OUTCOME AFTER DIAGNOSIS OF PSYCHOGENIC NONEPILEPTIC SEIZURES

Information regarding outcome in patients with psychogenic nonepilepti c seizures (PNES) is limited. We attempted to contact 72 consecutive p atients with PNES confirmed by video-EEG monitoring: 51 of 72 (71%) we re reached a mean of 15 months (range 12-27 months) after diagnosis an d agreed to answer a structured telephone questionnaire, The questionn aire assessed the number of PNES in the last 6 months, antiepileptic d rug (AED) use, occupational status, global self-rating, and extent of psychotherapeutic treatments. PNES had ceased in 18 of 51 (35%), decre ased > 80% in 21 of 51 (41%), and decreased < 80% in 12 of 51 (24%). T hirty-three of 51 (65%) were not taking AEDs. Occupational status impr oved in 20% and did not change in 75%. Overall, 29 of 51 (57%) rated t hemselves markedly improved and 15 of 51 (29%) rated themselves unchan ged or worse. Persisting PNES were associated with longer duration of PNES before diagnosis (p < 0.02) and presence of additional psychiatri c disease (p < 0.01). Persisting PNES were not associated with gender, presence of epileptic seizures, or extent of psychotherapeutic treatm ents after diagnosis. Placebo saline infusion had been administered in some patients to help precipitate PNES. This did not affect the numbe r of psychotherapy visits or outcome. We conclude that PNES cease or s ignificantly decrease in most patients, but occupational status does n ot improve as often. Earlier diagnosis may improve outcome.