Women may be more prone to developing psychogenic nonepileptic seizures (PNES) than men, often due to sexual assault trauma, according to new findings presented at the American Epilepsy Society virtual meeting, AES2020.¹

Researchers arrived at their conclusion after analyzing 2,346,808 patients who received treatment at the Vanderbilt University Health System between October 1989 and October 2018.

Ultimately, the results of the study indicated that 3341 adults in the study population had developed PNES. Of these patients, nearly three-quarters were women. Nearly one-quarter of the association between female sex and PNES was mediated by sexual assault trauma, and an odds ratio of 10.26 was determined for the association between PNES and sexual assault trauma.

“We found that overall, people who had PNES were 15 times more likely than the general hospital population to have experienced and disclosed sexual assault trauma to their health care providers,” said lead study author Slavina Goleva, BS, a PhD candidate at Vanderbilt University, in a press release.²

The study findings also demonstrated that individuals with PNES had an 8% increased likelihood of stroke compared with the general hospital population. Ninety-two patients in the study population had both PNES and stroke. Of these patients:

• 48% had a stroke and were subsequently diagnosed with PNES
• 29% were diagnosed with PNES prior to having a stroke
• 23% were diagnosed with PNES and stroke at about the same time

“These results identify stroke as a possible predictor for PNES and reinforce that people who are experiencing seizures and have psychiatric risk factors should be referred for video-[electroencephalogram] monitoring to diagnose whether they are experiencing epileptic seizures or nonepileptic seizures,” said Kevin Haas, MD, PhD, study coauthor and associate professor of neurology at Vanderbilt University, in a press release.²

“Early diagnosis for patients with PNES is critical, allowing them to begin an appropriate treatment plan while avoiding misdiagnosis with epilepsy and the dangers of inappropriate treatments,” Dr Haas added.²

The mechanism behind the association between PNES and stroke remains unclear and will need to be researched further, Dr Haas and his coauthors noted.

—Christina Vogt

References:

1. Goleva S, Torstenson E, Haas KF, Davis L. The clinical epidemiology of psychogenic nonepileptic seizures in a hospital sample of 2,346,808 patients. Paper presented at: American Epilepsy Society AES 2020; December 4-8, 2020; Virtual.
2. Sexual assault trauma may partly explain why women more likely to develop psychogenic nonepileptic seizures, large study shows. News release. American Epilepsy Society. December 4, 2020. Accessed December 4, 2020.