2026 ECNP Congress

PS04-4173

Psychogenic non-epileptic seizures at a national epilepsy centre: a case series integrating psychiatric, traumatic and neurophysiological profiles

Lidia Sanduleac — A. Glavan, V. Chiosa, S. Groppa · National Institute of Emergency Medicine, National Epileptology Center, Chisinau, Moldova

2026 ECNP Congress

Introduction

Psychogenic non-epileptic seizures (PNES) are paroxysmal episodes resembling epileptic seizures without ictal EEG correlate, classified in ICD-10 as F44.5. With an incidence of 2–33/100,000/year and a prevalence of 15–30% in epilepsy monitoring units, PNES carry a burden comparable to drug-resistant epilepsy, significantly affecting employment, quality of life, and mortality [2]. Diagnosis is delayed by an average of 7–8 years, during which patients frequently receive inappropriate antiseizure medication (ASM), resulting in iatrogenic harm and substantial healthcare costs [1]. The psychiatric and psychotraumatic underpinnings of PNES remain rarely described [5]. Aims:To characterise the clinical, psychiatric, psychotraumatic, neurophysiological, and socio-occupational profiles of all patients receiving a PNES diagnosis at the National Epilepsy Centre (NEC), Chișinău, Republic of Moldova, over a three-month period, and to identify actionable patterns for multidisciplinary management. Methods:We conducted a retrospective descriptive analysis of 18 consecutive patients (February–May 2026) assigned a primary or comorbid diagnosis of F44.5 or suspected PNES at the NEC. All patients underwent structured psychiatric interview, neurophysiological review (EEG and/or Video-EEG), and neuroimaging review [3]. Standardised psychometric instruments were administered where feasible: DASS-21, DES-II, BSL-23, Hamilton Depression Rating Scale, GAD-7. Psychotraumatic history, prior treatment, and socio-occupational status were systematically documented. Descriptive statistics were computed for all variables. Results:Eighteen patients were included (17 female, 1 male; F:M ratio 17:1), with a mean age of 34.6 years (range 13–69); two were adolescents (11.1%). The series spanned the full clinical spectrum, from pure PNES (n=7) to PNES with comorbid confirmed epilepsy (n=11, 61.1%), including cases of long-standing epilepsy with superimposed functional seizures identified only through integrated psychiatric evaluation. Psychotraumatic burden was universal (18/18, 100%), with childhood trauma documented in 12/18 (66.7%) and childhood sexual abuse in 5/18 (27.8%), including one case of institutional abuse within a psychiatric facility. Dissociative symptomatology beyond seizures — including transient hallucinations with spontaneous remission, depersonalisation, and post-ictal amnesia — was documented across multiple cases, consistent with complex PTSD in a substantial subgroup. Prior ASM exposure was present in 17/18 (94.4%), ranging from several months to over a decade; one patient had received five distinct ASM regimens. DASS-21 data indicated moderate-to-severe stress (mean 14.8), anxiety (11.0), and depression (11.5). DES-II scores ranged from 5 to 65 out of 100. Suicidal ideation or attempts were identified in 7/18 (38.9%), including one intensive care unit admission. Social functioning was severely impaired: 16/18 (88.9%) were occupationally inactive and 9/18 (50.0%) held a disability certificate. Three cases represented exceptional clinical vulnerability requiring urgent interdisciplinary response. Conclusions:This case series from the National Epilepsy Centre of the Republic of Moldova documents a clinically severe and psychiatrically complex PNES population characterised by universal psychotraumatic burden, near-universal prior inappropriate ASM exposure (94.4%), high comorbid epilepsy rates (61.1%), suicidality (38.9%), and severe functional impairment (88.9% occupationally inactive). These Eastern European data extend international findings, confirming that the PNES burden is global, clinically severe, and persistently undertreated [2]. Systematic psychiatric integration within epilepsy centres, PNES-specific cognitive-behavioural therapy [4], trauma-focused psychotherapy, and urgent reduction of inappropriate ASM prescribing are imperative [1].

References

  1. Tolchin B. et al. Management of Functional Seizures Practice Guideline. Neurology, 2026; 106: e214466.
  2. Asadi-Pooya A.A. et al. Functional seizures are not less important than epilepsy. Epilepsy Behav. Rep., 2021; 16: 100495.
  3. Turner K. et al. PNES: Video-EEG, clinical and neuropsychological evaluation. Seizure, 2011; 20: 706–710.
  4. Goldstein L.H. et al. CBT for adults with dissociative seizures (CODES): RCT. Lancet Psychiatry, 2020; 7: 491–505.
  5. Ristić A.J. et al. Phenomenology and psychiatric origin of PNES. Srp Arh Celok Lek, 2004; 132: 22–27.