Ictal injury in psychogenic non-epileptic seizures

Purpose: Whilst ictal injuries in psychogenic non-epileptic seizures (PNES) have been reported previously, very few studies have described the spectrum of ictal injuries in these patients. In the current study, we tried to determine the spectrum of reported ictal injuries associated with PNES and to investigate the possible associated risk factors.

Methods: All patients with PNES were recruited prospectively in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, between 2008 and 2013. The diagnosis was made by clinical assessment and ictal video-EEG recordings. We asked all patients and their caregivers about history of any minor (e.g., tongue biting, bruises, and lacerations) or major (e.g., burns and fractures) physical injuries associated with their seizures, since their disease started. Clinical variables, factors potentially predisposing to PNES and video-EEG recordings of all patients were analyzed.

Results: Two hundred and eleven patients were studied. Sixty-five patients (30.8%) reported injuries with one or more of their attacks. The most common type of reported injury was tongue biting. Lacerations, bruises, limb fractures, dental injury, and burn were also reported.

Conclusion: PNES commonly produce physical injuries. Despite the shibboleth that injuries rarely occur during PNES, mild injuries commonly happen and even severe injuries such as fractures and burns are not uncommonly reported in these patients. Patients with more dramatic seizure manifestations (e.g., urinary incontinence) were more likely to report ictal injuries.