De novo psychogenic nonepileptic attacks after adult epilepsy surgery: An underestimated entity

Authors

  • Sofia Markoula,

    Corresponding author
    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
    2. Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
    3. Neurology Department, University Hospital of Ioannina, Ioannina, Greece
    • Address correspondence to Sofia Markoula, Department of Neurology, University of Ioannina, Panepistimiou Avenue, Panepistimioupoli, 45110 Ioannina, Greece. E-mail: smarkoula@grads.uoi.gr

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  • Jane de Tisi,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
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  • Jacqueline Foong,

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
    2. Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
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  • John S. Duncan

    1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
    2. Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
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Summary

We retrospectively assessed all patients in a large cohort of patients with epilepsy surgery at the National Hospital for Neurology and Neurosurgery (NHNN) over 12 years, to identify patients with postoperative psychogenic nonepileptic attacks (PNEA). Twenty-nine patients (23 women) were identified of a total of 790 patients, a frequency of 3.7%. Female gender and presurgical psychiatric diagnosis, other than psychosis, were significant risk factors for PNEA development. In female patients with a preoperative psychiatric diagnosis the chance of developing PNEA after epilepsy surgery was 8.5%. PNEA developed between 2 weeks and 10 years after epilepsy surgery, independently of outcome of epileptic seizures. In most cases, PNEA differed from the present or past epileptic seizures, and motor symptoms were the most common manifestations. Seizures after epilepsy surgery should be carefully evaluated. Physicians should consider the possibility of PNEA, especially in female patients with preoperative psychiatric comorbidity developing “atypical” seizures with motor manifestations postoperatively, even many years after epilepsy surgery.

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