Dramatic presentations in psychogenic nonepileptic seizures.

PURPOSE: The aim of this study was to investigate the frequency of dramatic presentations of psychogenic nonepileptic seizures (PNES) (i.e., urine incontinence and ictal injury) and to characterize the patients' historical risk factors that may be associated with such dramatic manifestations.

METHODS: In this retrospective database study, all patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 until 2018, were studied.

RESULTS: 259 patients with PNES-only were studied. Thirty-one patients (12%) reported experiencing urinary incontinence. Seventy-five patients (29%) reported having a bodily injury. The associated injuries were as follows: lacerations (35; 13.5%), tongue biting (32; 12%), fractures (5; 2%), burns (2; 1%), and dental injuries (1; 0.5%). Fifty-seven (67%) patients with one of these features and 91 patients (53%) without any of these features were taking antiepileptic drugs; the difference was significant (p = 0.03).

CONCLUSION: Patients with PNES may frequently present with dramatic features including, ictal injury or urinary incontinence, and as a result are at great risk of receiving wrong diagnosis and unnecessary treatments.