Intact vs. impaired ictal sensorium: Does it affect outcome of psychogenic nonepileptic events following disclosure of diagnosis?

It remains uncertain whether particular ictal manifestations of psychogenic nonepileptic events (PNEE) can reflect distinctive psychological processes or prognostic outcomes. We hypothesize that the integrity of ictal sensorium may affect the clinical outcome of PNEE following disclosure of diagnosis. We prospectively studied 47 veterans who were diagnosed with video-EEG-confirmed PNEE, presented with the diagnosis utilizing a standardized communication strategy, and followed for their clinical progress. When compared to patients with intact ictal sensorium, significantly smaller proportion of patients with impaired ictal sensorium endorsed improvement of either PNEE frequency or intensity across both the initial 1- to 3-month (p = 0.005) and ensuing 6- to 9-month (p = 0.01) follow-ups. However, improvement among patients with impaired ictal sensorium was more significantly associated with their level of understanding for the PNEE diagnosis across both the initial (rho = 0.41, p = 0.017) and ensuing (rho = 0.43, p = 0.015) follow-ups. Our study presents preliminary evidence underscoring the potential clinical significance of ictal sensorial integrity when evaluating patients with PNEE.

► We collected data from 47 patients with Video-EEG confirmed pseudoseizures. ► We examined the integrity of ictal sensorium during each captured event. ► Patients with impaired ictal sensorium were less likely to improve upon follow-up. ► Improvement from this group correlated with level of diagnostic understanding.