Psychogenic non-epileptic seizures in an epilepsy surgery unit

Introduction. The psychogenic non-epileptic seizures (PNES) represent a significant percentage of patients in different units of epilepsy surgery. Aims. To analyze the characteristics of patients with PNES and compared with epileptic patients, to analyze the early response to the application of placebo and to discuss the multidisciplinary approach to these patients. Patients and methods. 408 patients, candidates for epilepsy surgery in the last nine years, were retrospectively evaluated. All patients were studied with scalp electroencephalography, magnetic resonance imaging, interictal single photon emission computed tomography and video-EEG. Results. Patients were ascribed to the following diagnostic groups: epileptics (90.2%), patients with PNES and/or without seizures or signs of epilepsy (6.4%) and patients for whom no seizures were recorded, but showed signs of epilepsy (3.4%). There were no differences between patients with PNES and epileptic respect to age, average frequency, distribution of seizures or drug treatment, but the time of onset was earlier in PNES. Patients with PNES (n = 15) revealed the presence of epilepsy or irritative manifestations in 10 cases. Most (n = 13) were women and only five had a history of mild psychiatric disorders that were not present in the group of patients exclusively with PNES. In four cases was carried out an induction with placebo, which was positive. Conclusion. A multidisciplinary approach is required for the proper evaluation and treatment of patients with PNES.