Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are events that appear like epileptic seizures but are related to psychological factors, not abnormal electrical activity. Although youth diagnosed with PNES have high mental health comorbidity, few studies have explored the relationship between comorbid mental health disorders and PNES outcomes. Furthermore, no studies have evaluated whether specific mental health disorders are associated with differing outcomes for youth. The purpose of our study is to determine if there is an association between comorbid mental health disorders and/or psychosocial risks factors and one-year PNES outcomes. We hypothesize that youth with comorbid mental health disorders and psychosocial risk factors will have worse outcomes.

Methods: We performed a retrospective chart review of children and adolescents seen at the multidisciplinary PNEE clinic at Nationwide Children's Hospital from November 2017 to April 2022. Clinic visits are joint sessions with both neurology and psychology. Mental health diagnoses, underlying stressors, and psychosocial risk factors were included if explicitly disclosed by patient families during the visit. Measured psychosocial risk factors included a history of other functional neurologic symptom disorders, suicidal ideation/self-harm, or sexual abuse as well as the presence of intellectual disability, learning concerns, or autism. We also measured whether patients were able to identify an underlying stressor. Outcomes at one year were determined via follow-up phone calls. The three outcome measures were freedom from events (remission), event improvement (includes improvement and remission), and family acceptance of diagnosis. Fisher’s exact test was used to measure the associations between covariates and outcome measures. Mood’s median test was used to evaluate the relationships between the number of comorbid mental health diagnoses and psychosocial factors with outcomes.  

Results: A total of 224 patients were included in this study with 134 responding to 12-month follow-up phone calls. Mental health disorders were seen in 139 (62%) patients, with mood disorders (67%), anxiety disorders (51%) and attention deficit/hyperactivity disorder (41%) being the most common among these patients. Over half (56%) of patients had more than one comorbid diagnosis (range, 0-5). A majority (84%) of patients identified an underlying stressor. We found no association between specific comorbid mental health disorders or psychosocial risk factors and PNES improvement rate, remission rate, or acceptance of diagnosis. Likewise, there was no association between multiple mental health diagnoses or multiple psychosocial factors and outcomes.

Conclusions: Youth with a comorbid mental health disorder have similar outcomes to patients without comorbidity, whether focusing on specific or multiple diagnoses. The presence of psychosocial risk factors also lacks evidence of associations with outcome. Our study is significant because it suggests that greater mental health comorbidity or psychosocial factors may not be associated with PNES prognosis.

Funding: None