Structural brain abnormalities in patients with psychogenic nonepileptic seizures

  • Ali A. Asadi-PooyaEmail author
  • Maryam Homayoun
Original Article



We assessed the relationship between the clinical features of patients with psychogenic nonepileptic seizures (PNES) and referrals for brain imaging tests. We also hypothesized that some clinical factors might be associated with structural brain imaging abnormalities in these patients.


In this retrospective study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were studied.


One hundred thirty-two patients had a brain magnetic resonance imaging (MRI) study available. Forty-seven patients (36%) had abnormal finding(s) in their MRI. Age (odds ratio = 1.040, p = 0.02), and comorbid epilepsy (odds ratio = 3.006, p = 0.005) were significantly associated with having an abnormal brain MRI. In a subanalysis, we excluded the patients with comorbid epilepsy (46 patients). From the remaining 86 patients (with PNES only), 23 patients (26.7%) had abnormal findings on their MRIs. Common epileptogenic structural brain abnormalities (e.g., tumors, mesial temporal sclerosis, encephalomalacia, and developmental anomalies) were common in patients with comorbid PNES and epilepsy (in 19 out of 46 patients; 41%), but not in those with PNES only (in 4 out of 86 patients; 5%) (p = 0.00001).


While the evidence is convergent on the relatively high prevalence of structural brain abnormalities in patients with PNES, the data so far is suboptimal. In order to investigate the significance of structural brain abnormalities in the development of PNES, future well-designed multicenter studies, which include a large number of patients with a unified methodology of imaging, are desirable.


Epilepsy Imaging PNES Psychogenic Seizure 



We thank the Neuroscience Research Center, Shiraz University of Medical Sciences, for supporting this study.

Author contribution

The authors conducted the statistical analyses.

Compliance with ethical standards

Conflict of interest

Ali A. Asadi-Pooya, M.D.: Honoraria from Cobel Daruo; Royalty: Oxford University Press (Book publication). Maryam Homayoun, M.D.: none.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Neuroscience Research Center, Shiraz Medical SchoolShiraz University of Medical SciencesShirazIran
  2. 2.Jefferson Comprehensive Epilepsy Center, Department of NeurologyThomas Jefferson UniversityPhiladelphiaUSA

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