Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes

Epilepsia. 2013 Apr;54(4):718-25. doi: 10.1111/epi.12053. Epub 2013 Jan 2.


Purpose: To investigate the relationship between traumatic brain injury (TBI) and psychogenic nonepileptic seizures (PNES). We hypothesized that PNES with TBI would be associated with more psychiatric comorbidities and disability than PNES without TBI.

Methods: In this cross-sectional study comparing patients with PNES with TBI to patients with PNES without TBI, medical records from 255 consecutive patients with electroencephalography (EEG)-confirmed PNES were reviewed to assess variables including demographic, head injury, neurologic, psychiatry, social variables, and quality of life and symptoms scales. Parametric, analysis of covariance (ANCOVA), and logistic regression analyses were performed, to compare psychiatric and function variables between the two study groups while controlling for age and sex.

Key findings: Of the 92 patients with PNES who fulfilled inclusion/exclusion criteria, 41 (44.6%) had a history of TBI. Of the 41 patients with TBI, 30 (73%) met criteria for mild TBI (mTBI). Patients with TBI had more mood disorder diagnoses, were more likely to receive disability, and had lower global functioning than non-TBI patients with PNES, after adjusting for age and sex. Patients with TBI and PNES had significantly increased odds for having major depression, behavioral impulsivity, posttraumatic stress disorder diagnosis, and a trauma/abuse history.

Significance: TBI is a significant risk factor in patients with PNES, being associated with increased psychiatric diagnostic comorbidity, symptoms severity, poorer functioning, and increased disability. This study reveals the importance of identifying and addressing the impact of TBI in patients with seizure disorders. Addressing the sequelae of TBI in PNES may be a target to improve functioning.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Age of Onset
  • Brain Injuries / complications*
  • Brain Injuries / psychology
  • Brain Injuries / therapy*
  • Conversion Disorder / complications*
  • Conversion Disorder / psychology
  • Conversion Disorder / therapy*
  • Cross-Sectional Studies
  • Databases, Factual
  • Depression / psychology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Disability Evaluation
  • Female
  • Humans
  • Male
  • Mental Disorders / complications
  • Middle Aged
  • Quality of Life
  • Seizures / complications*
  • Seizures / psychology
  • Seizures / therapy*
  • Sex Factors
  • Socioeconomic Factors
  • Somatoform Disorders / complications
  • Somatoform Disorders / psychology
  • Treatment Outcome