Clinical Manifestations and Cultural Correlates of Psychogenic Nonepileptic Seizure Symptoms: An Indian Perspective

BACKGROUND: Patients with psychogenic non epileptic seizures (PNES) tend to have more frequent and disabling seizures than those which true epilepsy and are often misdiagnosed as epilepsy due to lack of clear diagnostic criteria and variations in clinical semiology. AIMS & OBJECTIVES: To understand the type of clinical manifestations seen in patients of PNES and the cultural beliefs regarding their symptoms. MATERIAL & METHODS: 71 patients who consented were enrolled in the study after institutional ethics committee approval. They were diagnosed by the neurologist to be having psychogenic seizures on the basis of their clinical presentation and a 2 hours VEEG recording which was normal. The details of the psychogenic seizure viz. clinical manifestation, duration of the episode, loss of consciousness, incontinence and injuries were recorded on a proforma. Patient’s history was taken in detail to understand areas of conflicts, interpersonal problems, discord or any other stressors. The cultural attributions of the patients were also recorded in open and closed ended questions. RESULTS: Clinical manifestations included verbal unresponsiveness (74%), whole body rigidity (72%), upper limb (55%) and lower limb movements (39%), vocalisations and head movements in less than 25% and automatisms in only 6 patients. Pelvic thrusting as a manifestation was seen in only 1 patient. 38 patients attributed their symptoms to being possessed by God/ghost/evil spirit; 9 to black magic being done on them; 24 patients did not relate symptoms to religious beliefs. 62 patients had visited faith healers. CONCLUSIONS: This study is first of its kind which looks at the various clinical presentations of PNES patients in order to assess if there is any cultural basis for the symptoms.