Quality of life outcome is associated with cessation rather than reduction of psychogenic nonepileptic seizures

The outcome of psychogenic nonepileptic seizures (NES) is usually judged by recurrence of spells, but functional outcome or quality of life (QOL) is less well described. We tested the hypothesis that a decrease in NES recurrence yields corresponding improvement in QOL. Patients with NES were diagnosed with continuous video-EEG. We determined spell rate and QOL through a telephone interview at least six months after diagnosis. Thirty subjects consented to a follow-up interview (mean 17.4 ± 1.5 months between diagnosis and interview). The rate of NES per week decreased significantly, and 10/30 (33%) had complete resolution. QOL, measured by the QOLIE-10 scale, did not improve proportionately with reduction in NES. However, subjects who reported a cessation of NES noted a significantly better total QOLIE-10 score (20.7 ± 2.2) than those with continuing NES (27.4 ± 1.6, P = 0.02 by unpaired t test). Cessation rather than reduction of NES is associated with better QOL outcome.