Pooya AA, Duncan R, et al. The aetiology of psychogenic non-epileptic seizures: risk factors and comorbidities. Epileptic Disord. 2019;21(6):529–547. DOI:10.1684/epd.2019.1107.

19. Odintsova GV, Aleksandrov MV, Ulitin AYu, Koloteva AV. Duration of epilepsy and severity of the disease in neurosurgical patients. Epilepsy and paroxysmal conditions. 2018;10(3):44–51. In Russian. DOI:10.17749/2077-8333.2018.10.3.044-051.

20. LaFrance WC Jr, Baker GA, Duncan R, et al. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013;54(11):2005–2018. DOI:10.1111/epi.12356.

21. Seneviratne U, Reutens D, D’Souza W. Stereotypy of psychogenic nonepileptic seizures: insights from video EEG monitoring. Epilepsia. 2010;51(7):1159–1168. DOI:10.1111/j.1528-1167.2010.02560.x.

22. Odintsova GV, Ermolaeva VD, Samochernykh KА, et al. Comorbid emotional disturbances in drug resistant epilepsy in neurosurgical patients during the preoperative and postoperative periods. Translyatsionnaya medicina=Translational Medicine. 2022;9(6):36–43. In Russian. DOI:10.18705/2311-4495-2022-9-6-36-43.

23. Madec T, Lagarde S, McGonigal A, et al. Transient cortico-cortical disconnection during psychogenic nonepileptic seizures (PNES). Epilepsia. 2020;61(8):e101 e106. DOI:10.1111/epi.16623.

24. Krylov VV, Gusev EI, Guekht AB, et al. The history of surgical treatment of epilepsy in the Russian Federation. Zhurnal Nevrologii i Psikhiatrii im. S. S. Korsakova=S. S. Korsakov Journal of Neurology and Psychiatry. 2016;116(9–2):6–12. In Russian. DOI:10.17116/ jnevro2016116926-12.