Psychogenic nonepileptic seizures are predominantly seen in women: potential neurobiological reasons

Abstract

There is a predominance of female gender among patients with psychogenic nonepileptic seizures (PNES). Reasons for this preponderance are not entirely explained in the literature yet. The evidence shows that there exist sex-dependent intrinsic functional connectivity differences in brain areas responsible for emotional and cognitive processing. As a consequence, women and men may differ in vulnerability to physical or emotional trauma. An abnormal connectivity between brain areas involved in emotional processing, cognitive integration systems, motor and premotor regions and/or other related regions may explain the ictal events seen in patients with PNES. The intrinsic brain connectivity differences between men and women may be one reason for the predominance of female gender among patients with PNES. In addition, some early life experiences associated with PNES (e.g., childhood sexual abuse) are more prevalent among female gender. These lifetime experiences affect and alter brain connectivity in women differently compared with men and more often predispose female gender to psychopathology. These neurobiological, social and vulnerability differences may explain why PNES is predominantly seen in female gender.

Keywords: Brain; Connectivity; Etiology; Female; Gender; Nonepileptic seizures.