What is the most important prognostic factor in psychogenic nonepileptic seizures (PNES)?

Updated: Jul 26, 2018
  • Author: Selim R Benbadis, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The duration of illness is probably the most important prognostic factor in PNES; the longer the patient has been treated for epilepsy, the worse the prognosis.

  • Obtaining a definite diagnosis of PNES early in the course of disease is critical.

  • The average delay in the diagnosis of PNES is long, indicating that the index of suspicion for psychogenic symptoms may not be high enough.

  • In addition, an accurate diagnosis of PNES significantly reduces subsequent healthcare costs.

With PNES, outcomes are generally better in children and adolescents than in adults, probably because the duration of illness is shorter and the psychopathology or stressors are different in pediatric patients than in adults.

  • A refusal to go to school and family discord may be significant factors.

  • Serious mood disorders and ongoing sexual or physical abuse are common in children with PNES and should be investigated in every case.


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