Jareno-Badenas Aleix, Matute-González Mario, Pintor Luis, Conde-Blanco Estefanía, Carreño Mar, Setoain Xavier, Pineda Camilo, Choque-Chávez Fernando Diego, Fernández Tomás, Bargalló Núria, González-Ortiz Sofía
Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
Psychiatry Department, Hospital Clinic of Barcelona, Barcelona, Spain.
Epilepsia Open. 2025 Feb;10(1):269-276. doi: 10.1002/epi4.13114. Epub 2024 Dec 12.
Psychogenic non-epileptic seizures (PNES) mimic epileptic seizures without electroencephalographic correlation. Although classified as psychiatric disorders, their neurobiological or structural basis remains unclear. This study aimed to assess the prevalence and characteristics of MRI abnormalities in patients with PNES and those with comorbid epilepsy, compared to the general population, to enhance radiological evaluation and management.
We retrospectively identified patients with a definitive diagnosis of PNES, evaluated in the refractory epilepsy unit of our tertiary epilepsy center. Patients were classified into two groups according to their comorbidity with epilepsy (PNES and PNES+). The MRI findings were evaluated and classified by two radiologists, who reported the category of the findings, laterality, and location. The two groups were compared using the chi-square test, as well as the frequencies of findings in the general population extracted from the literature.
Forty-six patients fulfilled the inclusion criteria. Thirty females and 16 males. MRI findings were present in 25/35 (71.4%) patients in the PNES group and 9/11 (81.8%) In the PNES + group, showing statistically significant differences in the frequency of findings with the general population (8.4-28.1%).
MRI anomalies are common in PNES patients and even more prevalent in complex cases referred to epilepsy units, underscoring the necessity of correlating MRI findings with clinical-electrical patterns.
In this article, we observed a higher frequency of cerebral magnetic resonance findings in patients with psychogenic non-epileptic seizures than in the general population. We also observed a higher frequency of this pathology among women, as well as right cerebral hemisphere affections. The exposed findings suggest a potential structural basis of this pathology. This hypothesis requires confirmation with larger studies.
心因性非癫痫性发作（PNES）可模拟癫痫发作，但无脑电图相关性。尽管被归类为精神疾病，但其神经生物学或结构基础仍不清楚。本研究旨在评估PNES患者以及合并癫痫患者与普通人群相比MRI异常的患病率和特征，以加强影像学评估和管理。
我们回顾性确定了在我们三级癫痫中心难治性癫痫单元接受评估的确诊为PNES的患者。根据患者是否合并癫痫将其分为两组（PNES组和PNES+组）。两名放射科医生对MRI结果进行评估和分类，报告结果类别、侧别和位置。使用卡方检验对两组进行比较，并与从文献中提取的普通人群的结果频率进行比较。
46名患者符合纳入标准。其中30名女性和16名男性。PNES组25/35（71.4%）患者有MRI异常发现，PNES+组9/11（81.8%）有异常发现，与普通人群相比，发现频率差异有统计学意义（8.4%-28.1%）。
MRI异常在PNES患者中很常见，在转诊至癫痫单元的复杂病例中更为普遍，强调了将MRI结果与临床-电模式相关联的必要性。
在本文中，我们观察到心因性非癫痫性发作患者的脑磁共振成像结果频率高于普通人群。我们还观察到该病理在女性中以及右侧大脑半球受累的频率更高。所呈现的结果提示了这种病理的潜在结构基础。这一假设需要更大规模的研究来证实。
