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PNES – Increased Mortality from Pseudoseizure?

September 10, 2020

Written by Clay Smith

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Patients with psychogenic non-epileptic seizure (PNES) had 2.5 times greater mortality than the general population, many of them by suicide.

Why does this matter?
We have all seen them – PNES can present in creative and interesting ways. But PNES may be a marker of more sinister underlying illness; 49-100% have underlying psychiatric illness; 5-20% have comorbid epilepsy. Do people die from PNES?

PNES may indicate other things
This was a retrospective study of 674 patients with a diagnosis of PNES based on video EEG monitoring confirming a non-epileptogenic cause of abnormal motor activity over 20 years. The mortality rate of these patients was 8.2%, 2.5 times higher than the general population. This is also called standard mortality ratio (SMR), which is a ratio of observed to expected mortality based on age, gender, and year – meaning, the observed mortality was 55; expected 21.6 = SMR (or O/E mortality) 2.5. By way of comparison, this is comparable to the mortality of patients with drug-resistant epilepsy. Patients with both PNES and epilepsy had a SMR of 3.7. Of the 55 who died during the time frame of the study, 16.4% were from suicide or accidental drug overdose; 24% had “epilepsy” as the cause; 18.2% died of external causes. In those under age 50 (n=20), suicide and accidental poisoning was the cause in 20%. We don’t know exactly how all these patients died. What we do know is that psychiatric illness and PNES are found together more often than not. PNES may have feigned or voluntary motor movements, but the underlying psychopathology is very real and needs to be treated. Also, some of these patients likely had real seizure activity as well.

Mortality in patients with psychogenic nonepileptic seizures. Neurology. 2020 Aug 11;95(6):e643-e652. doi: 10.1212/WNL.0000000000009855. Epub 2020 Jul 20.

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