Why is psychogenic nonepileptic seizure diagnosis missed? A retrospective study.

PURPOSE:The aim of this retrospective study was to scrutinize factors that are associated with a delay in making the diagnosis of psychogenic nonepileptic seizures (PNES). METHODS:In this study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 to 2019, were studied. We categorized the patients into the following: 1. those with a definite diagnosis of PNES in less than a year since the onset of their attacks; 2. those with a definite diagnosis of PNES later than 10 years since the onset of their attacks. RESULTS:During the study period, 330 patients were recorded. In 98 patients (30%), the diagnosis of PNES was made in less than a year since their seizure onset. In 67 patients (20%), the diagnosis of PNES was made later than 10 years since their seizure onset. Taking antiepileptic drugs (AEDs) (odds ratio (OR) = 6) and a history of ictal injury (OR = 3.6) had a positive association, and age at the onset (OR = 0.8) had an inverse association with a delay in receiving a definite diagnosis of PNES (p = 0.0001). CONCLUSION:Some demographic variables (i.e., early age at the onset of seizures), patients' clinical variables (i.e., severe seizure manifestations such as ictal injury), and finally, some physician-related variables (i.e., prescribing AEDs) have significant associations with a delay in making a definite diagnosis of PNES.