The three items listed in the title of this blog post might seem unrelated but they  were part of an article that was published last month. The article drew some useful and thought-provoking conclusions that might be useful for clinicians working with PNES.

The study described in “Characteristics of patients diagnosed with psychogenic non-epileptic seizures (PNES) who request reinstatement of their driving privileges” (https://www.epilepsybehavior.com/article/S1525-5050(25)00004-6/abstract) looked at over 400 patients diagnosed with PNES. Differences were identified in those who requested reactivation of their driving privileges as compared to the ones who did not.  

Why is this article worth reading?

• For any health disorder, a key question is “what is the PROGNOSIS for this condition?” In other words, how many people will recover and of those, is there something that makes them different than the ones who don’t recover?  Unfortunately, there are not that many studies that look at post-diagnostic outcome/prognosis in PNES. A few excellent papers on this topic that come to mind include ones authored by Roderick Duncan (Outcome at 5-10 years in psychogenic nonepileptic seizures: what patients report vs. what family doctors report) and Markus Reuber (Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients).

This recent paper, “Characteristics of patients diagnosed with psychogenic non-epileptic seizures (PNES) who request reinstatement of their driving privileges,” approached prognosis with an interesting twist defining recovery as at least 6 months of seizure-freedom confirmed through a signed formal request for reactivation of the patients’ drivers’ licenses.  This last point is unique and strengthens our confidence in the “recovered” status because patients stated in writing and their neurologist confirmed that they were seizure-free; this was then submitted to the Department of Motor Vehicles.

• Once the 400+ patients were divided into two groups (recovered and not recovered), the authors went back to look at certain neuropsychological measures that were administered when the patients were initially diagnosed with PNES. And what they found is not only interesting and useful information, but also confirms what we know about mood disorders and depression and how these can weigh someone down and slow down recovery.  The study reported that patients who requested to regain their driving privileges due to seizure-freedom were less depressed at the time of testing and as could also be expected (from what we know about depression and psychomotor slowing), had faster psychomotor speed, and better coordination and visuomotor functions.
• Therefore, the authors concluded that their “findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.”
• And that last sentence is especially important for clinicians like myself because if we evaluate a patient who is markedly depressed, this suggests that it may make sense to treat that depression from the start because this might ensure the possibility of better outcome. Of course, additional research is always needed, but this is something to consider.