Sexual Assault Trauma May Play Role in Female Preponderance of Psychogenic Nonepileptic Seizures

According to a study presented virtually at American Epilepsy Society AES2020, women are more likely than men to develop psychogenic nonepileptic seizures (PNES), in many cases because of to sexual assault trauma.  

Unlike epilepsy, in which a pattern of electric activity can be seen on EEG, the underlaying pathophysiology of PNES is unknown. Although psychiatric comorbidities are frequent and may have a shared mechanism, the seizures of PNES are not simply a symptom of psychiatric conditions. 

In an analysis of electronic health records (EHRs) and identified a much larger group of people with PNES. A very strong association between PNES and sexual assault trauma was observed. Of more than 2.3 million patients treated at 1 health system between October 1989 and October 2018, 3,341 adults were diagnosed with PNES and nearly 75% of these individuals were identified in the EHRs as women. These individuals were approximately 15 times more likely to have disclosed sexual assault trauma to their clinical care team. Overall, sexual assault trauma accounted for 22% of the increased risk of PNES in women. 

The researchers also determined that people diagnosed with PNES were 8% more likely than the general hospital population to have suffered a stroke. Among the 92 patients who had both PNES and stroke, 48% experienced a stroke and then were diagnosed with PNES; 29% were diagnosed with PNES before the stroke; and 23% were diagnosed with both at about the same time. The researchers note that the reason for the association is not clear and needs to be explored further. 

“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-EEG monitoring to diagnose whether they are experiencing epileptic seizures or nonepileptic seizures,” said Kevin Haas, MD, PhD, associate professor of neurology, Vanderbilt University. “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.”