This month, researchers from Argentina (Consejo Nacional de Investigaciones Científicas y Técnicas, de la Universidad de Buenos Aires y del ENyS) together with Dr. Lorna Myers (Director, Psychogenic Non-epileptic Seizures Program at the Northeast Regional Epilepsy Group) published an article in the Epilepsy and Behavior Journal: “Long-term outcome in a sample of underprivileged patients with psychogenic nonepileptic seizures (PNES) living in Argentina.”
This project aimed to conduct a follow-up of patients who had been diagnosed with psychogenic non-epileptic seizures (PNES) in two public hospitals in Argentina.
Until now, most follow-up studies of patients with PNES have been completed in Western, first-world countries (e.g. USA, Great Britain). Presently, there are very few studies of PNES in developing countries, such as Argentina.
In this particular study we aimed to understand characteristics patients reported before and after receiving the diagnosis of PNES. Specifically, we focused on the following variables: frequency and intensity of PNES episodes, whether the patient understood and agreed with the diagnosis, whether new neurological-like symptoms appeared, and whether psychopharmacological and psychotherapeutic treatments were initiated. Additionally, the study checked whether patients had also relied on alternative and complementary treatments.
Information from patient charts (e.g. personal and family histories, age of PNES onset, and general demographic features, such as education and work status) was also gathered.
The results obtained were very interesting. On one hand, almost all patients reported having experienced some form of psychological trauma, which is clearly consistent with most previous studies of PNES antecedents. Second, follow-up revealed that there had been noticeable improvements in work status of many of the patients. This is especially meaningful since Argentina is currently experiencing a financial crisis and has an unemployment rate of almost 20% and a poverty rate of 27%. It should be noted that all patients who reported obtaining a job after diagnosis also reported experiencing a decrease (improvement) in PNES frequency.
Moreover, the sorts of treatments patient had sought out after being diagnosed were tallied. Often, treatment choice related to beliefs and attributions that patients hold about their illness. At the time of our inquiry, nearly all patients reported having participated in some form of psychological treatment. Although some of them (25%) claimed this form of treatment had not been helpful, the majority of the patients who had undergone psychological treatment had experienced improvements in seizure frequency. This inconsistent finding may be associated with another interesting finding: many of the patients stated they were in disagreement with the PNES diagnosis.
Even so, over half of the patients were taking some form of psychopharmacological agent, in particular, benzodiazepines. This too is an important finding since these rates are higher than general rates of benzodiazepine consumption in Argentina. It is also intriguing since this form of treatment is not necessarily a first line of treatment choice for PNES.
Patients also reported relying on complementary and non-conventional treatments, including visiting faith healers, religious healing, cannabidiol oil, homeopathic therapies, and even non-Western approaches such as yoga, meditation and reiki.
A number of the results this study produced differ from results obtained in other more developed countries, which suggests that context and cultural characteristics are tremendously important when designing treatment approaches. In sum, international studies of PNES may reveal similarities and differences that assist in understanding what is universal about this condition and what is discrete to unique cultures.