Ab. Ettinger et al., A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures, EPILEPSIA, 40(9), 1999, pp. 1292-1298
Purpose: To attain a comprehensive profile of clinical, psychiatric and psy
chosocial characteristics of patients with psychogenic nonepileptic seizure
s (NESs), and to assess the relation of these factors to NES outcome.
Methods: We administered a telephone-based structured questionnaire to 56 p
atients with NESs (16 male and 40 female patients; mean age, 35 years) at a
mean follow-up time of 18 months after making the diagnosis of NES.
Results: Mean age of NES onset was 28 years with a mean duration of 8 years
. Episodes resolved in 29 (51.8%) cases, decreased in 24 (42.9%), persisted
unchanged in two (3.6%), and increased in frequency in one (1.8%). Thirty
(53.6%) patients, including 13 (44.8%) of patients whose NESs resolved, wer
e rehospitalized for NESs or for other symptoms. Twenty-nine (51.8%) had si
gnificant depressive symptoms, 22 (39.3%) had suicidal ideation, and 11 (19
.6%) attempted suicide [including 6 (21%) of the patients whose NESs resolv
ed]. Believing the NES diagnosis was associated with resolution or improvem
ent of NES frequency (p < 0.029), whereas anger in response to receiving th
e diagnosis did not predict a poorer outcome. Patients' perceptions of havi
ng good health (p < 0.02) and good occupational functioning (p < 0.04) were
highly correlated with NES resolution. Only patients whose episodes resolv
ed were employed at the time of follow-up.
Conclusions: At a mean of 1.5 years, NES outcome was poor, with resolution
in only half the group and with frequent rehospitalizations after NES diagn
osis, even among patients whose NES resolved. Depressive symptoms, suicidal
ideation, and suicide attempts were common. Believing the NES diagnosis an
d patient perceptions of having good health and good occupational functioni
ng correlated well with NES resolution.