Structural brain abnormalities in patients with psychogenic nonepileptic seizures
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ORIGINAL ARTICLE
Structural brain abnormalities in patients with psychogenic nonepileptic seizures Ali A. Asadi-Pooya 1,2
&
Maryam Homayoun 1
Received: 20 June 2019 / Accepted: 14 October 2019 # Fondazione Società Italiana di Neurologia 2019
Abstract Objectives We assessed the relationship between the clinical features of patients with psychogenic nonepileptic seizures (PNES) and referrals for brain imaging tests. We also hypothesized that some clinical factors might be associated with structural brain imaging abnormalities in these patients. Methods In this retrospective study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were studied. Results One hundred thirty-two patients had a brain magnetic resonance imaging (MRI) study available. Forty-seven patients (36%) had abnormal finding(s) in their MRI. Age (odds ratio = 1.040, p = 0.02), and comorbid epilepsy (odds ratio = 3.006, p = 0.005) were significantly associated with having an abnormal brain MRI. In a subanalysis, we excluded the patients with comorbid epilepsy (46 patients). From the remaining 86 patients (with PNES only), 23 patients (26.7%) had abnormal findings on their MRIs. Common epileptogenic structural brain abnormalities (e.g., tumors, mesial temporal sclerosis, encephalomalacia, and developmental anomalies) were common in patients with comorbid PNES and epilepsy (in 19 out of 46 patients; 41%), but not in those with PNES only (in 4 out of 86 patients; 5%) (p = 0.00001). Conclusion While the evidence is convergent on the relatively high prevalence of structural brain abnormalities in patients with PNES, the data so far is suboptimal. In order to investigate the significance of structural brain abnormalities in the development of PNES, future well-designed multicenter studies, which include a large number of patients with a unified methodology of imaging, are desirable. Keywords Epilepsy . Imaging . PNES . Psychogenic . Seizure
Introduction Psychogenic nonepileptic seizures (PNES) are relatively common occurrences in epilepsy centers [1]. Pathophysiology of PNES is still poorly understood [2]. However, association with head injury has been observed in many studies [3, 4]. Psychogenic nonepileptic seizures are considered to be the
* Ali A. Asadi-Pooya [email protected] Maryam Homayoun [email protected] 1
Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
2
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
most common and important differential diagnoses of epilepsy; however, misdiagnosis and diagnostic delay are common in daily practice. As a result, patients with PNES are at risk of receiving unnecessary diagnostic procedures and treatments [e.g., antiepileptic drugs (AEDs)] [5]. Prior to a definite diagnosis, patients with PNES are often investigated with neurodiagnostic imaging(s) that contributes to the high cost of their care [6]. In this
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