E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Medical comorbidities in patients with psychogenic nonepileptic spells (PNES) referred for video-EEG monitoring.
Dixit, Ronak, Popescu, Alexandra, Bagić, Anto et al. · Epilepsy & behavior : E&B · 2013 · DOI
Quick Summary
This study looked at 280 patients seen at a hospital epilepsy unit to understand what health conditions are more common in people with psychogenic nonepileptic spells (PNES)—seizure-like episodes that aren't caused by epilepsy—compared to those with actual epilepsy. They found that patients with PNES were more likely to be female, have a history of trauma, and experience conditions like fibromyalgia, chronic fatigue syndrome, chronic pain, and irritable bowel syndrome. The researchers suggest these patterns might help doctors identify PNES earlier and order the right tests sooner.
Why It Matters
This research is relevant to ME/CFS patients because chronic fatigue syndrome was explicitly identified as a comorbidity more common in PNES patients, suggesting potential overlap or misdiagnosis in clinical populations. Understanding how functional somatic syndromes cluster together may help clarify diagnostic distinctions and improve recognition that some patients with overlapping symptoms may benefit from different clinical approaches. The findings underscore the importance of comprehensive medical history—including trauma screening—in understanding post-exertional malaise and symptom patterns in ME/CFS.
Observed Findings
PNES patients were significantly more likely to be female (74.7% vs 46.7%) than epilepsy patients.
PNES patients had higher rates of history of abuse compared to epilepsy patients.
Functional somatic syndromes (fibromyalgia, chronic fatigue syndrome, chronic pain, tension headaches, IBS) were more prevalent in PNES patients.
Intermittent chronic conditions (migraines, asthma, GERD) occurred more frequently in PNES patients.
The presence of at least one of these comorbid conditions was associated with PNES diagnosis.
Inferred Conclusions
Specific medical comorbidity patterns may serve as clinical discriminators that prompt earlier suspicion of PNES over epilepsy.
Functional somatic syndromes and psychosocial factors (abuse history) cluster more frequently in PNES populations.
Comorbidity profiling could expedite appropriate video-EEG referral and diagnostic confirmation.
Gender and trauma history may be important risk factors or phenotypic markers in PNES.
Remaining Questions
Why do functional somatic syndromes cluster with PNES rather than epilepsy? Is this a mechanistic association or a selection/referral bias?
What This Study Does Not Prove
This study does not prove that chronic fatigue syndrome causes PNES or vice versa; it only documents an association in a selected hospital population. The cross-sectional design means causation cannot be inferred, and patients evaluated at an EMU may not represent the broader ME/CFS or PNES populations. The findings do not establish that comorbidity screening alone can reliably diagnose either condition without definitive testing like video-EEG.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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