Mortality in patients with psychogenic nonepileptic seizures.
Adolescent
Adult
Age Distribution
Anxiety Disorders
/ mortality
Cause of Death
Child
Child, Preschool
Comorbidity
Conversion Disorder
/ mortality
Depressive Disorder
/ mortality
Diagnosis-Related Groups
Dissociative Disorders
/ mortality
Electroencephalography
Epilepsy
/ mortality
Female
Humans
Male
Middle Aged
Retrospective Studies
Risk
Seizures
/ mortality
Substance-Related Disorders
/ mortality
Suicide
/ statistics & numerical data
Tertiary Care Centers
/ statistics & numerical data
Victoria
/ epidemiology
Video Recording
Young Adult
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
11 08 2020
11 08 2020
Historique:
received:
18
08
2019
accepted:
06
02
2020
pubmed:
22
7
2020
medline:
21
10
2020
entrez:
22
7
2020
Statut:
ppublish
Résumé
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. 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. 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%. 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.
Identifiants
pubmed: 32690794
pii: WNL.0000000000009855
doi: 10.1212/WNL.0000000000009855
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e643-e652Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 American Academy of Neurology.