Outcome of Psychogenic Non-epileptic Seizures After a Diagnosis is Communicated

In the November 16th articles in press of the journal, Epilepsy and Behavior, Drs. Mayor and colleagues from a number of departments and institutions in the United Kingdom present an interesting analysis of the outcome of individuals who have a diagnosis of psychogenic nonepileptic seizures after their diagnosis has been communicated. It is often believed that once a diagnosis of psychogenetic non-epileptic seizures is made and presented to the patient, the knowledge that the diagnosis is not epilepsy is believed to lead to more positive results for the individual patient. The investigators in this analysis sought to assess the results of how individuals who have been recently presented with the diagnosis of psychogenic non-epileptic seizures after the utilization of a particular communication strategy fare with regards to health-related quality of life.

The investigators, as part of a prospective multicenter study, assessed short-term seizure and psychosocial outcomes after the communication of the diagnosis with no additional intervention or treatment. Participants completed a self-reported measure at baseline, two and six months after the diagnosis, with assessment of seizure frequency, quality of life, healthcare utilization, activity level, symptom attributions and level of functioning. Thirty-six participants completed the self-report questionnaire. A further eight individuals provided seizure frequency data. After six months, the median spell frequency had dropped from 10 to 7.5 per month. Seven of the 44 participants, or 16%, were without spells, and an additional 10 of the 44 or 23% showed greater than 50% improvement in spell frequency. The baseline questionnaire measures demonstrated still a high level of impairment, which had not improved at followup. The lack of change in self-report measures illustrates the need for further interventions in this particular patient group.

This study is important because it shows that simply having the knowledge that an individual with psychogenic non-epileptic spells does not have epilepsy may reduce spell frequency but does not impact quality of life measures for the individual. This research underscores the need that better interventions are needed for these patients. This is germane to epilepsy specialists because epilepsy neurologists often see many of these individuals as they often comes through the same medical channels from which epilepsy patients arrive at their specialist. It is by sorting out the principal issue of diagnosis and ultimately treatment that we can better have access to the individuals with epilepsy that merit more aggressive treatment and have better ability to move the individuals with psychogenic non-epileptic seizures to the appropriate areas of care for their life to improve as well.