Open AccessPsychogenic non‐epileptic seizures among patients with functional neurological disorder: A case series from a Tanzanian referral hospital and literature review
Author(s) -
Dekker Marieke C. J.,
Urasa Sarah J.,
Kellogg Marissa,
Howlett William P.
Publication year - 2018
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12096
Subject(s) - medicine , psychogenic disease , referral , pediatrics , epidemiology , presentation (obstetrics) , retrospective cohort study , conversion disorder , psychiatry , surgery , family medicine
Summary Objective Functional neurological disorders ( FND s) and psychogenic nonepileptic seizures ( PNES ) are likely as common in Sub‐Saharan Africa ( SSA ) as in the rest of the world, but there is a dearth of literature on the epidemiology and clinical presentation of these disorders in Africa. The purpose of this paper is to describe a case series of FND s presenting to a referral hospital in SSA . In addition, we review the existing literature on FND s in Africa. Methods A hospital‐based retrospective cross‐sectional study was conducted to determine the prevalence, epidemiology, and clinical phenotype of FND s and PNES in a referral hospital in Northern Tanzania over a 6‐year period (2007–2013). Results Of 2,040 patients presenting with neurological complaints, 44 (2.2%) were diagnosed with FND s. Half (n = 22) had the clinical presentation of PNES . Age of presentation for FND s and PNES peaked in the teen years 12–19 (n = 21 48%; and n = 14, 63%, respectively), and the majority were female (n = 30, 68%; and n = 14, 63%, respectively). The majority presented acutely with short‐lived and self‐limiting symptoms (only 2 recurrent cases). Literature review revealed multiple reports of “mass hysteria” in SSA often meeting the clinical criteria of epidemic FND s. Significance FND s and PNES occur in Africa with age and gender distribution comparable to that found elsewhere. Although the percentage of FND cases overall was relatively low (2.2%), it is likely to be an underestimate because not all cases were recorded, and cases may be appropriately managed locally before patients are referred to a hospital. PNES was the most common phenotype of FND s reported, and the African phenotype may be short‐lived and self‐limiting rather than chronic and recurrent, as reported elsewhere in the world. PNES presentations may also occur in clusters, which may have cultural significance in Africa. FND s in Africa appear to be underreported, particularly over the last 30 years.