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Title: Mortality in patients with psychogenic nonepileptic seizures.
Austin Authors: Nightscales, Russell ;McCartney, Lara;Auvrez, Clarissa;Tao, Gerard;Barnard, Sarah;Malpas, Charles B;Perucca, Piero ;McIntosh, Anne;Chen, Zhibin;Sivathamboo, Shobi;Ignatiadis, Sophia;Jones, Simon;Adams, Sophia;Cook, Mark J;Kwan, Patrick;Velakoulis, Dennis;D'Souza, Wendyl;Berkovic, Samuel F ;O'Brien, Terence J
Affiliation: Department of Neuroscience, Central Clinical School, and Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne
Departments of Medicine and Neurology and Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, Australia
The Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
Department of Neurology, The Alfred Hospital, Melbourne, Australia
Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: 11-Aug-2020
Date: 2020-07-20
Publication information: Neurology 2020; 95(6): e643-e652
Abstract: 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.
DOI: 10.1212/WNL.0000000000009855
ORCID: 0000-0001-9108-207X
Journal: Neurology
PubMed URL: 32690794
Type: Journal Article
Appears in Collections:Journal articles

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