The prevalence of comorbidities in people with psychogenic non-epileptic seizures (2013–2023)

Objective: To better understand medical comorbidity in people with psychogenic non-epileptic seizures (PNES), we used real-world electronic health records (EHR) to evaluate rates of co-occurring diagnoses and psychotropic prescribing in people receiving their first diagnosis of PNES. Methods: We conducted a descriptive analysis of the TriNetX databases, a federated network of >80 health care organizations with access to electronic health records and linked insurance claims. We identified 25,858 individuals with a new PNES diagnosis (ICD-10-CM F44.5) and ≥5 years of EHR or claims data prior to the first PNES encounter. We subsequently evaluated baseline medical comorbidities and outpatient psychotropic prescriptions during the 5 year lookback period preceding the first PNES encounter. Results: In the 5 years before the first PNES encounter, >50% of patients with PNES had encounters where mood-related disorder, anxiety-related disorder, or epilepsy was coded. Past 5-year injuries or poisonings (46.0%), benzodiazepine or Z drug prescriptions (63.5%), and opioid prescriptions (48.6%) were particularly common. Approximately one-third of the sample had past 5-year pain-related diagnoses. Prior diagnoses of PTSD (17.0%), borderline personality disorder (<5%), intellectual disability (<5%), and autism-spectrum disorders (<5%) were comparatively less common. Conclusion: The needs of people with PNES extend beyond psychiatric management. Clinicians should consider the impact of injuries, pain-related diagnoses, and opioid and benzodiazepine exposure in differential diagnosis.