Presentation of Psychogenic Nonepileptic Seizures in Hawaii's Ethnoracially Diverse Population

Epilepsy Behav. 2019 Jul;96:150-154. doi: 10.1016/j.yebeh.2019.04.024. Epub 2019 May 28.


Purpose: This exploratory study compared the semiology of psychogenic nonepileptic seizures (PNES) between a diverse group of patients in the state of Hawaii. This study may expand understanding of PNES across different ethnocultural and gender groups.

Methods: A retrospective chart review of patients admitted to our Epilepsy Monitoring Unit (EMU) over a 4-year period was performed to compare semiology in different ethnic groups and gender.

Results: A total of 139 patients were included in this study, 37% (n = 51) with PNES, 34% (n = 47) with epilepsy only, and 29% (n = 41) with other non-PNES, nonepilepsy diagnosis. The number of Asians with PNES were found to differ when compared with the patients with epilepsy and the patients with non-PNES, nonepilepsy diagnosis. A positive trend was found in the number of Native Hawaiians and Caucasians with PNES in comparison with patients with non-PNES, nonepilepsy diagnosis. In addition, three semiology of PNES in Native Hawaiians were found to differ in comparison with other ethnic groups with PNES: rhythmic motor, mixed semiology, and nonepileptic aura. There is a significant difference in all motor manifestation between males and females in Native Hawaiians. Between patients with PNES, patients with epilepsy, and patients with non-PNES, nonepilepsy diagnosis, significant correlation was found in psychiatric disorders including posttraumatic stress disorder (PTSD), anxiety, and any psychiatric disorder.

Conclusion: This cross-cultural study found significant differences in the expression of PNES across key ethnoracial groups for the Islands of Hawaii. These findings have implications to the diagnosis and treatment of PNES for Native Hawaiians and other Pacific Islanders in the United States.

Keywords: Ethnicity; Native Hawaiian; PNES; Psychogenic; Semiology; Video-EEG.

MeSH terms

  • Adult
  • Asian Continental Ancestry Group
  • Brain / physiopathology*
  • Conversion Disorder / diagnosis*
  • Conversion Disorder / physiopathology
  • Conversion Disorder / psychology
  • Cross-Cultural Comparison
  • Electroencephalography
  • Ethnic Groups
  • Female
  • Hawaii
  • Hospital Units
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Seizures / diagnosis*
  • Seizures / physiopathology
  • Seizures / psychology