Psychogenic nonepileptic seizures in patients with surgically treated temporal lobe epilepsy: Presurgical and de novo postsurgical occurrence |
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Affiliation: | 1. Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Canada;2. University of California San Francisco Medical Center, USA;3. Department of Neurology, National Neuroscience Institute, Singapore;4. Department of Mathematics and Statistics, McGill University, Canada;1. Department of Neurology, University of Cape Town, South Africa;2. Department of Neurology, University of Stellenbosch, South Africa;1. Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA;2. School of Public Health, Drexel University, Philadelphia, PA, USA;1. Yale University School of Medicine, New Haven, CT, United States;2. Yale University School of Public Health, New Haven, CT, United States;3. Ann & Robert H Lurie Children''s Hospital of Chicago & Northwestern University Feinberg School of Medicine, Chicago, IL, United States;4. Icahn School of Medicine at Mount Sinai, New York, NY, United States;5. Department of Neurology Sidney Kimmel Medical College, Thomas Jefferson University Medical School, Philadelphia, United States;6. Albert Einstein College of Medicine, New York, United States;7. University of Rochester School of Medicine, New York, United States;8. MINCEP University of Minnesota Medical School Epilepsy Care, Minneapolis, MN, United States;9. Columbia University Medical School, New York, United States;10. New York University School of Medicine, New York, United States;1. Owensboro Medical Health System Neurology, USA;2. Department of Neurology, Vanderbilt University, Nashville, TN, USA;3. Hamad Medical Corporation, Doha, Qatar |
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Abstract: | Whether occurring before or after an epilepsy surgery, psychogenic nonepileptic seizures (PNES) impact treatment options and quality of life of patients with epilepsy. We investigated the frequency of pre- and postsurgical PNES, and the postsurgical Engel and psychiatric outcomes in patients with drug-resistant temporal lobe epilepsy (TLE). We reviewed 278 patients with mean age at surgery of 37.1 ± 12.4 years. Postsurgical follow-up information was available in 220 patients, with average follow-up of 4 years.Nine patients (9/278 or 3.2%) had presurgical documented PNES. Eight patients (8/220 or 3.6%) developed de novo PNES after surgery. Pre- and postsurgery psychiatric comorbidities were similar to the patients without PNES. After surgery, in the group with presurgical PNES, five patients were seizure-free, and three presented persistent PNES. In the group with de novo postsurgery PNES, 62.5% had Engel II–IV, and 37.5% had Engel I. All presented PNES at last follow-up.Presurgical video-EEG monitoring is crucial in the diagnosis of coexisting PNES. Patients presenting presurgical PNES and drug-resistant TLE should not be denied surgery based on this comorbidity, as they can have good postsurgical epilepsy and psychiatric outcomes. Psychogenic nonepileptic seizures may appear after TLE surgery in a low but noteworthy proportion of patients regardless of the Engel outcome. |
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