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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.
Glossary
- AIHW=
- Australian Institute of Health and Welfare;
- COD=
- cause of death;
- ICD-10=
- International Classification of Diseases–10;
- IRSAD=
- Index of Relative Socioeconomic Advantage and Disadvantage;
- NCIS=
- National Coronial Information System;
- NDI=
- National Death Index;
- PNES=
- psychogenic nonepileptic seizures;
- PNES + E=
- psychogenic nonepileptic seizures and epilepsy;
- RR=
- risk ratio;
- SMR=
- standardized mortality ratio;
- SUD=
- sudden unexpected death;
- SUDEP=
- sudden unexpected death in epilepsy;
- VEM=
- video-EEG monitoring
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Editorial, page 237
Podcast: NPub.org/i8i5ty
- Received August 18, 2019.
- Accepted in final form February 6, 2020.
- © 2020 American Academy of Neurology
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