A comparative retrospective exploration of the profiles of patients in South Africa diagnosed with epileptic and psychogenic non-epileptic seizures

Abstract

Psychogenic non-epileptic seizures (PNES) have a high prevalence globally but the accurate diagnosis of this condition still remains a challenge. This is particularly the case in countries where there is scarce expertise and insufficient affordable medical facilities to which patients have access. The rate of PNES diagnosis in epilepsy units is typically within the range of 20 to 30%. In the context of developing countries, this rate tends to be higher and increases demand on the existing scarce health care capacities. Although the profiling of patients with different seizure presentations is essential for informing appropriate treatment, to date there has been no comparative analysis of the profiles of patients with PNES and epilepsy in South Africa. The aim of the present study was to explore retrospectively the demographic and medication characteristics of these patients and to compare these characteristics to those reported in patient populations from other countries and regions. The total sample of 246 participants included 85 (35%) male and 161 (65%) female patients who were admitted to the Epilepsy Monitoring Unit (EMU) at Milpark Hospital, South Africa. Following the video-EEG monitoring assessment, 123 patients (50%) were diagnosed with PNES, and for 123 patients (50%) the diagnosis of epilepsy was confirmed. The results indicated that the demographic profiles of the groups of patients with epilepsy and PNES were similar with reference to age and self-ascribed ethnicity. In both groups, the majority of the patients were females, but proportionally their prevalence was higher in the PNES patient group than in the epilepsy patient group, which is compatible with the trends found in the PNES patient populations internationally. Pre-diagnostically, the type and the number of medications prescribed to patients with PNES and epilepsy were comparable. Subsequent to the diagnosis at the EMU, there was a significant reduction of overall medications in each group, but this reducton was more pronounced in the group with PNES. It is concluded that the rate of misdiagnosis of PNES in South Africa surpasses the rates reported for the patient populations in other countries and is one of the highest documented worldwide. Considering that post-diagnostically, there was reduction in central nervous system (CNS) medications as well as anti-epileptic drugs (AEDs) in both patients with epilepsy and those with PNES, it is likely that pre-diagnostically a significant proportion of all patients were over medicated. Compared to the epilepsy diagnosis, the PNES diagnosis resulted in a more substantial reduction of medication. These findings outline important dimensions of the diagnostic and medication treatment practices of epilepsy and PNES and point to the urgent need to improve these practices in South Africa and the African continent.

Keywords: Anti-epileptic drugs; Epilepsy; Psychogenic non-epileptic seizures (PNES); Seizure presentations; Seizures; South Africa patient profiles.