Psychogenic non‐epileptic seizure‐status in patients admitted to the intensive care unit. (20th June 2021)

• Record Type: Journal Article
• Authors: Mezouar, Nicolas; Demeret, Sophie; Rotge, Jean Yves; Dupont, Sophie; Navarro, Vincent
• Is Part Of: European journal of neurology. Volume 28:Number 8(2021)
• Page Start: 2775
• Page End: 2779
• Publication Date: 2021-06-20
• Subjects: intensive care unit (ICU) -- psychogenic non‐epileptic seizures (PNES) -- psychogenic non‐epileptic seizure‐status (PNES‐status) -- status epilepticus (SE); Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14941
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background: Psychogenic non‐epileptic seizure‐status (PNES‐status), defined by psychogenic non‐epileptic seizures (PNES) over 30 min, are often misdiagnosed as status epilepticus. We aimed to describe the features of patients who experienced PNES‐status, admitted to an intensive care unit (ICU). Methods: We screened the patients hospitalized in our epilepsy unit during a 4‐year period, with a diagnosis of PNES‐status and ICU admission. Results: Among 171 patients with PNES, we identified 25 patients (15%) who presented 39 episodes of PNES‐status leading to ICU admission. Some 76% of the patients were women. The median age at the time of the PNES‐status episode was 35 years. Half (48%) alleged a history of epilepsy, but epilepsy was confirmed in only 12%. A history of psychiatric disease was found in 68%. PNES were present in 85% of patients before PNES‐status, and semiology of PNES and PNES‐status was similar for 79% of the patients, including hyperkinetic movements in 95% of the episodes and suspected loss of consciousness in 87%. Benzodiazepines were administrated in 77% of the episodes, antiepileptic drugs in 87%, and antibiotherapy for a ICU‐related infection in 15% of the episodes. Oral intubation was performed in 41% of the episodes. Blood tests showed normal levels of creatine phosphokinase and leucocytes in 90% and 95% of the episodes, respectively. No epileptic activity was found during per‐event electroencephalography but interictal epileptic activity was found in 10% of the episodes. Conclusion: Hyperkinetic PNES‐status should always be considered as a differential diagnosis of status epilepticus, with a high risk of iatrogenic consequences. Abstract : Psychogenic non epileptic seizure‐status (PNES‐Status) can be misdiagnosed as status epilepticus. Among 171 patients with PNES, we identified 25 patients who experienced 39 episodes of PNES‐status leading to intensive care unit admission. 48% alleged a history of epilepsy but epilepsy was confirmed in only 12%. The clinical presentation was hyperkinetic movements and a suspected loss of consciousness. Benzodiazepines were administrated in 77% of the episodes, and antiepileptic drugs in 87%. Oral intubation was performed in 41%. PNES‐status should always be considered as differential diagnosis of status epilepticus, because of a high risk of iatrogenic consequences.