Objective: To determine the extent to which cortical epileptic foci of patients with comorbid psychogenic non-epileptic and epileptic seizures (PNES/ES) differ from age- and gender-matched ES patients without PNES and whether the clinical features of PNES/ES patients differ from PNES-only patients.

Background: Patients with combined PNES/ES provide a unique window into the neurobiology of functional disorders. The features that render ES patients vulnerable to developing comorbid PNES are unclear.

Methods: We retrospectively evaluated the clinical and electrographic features of 138 patients (105 women [77.1%]) from seven participating epilepsy centers with electroencephalography (EEG)-confirmed dual PNES/ES (n = 46; 38.87 ± 11.75 years), age- and gender-matched to PNES-only (n = 46; 38.93 ± 11.47 years) and ES-only patients (n = 46; 39.28 ± 11.43 years). Group differences were assessed using a logistic regression analysis after adjusting for clustering effect.

Results: Compared with ES-only patients, PNES/ES patients had longer seizure duration (p=0.007) with more epileptic activity in the right hemisphere (60.87% vs. 41.3%; p=0.060), and less in the left temporal lobe (15.22% vs. 34.78%; p=0.030). Compared to ES, patients with PNES/ES showed more “disorganized/unclear” EEG patterns, less absence/staring epileptic patterns (p=0.004) and higher depression and anxiety scores (p=0.006 and 0.004, respectively).

Conclusions: Right-hemispheric seizures were more common in patients with combined PNES/ES, supporting a neurobiological basis for functional complications in organic disorders.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychogenic-non-epileptic-seizures-among-patients-with-temporal-lobe-and-other-epilepsies-phenomenology-and-eeg-correlates/