Abstract
Markers of brain abnormalities in patients with psychogenic nonepileptic
seizures (PNES) were studied to explore whether physical brain disorder is
associated with an increased risk of PNES. Evidence of epileptiform EEG
changes, MRI abnormalities, and neuropsychological (NPS) deficits was
obtained from the records of 329 consecutive patients in whom the
diagnosis of PNES was established at our center between 1991 and 2001. Two
hundred six patients had PNES alone, and 123 PNES and epilepsy (PNES+E).
In the PNES-only group, at least one marker of brain disorder was detected
in 22.3% of patients (epileptiform potentials in 8.7%, MRI changes in
9.7%, NPS deficits in 9.7%). The actual prevalence of abnormalities is
likely to be higher because 54.9% of the patients with only psychogenic
seizures did not undergo MRI or neuropsychological testing. Evidence of
brain abnormality was found more frequently in the PNES+E group
(epileptiform potentials in 70.7%, MRI changes in 60.2%, NPS deficits in
52.8%). Although markers of brain abnormality were detected much less
commonly in the PNES than in the PNES+E group, they were still found in a
substantial proportion of patients with PNES alone. This suggests that
physical brain disease plays a role in the development of PNES. Markers of
physical abnormality were not more common in the right hemisphere.
