Psychogenic non-epileptic seizure in patients with intellectual disability with special focus on choice of therapeutic intervention

PURPOSE There have been a number of studies exploring treatments for psychogenic non-epileptic seizure (PNES) but largely neglecting the sizable subgroup of patients with intellectual disability (ID). In the present study, we attempted to demonstrate effects and preferred modes of therapeutic intervention in PNES patients with ID being treated at a Japanese municipal center with a short referral chain. METHODS We examined 46 PNES patients with ID (ID group) and 106 PNES patients without ID (non-ID group) retrospectively in case charts. In addition to examining basic demographic and clinical data, effects of different therapeutic intervention were examined as a function of decrease or disappearance of PNES attacks in the ID group. RESULTS Age at the first visit as well as PNES onset was younger in the ID than in the non-ID group (t=2.651, p=0.009; t=3.528, p=0.001, respectively). PNES-free ratio at the last visit tended to be higher in the non-ID group (chi square=3.455; p=0.063). Psychosis was more often encountered in the ID group (chi square=13.443; p=0.001). Although cognitive therapy and pharmaco-therapeutic approaches were quite similarly distributed in both groups, environmental adjustment was often introduced in the ID group (44%) as compared to the non-ID group (15%) (chi square=14.299; p=0.001). Brief weekly visit service is also more often utilized by the patients with ID (54%) than by those without ID (35%) (chi square=5.021, p=0.025). CONCLUSIONS Optimal treatment approaches in this sizable patient subgroup should be the subject of future prospective studies.