Comparison of psychogenic movement disorders and psychogenic nonepileptic seizures: is phenotype clinically important?

Abstract

Background: Psychogenic non-epileptic seizures (PNES) and psychogenic movement disorders (PMDs) are common in neurology practice, yet it is not established whether clinically relevant differences between these two groups exist.

Methods: In this retrospective chart review 172 patients were identified (PNES n = 116, PMD n = 56).

Results: The whole group was characterized by female gender (82%), abuse history (45%), chronic pain (70%), depression (42%), subjective fatigue (47%), subjective cognitive complaints (55%), and referral for psychiatric evaluation (54%). Statistically significant differences (P <. 01) were found for age, education, frequency of symptoms, altered consciousness, developmental abuse, and coexisting anxiety. Clinical practice also differed for the two groups in history-taking and referrals for neuropsychological testing and/or psychiatric evaluation.

Conclusions: This retrospective study revealed more similarities than differences suggesting these are manifestations of the same psychopathology, with age and co-morbid anxiety potentially being important factors in predicting the symptomatic presentation. Prospective studies are needed to confirm our results. Future studies focusing more globally on somatoform disorders, rather than each phenotypic presentation, are likely needed to improve clinical care and outcomes.