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. 2021 Aug;28(8):2775-2779.
doi: 10.1111/ene.14941. Epub 2021 Jun 20.

Psychogenic non-epileptic seizure-status in patients admitted to the intensive care unit

Nicolas Mezouar  1   2   3 , Sophie Demeret  4   5 , Jean Yves Rotge  5   6 , Sophie Dupont  1   2   3   7 , Vincent Navarro  1   2   3   5
Affiliations

Psychogenic non-epileptic seizure-status in patients admitted to the intensive care unit

Nicolas Mezouar et al. Eur J Neurol. 2021 Aug.

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.

Keywords: intensive care unit (ICU); psychogenic non-epileptic seizure-status (PNES-status); psychogenic non-epileptic seizures (PNES); status epilepticus (SE).

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References

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