Are psychogenic nonepileptic seizures risk factors for a worse outcome in patients with refractory mesial temporal epilepsy submitted to surgery? Results of a retrospective cohort study

Abstract

Objective: The objective of this study was to verify if the presence of psychogenic nonepileptic seizures (PNES) could be a risk factor precluding corticoamygdalohippocampectomy (CAH) in patients with refractory temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) (TLE-MTS).

Methods: This retrospective cohort study analyzed medical data of patients with refractory TLE-MTS accompanied in a Brazilian epilepsy surgery center. Presurgical psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Engel's I classification two years after surgery was considered as a favorable outcome.

Results: Of the 81 patients initially included (65 females; 56.5%), 49 (60.5%) had TLE-MTS without PNES, 24 (29.7%) with TLE-MTS and PNES, and eight (9.8%) with PNES only, who were excluded from further statistical comparisons. Nine patients with PNES (37.5%) underwent CAH versus 35 (71.4%) without PNES (p = 0.005). Five patients (55.5%) with PNES versus 26 (74.3%) without PNES presented Engel I (p = 0.54). The relative risk (RR) was of 1.90 for patients without PNES to undergo CAH and of 1.33 to be at Engel I.

Conclusions: In this study, PNES were associated with less CAH. There were no differences, however, regarding favorable postsurgical outcomes. These results highlight that the sole presence of PNES should not preclude CAH in patients with TLE-MTS, despite the necessity of careful presurgical psychiatric evaluation.

Keywords: Epilepsy surgery outcome; Mesial temporal sclerosis; Psychogenic nonepileptic seizures; Temporal lobe epilepsy.