Risk factors for comorbid psychopathology in youth with psychogenic nonepileptic seizures
Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Psychogenic Non-epileptic Seizures (PNES) have been given many different names over the years, but the phenomenon has been recognised for centuries. PNES are one of the most important differential diagnoses of epilepsy, and most patients subsequently diagnosed with PNES are initially given a diagnosis of epilepsy and erroneously treated with antiepileptic drugs.
The long heritage of PNES does not mean that this condition is well understood. In fact, the observation that so little was known about such an important clinical problem was one of the key reasons why NINDS/NIMH and the American Epilepsy Society co-sponsored a workshop about this condition in Bethesda MD, USA, in 2005. This workshop brought together experts in the field from around the world. Its most important outcome was a list of open questions and priorities for research (1). One of the areas identified as in particular need of more knowledge was that of PNES in children and adolescents. Children are not small adults – and there were some indications prior to 2005 that PNES in youth were not the same condition as in adults. However, there was very little PNES research of substance focusing on younger people prior to 2005.
The workshop in Bethesda was the start of a pan-US collaboration aiming to improve the knowledge base about PNES in children and adolescents. My editor’s choice article from the current issue of Seizure is the latest output of this group of clinical researchers. The group previously demonstrated that PNES youth have more and more severe psychopathology, such as internalizing disorders, posttraumatic stress disorder (PTSD), anxiety sensitivity (identification of body sensations as dangerous), and somatizing tendencies than their siblings (2). In their current study Plioplys et al. explore whether their earlier findings can be explained by a greater level of exposure to risk factors for psychopathology in young patients with PNES. Indeed, their study comparing 55 patients with 35 unaffected siblings demonstrates that the risk factors for internalizing disorders (girls, older age of PNES onset), somatization (older age, epilepsy), and anxiety sensitivity (girls, adversities) differ between cases and controls.
These observations add significantly to our understanding of PNES. They provide further evidence that PNES in young people can be understood as a developmental disorder in which the seizures represent an (arguably mal-) adaptive response to a range of challenges or adversities with effects which differ depending on the gender and age of the young person.
(1) LaFrance, W. C., Jr., Alper, K., Babcock, D., Barry, J. J., Benbadis, S., Caplan, R., et al. Nonepileptic seizures treatment workshop summary. Epilepsy Behav. 2006;8(3),451-61.
(2) Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M, et al. A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures. Epilepsia 2014;55:1739–47.
(3) Plioplys S, Doss J, Siddarth P, Bursch B, Falcone T, Forgey M,