Prevalence and distribution of MRI abnormalities in patients with psychogenic nonepileptic events

- Psychogenic nonepileptic events (PNEEs) are common but the pathophysiology of the disorder is not known
- Studies suggest that brain abnormalities may be present in patients with PNEEs
- We found significant brain MRI abnormalities in 33.8% of patients with video-EEG-diagnosed PNEEs
- There was a significant difference in the location of abnormalities in patients with PNEEs versus patients with epilepsy
- The multifocal nature of brain abnormalities in patients with PNEEs may provide clues to the underlying pathophysiology

IntroductionBoth structural and functional abnormalities have been reported in patients with psychogenic nonepileptic events (PNEEs), although no truly consistent abnormalities have been found.MethodsWe retrospectively identified patients discharged from our EMU with video-EEG diagnoses of epileptic seizures, PNEEs, epileptic seizures plus PNEEs, interictal epileptiform abnormalities only, and nondiagnostic admissions. We then collected brain MRI results for analysis.ResultsWe found significant brain MRI abnormalities in 33.8% of patients with PNEEs, clearly higher than the rate of brain MRI abnormalities in the healthy population. In addition, we found statistically significant differences in the locations of brain MRI abnormalities in patients with epileptic seizures (more frequently temporal) versus PNEEs (more frequently multifocal).ConclusionThis multifocal nature of abnormalities in patients with psychogenic nonepileptic events may help to explain the underlying pathophysiology as it relates to psychiatric disorders which are so frequently comorbid with PNEEs.