Stress and Seizures (3)

Continuing the review from the last post of research from Melbourne, Australia on psychogenic nonepileptic seizures (PNES), we have seen that there was no assessment of childhood stress in  their subjects (1).  This glaring omission meant that the opportunity to therapeutically address these issues in their patients was lost.  Consequently it is not surprising that the outcome in their subjects was poor.  In the 28% of their patients who returned a follow-up questionnaire (averaging four years later):

  • 83% continued to have PNES episodes, about half being unimproved or worse after their evaluation at the Melbourne research center.
  • 40% were still prescribed anti-epileptic medications and more than half were still under care of a neurologist even though they were proven not to have epilepsy.  (This means there was no reason for them to be taking this medication or seeing a neurologist.)
  • Only 36% had received care from a mental health professional even though up to 2/3 reported ongoing mental health problems.
  • 73% reported psychosomatic symptoms, 61% with more than one.
  • Responses to a questionnaire designed to assess their quality of life showed lower scores than patients suffering from true epilepsy.

In the 21st Century, following the work of Dr Vincent Felitti (2) and others documenting the profound long-term impact of childhood stress on health in adults, there is simply no reason not to assess any patient with a stress-induced illness for early adverse experience.  From detailed interviews with over 4000 of these patients I have learned that symptoms respond when long-term effects of childhood stress are uncovered and treated.  It is likely that a golden therapeutic opportunity was lost in these PNES patients and they suffered significantly because of it.

1. Jones SG et al.  Clinical Characteristics and Outcome in Patients with Psychogenic Nonepileptic Seizures.  Psychosomatic Medicine 72:481 – 486. June 2010.

2. Felitti VJ et al (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 14:245-258.

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