Childhood Trauma Highly Prevalent in People With PNES

People with psychogenic nonepileptic seizures (PNES) appear to have higher rates of childhood trauma compared with people with epilepsy, according to a new report published in Epilepsia.

The study adds depth to scientists’ understanding of the links between trauma and the seizure disorder, although the investigators did not find that any particular type of trauma could be used as a screening tool for PNES.

The study authors explained that PNES is significantly different from epilepsy, but is often misdiagnosed as epilepsy. The differences become clear on video electroencephalography monitoring (VEM), but they said it can often take many years before someone with PNES received an accurate diagnosis.

“Investigating PNES risk factors may facilitate early accurate diagnoses and decrease the misguided use of limited health care resources and other health burdens,” they wrote.

The causes of PNES are believed to be multifactorial, but the investigators said previous research has suggested that childhood trauma is highly prevalent in people with PNES and appears to increase a person’s risk of developing the condition. In their new study, the authors wanted to see whether examining the specific childhood trauma profiles of people with PNES might identify patterns or links suggesting which types of experiences were most likely to be associated with PNES.

The investigators decided to analyze the question by building 2 cohorts—one retrospective and one prospective—of people who were admitted to a hospital VEM unit for evaluation. Patients were included if they were at least 18 years old and had completed a childhood trauma questionnaire. A total of 203 people were admitted to the retrospective cohort, which covered patients admitted between 2014 and 2017. Another 209 people were in the retrospective cohort, which included patients admitted from April 2018 through October 2019. Most patients in both cohorts had received an epilepsy diagnosis (144 in the retrospective cohort and 172 in the prospective cohort).

The authors found that, in general, people with PNES were more likely to report childhood trauma than people with epilepsy, and the effect appeared to be true across trauma types. Yet they also found patterns related to particular types of trauma.

“Overall childhood trauma, sexual abuse, and physical neglect were associated with diagnostic group (PNES vs epilepsy) over and above clinicodemographic factors,” the authors found.

In particular, they said the severity of sexual abuse suffered as a child had the best performance as an individual screening factor, although they said it was insufficiently accurate to serve in screening or diagnostic applications.

The investigators noted that their findings are “remarkably consistent” with the findings of a previous study comparing adolescents with PNES to healthy controls.

“The similar findings of multiple childhood trauma types closely associated with PNES etiology, instead of earlier research only focusing on physical and sexual abuse, support the proposed mechanism of PNES, whereby seizures manifest from abnormal psychological processes,” they wrote.

The authors cited several limitations to their study. For instance, there were more females than males in both cohorts. In addition, their decision to use inpatients who underwent VEM involved a tradeoff; it increased the certainty of a correct diagnosis, but also meant that the results may not be generalizable to the entire PNES population. Nonetheless, the authors said the findings add to the evidence that childhood trauma is an important factor when it comes to PNES risk.

“Together these findings support the value of incorporating childhood trauma screening into routine clinical workflows and suggests that clinicians working in the epilepsy clinic should consider a differential diagnosis of PNES in patients with a severe childhood trauma history,” they concluded.

Reference

Yang T, Roberts C, Winton-Brown T, et al. Childhood trauma in patients with epileptic vs nonepileptic seizures. Epilepsia. Published online October 27, 2022. doi:10.1111/epi.17449