Risk Factors and Clinical Manifestations of PNES in Autoimmune Encephalitis
Abstract number :
3.332
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
113
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Seon-Jae Ahn, MD – Seoul National University Hospital
Seolah Lee, MD – Seoul National University Hospital
Han Sang Lee, MD – Seoul National University Hospital
Kyung-Il Park, MD, PhD – Seoul National University Hospital
Soon-Tae Lee, MD, PhD – Seoul National University Hospital
Kon Chu, MD, PhD – Seoul National University Hospital
Sang Kun Lee, MD, PhD – Seoul National University Hospital
Rationale: Psychogenic Non-Epileptic Seizures (PNES) are prevalent in patients with autoimmune encephalitis (AE). Despite the challenges in distinguishing PNES from true epileptic seizures (ES), understanding their risk factors and clinical manifestations is critical for effective management.
This study aims to investigate the demographic and clinical characteristics of PNES in AE patients and to explore potential treatment responses.
Methods: A retrospective review was conducted on 59 AE patients diagnosed with PNES from 2013 to 2023. Following exclusions, 36 patients were included in the analysis. Data were collected on demographics, clinical features, neuroimaging, EEG findings, and treatment responses. Statistical analysis was performed to evaluate the associations between clinical variables and treatment outcomes.
Results: Among the 36 patients (26 females, 72%; median age 29 years), 69% exhibited concurrent true seizures. Abnormal initial brain MRIs were observed in 72% of cases, and initial EEGs were abnormal in 69%. Clinical diagnoses included NORSE (35%), seronegative AE (32%), NMDAR encephalitis (9%), and LGI1 encephalitis (3%). The onset of PNES varied, with 25% of cases occurring within 0-3 months, 22% within 4-6 months, 19% within 7-12 months, 17% within 13-24 months, 8% after 25 months, and 8% unknown.
PNES frequency was diverse: more than twice a day in 31%, 2-7 times a week in 25%, 1-4 times a month in 19%, less than once a month in 6%, and unknown in 19%. Accompanying psychiatric symptoms were common, with depression (56%), anxiety (44%), and psychosis (33%) being the most frequent.
PNES semiology was analyzed using a heatmap, showing tremor/oscillation, tonic, clonic/jerking, hypermotor/agitation, atonic/akinetic, and automatism as common symptoms, predominantly affecting the face, lips/perioral region, jaw, head, and limbs.
A subgroup analysis based on PNES onset (acute/subacute vs. remote) revealed no significant differences in sex, age, diagnosis, MRI and EEG abnormalities, CSF pleocytosis, true seizure presence, PNES frequency, psychiatric burden, treatment response, and overall outcomes. However, immunotherapy was shown to be responsive in 47% of patients, with both mRS and PNES severity scores decreasing concurrently.
Overall treatment responses were analyzed, showing no statistically significant differences among groups. However, the poor response group had higher incidences of depression and previous psychiatric history, and a higher average psychiatric burden.
Conclusions: PNES in AE patients is frequently associated with true seizures and significant psychiatric comorbidities. Effective management necessitates a multidisciplinary approach involving neurology, psychiatry, and psychosocial support to optimize patient outcomes. This study highlights the need for further research to refine treatment strategies and elucidate the underlying mechanisms of PNES in autoimmune encephalitis. Despite the lack of statistically significant findings in subgroup analyses, trends suggest that psychiatric comorbidities and burdens may influence treatment responses.
Funding: This study received no specific grant from any funding agency.
Clinical Epilepsy