Brain tumors associated with psychogenic non-epileptic seizures: Case series

• Published in: Clinical neurology and neurosurgery Vol. 164; pp. 53 - 56
• Main Authors: Garcia, Catherine R., Khan, Gulam Q., Morrow, Amy M., Yadav, Priyanka, Lightner, Donita D., Gilliam, Frank G., Villano, John L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2018; Elsevier Limited
• Subjects: Adult; Brain cancer; Brain neoplasm; Brain Neoplasms - complications; Brain Neoplasms - diagnosis; Brain Neoplasms - physiopathology; Brain tumors; Consultation; Convulsions & seizures; Electroencephalography - methods; Epilepsy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Outcomes; Patients; Post traumatic stress disorder; Pseudoseizures; Psychogenic non-epileptic seizures; Quality of life; Seizures; Seizures - diagnosis; Seizures - etiology; Seizures - physiopathology; Tumors; AED; TMZ; EEG; Pseudoseizures; PNES; Brain neoplasm; Psychogenic non-epileptic seizures; ES; Outcomes
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2017.11.013

•PNES should be considered when having uncontrolled epileptic seizures in brain tumor patients.•Increased psychosocial distress may predispose these patients to PNES.•Recognition of PNES in our neuro-oncology clinic with proper psychological referrals decreased these events. The association of psychogenic non-epileptic seizures (PNES) with primary or secondary brain tumors has not been well described in the literature. We aim to discuss their association, and their impact in brain tumor treatment. We identified four patients retrospectively from our practice. The diagnosis of PNES was based on clinical suspicion and standard EEG, supplemented with video-EEG recording in 2 patients. The initial diagnosis of brain tumor was associated with a new onset seizure prior to diagnosis. The majority of the patients presented with ES followed by recurrent PNES during the course of their disease. Patients were treated with multiple anti-epileptic drugs, requiring frequent schedule adjustments. The preferred tumor treatment modality was chemotherapy, followed by surgical resection. The patients were offered psychological consultation achieving partial control of their events. These patients manifested recurrent disabling clinical events that required multiple medical consultations. None of these patients presented clinical evidence of tumor progression at the time of PNES presentation. A high index of suspicion and early psychological consultation referral will likely mitigate the quality of life impact of PNES in these patients.