Risk factors for the use of antiepileptic drugs in patients with psychogenic nonepileptic seizures

Purpose: The aim of this study was to investigate the frequency of antiepileptic drug (AED) use in patients with psychogenic nonepileptic seizures (PNES) and to characterize the patients' historical risk factors that may be associated with such a practice. Methods: In this retrospective database study, all patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 to 2018, were studied. Patients with concomitant epilepsy or abnormal Electroencephalogram (EEG) were not included. Results: Two hundred and seventy patients had the inclusion criteria; 162 patients (60%) were taking AEDs, and 108 (40%) were not taking any AEDs at the time of the diagnosis. Reporting auras (odds ratio: 0.5; 95% confidence interval (CI): 0.301-0.952; p = 0.03), having ictal or postictal urinary incontinence (odds ratio: 3.86; 95% CI: 136-10.94; p = 0.01), reporting a dysfunctional family (odds ratio: 1.75; 95% CI: 1.002-3.072; p = 0.04), and a longer duration of the condition before the diagnosis (odds ratio: 1.057; 95% CI: 1.005-1.112; p = 0.03) were significantly associated with AED use; 63.7% of the cases were correctly predicted by the model that was generated by regression analysis (p = 0.0001). Conclusions: Patients with PNES are at great risk of receiving unnecessary AEDs, and some patients' historical factors (e.g., urine incontinence) have a strong association with this practice. (C) 2018 Elsevier Inc. All rights reserved.