Presentation of psychogenic nonepileptic seizures in Hawaii's ethnoracially diverse population

Clinical characteristics of functional (psychogenic nonepileptic) seizures: An international retrospective study

PURPOSE

We conducted a multicenter international cross-cultural comparative study to investigate clinical semiology and predisposing factors of functional seizures in a large cohort of patients living in different countries around the world. We hypothesized that semiology and predisposing factors of functional seizures differ between various world regions.

METHODS

We conducted this retrospective observational study in adults with functional seizures admitted to epilepsy centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We assessed and compared the demographic and clinical seizure characteristics of these patients, according to the patients' reports and review of the ictal recordings during video-electroencephalogram (EEG) monitoring.

RESULTS

Five hundred nine patients were included (270 from Iran, 74 from Qatar, 63 from France, 43 from the USA, 22 from Egypt, 20 from UAE, and 17 from Georgia). Although all major manifestations of functional seizures (e.g., aura, loss of responsiveness, generalized motor seizures, ictal injury) were seen in all world regions, seizure semiology differed significantly across countries. Auras, ictal urinary incontinence, and ictal injury were more commonly reported by the American patients than patients from other world regions, whereas loss of responsiveness and generalized motor seizures were more frequently observed in the Iranian and American patients than the European and Arab patients.

CONCLUSION

Semiology of functional seizures seems to vary across various regions of the world; socioeconomic, cultural, ethnic, and religious differences may play an essential role in the modulation of functional seizures semiology across different nations and cultures.

International multicenter studies on psychogenic nonepileptic seizures: A systematic review

The aim of the current paper is to systematically review the literature on the existing international multicenter studies on various aspects of PNES and to highlight their findings and significance. I searched the electronic database PubMed for articles that included any of these search terms: Non-epileptic seizures, Nonepileptic seizures, Pseudoseizures, Non-epileptic events, Nonepileptic events, Dissociative seizures, Psychogenic, PNES, AND "international" or "multicenter" or "cross cultural", in their abstracts and titles and published before August 6, 2019. I searched PsycINFO database (keywords in the abstracts) and also included some of the references of the selected articles if they were relevant. I could identify 12 related manuscripts through the search strategy. These included seven studies on patients with PNES, two surveys, and three consensus group reports. This systematic review showed that international and cross-cultural studies on PNES to date are very limited in number and quality. However, these limited studies have resulted in intriguing observations and conclusions. International and cross-cultural studies may make important contributions to our understanding of different aspects of PNES across borders.