Structural brain abnormalities in patients with psychogenic nonepileptic seizures



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.

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  1. 1.

    Asadi-Pooya AA, Sperling MR (2015) Epidemiology of psychogenic non-epileptic seizures. Epilepsy Behav 46:60–65

    Article  Google Scholar 

  2. 2.

    Asadi-Pooya AA (2015) Neurobiological origin of psychogenic nonepileptic seizures: a review of imaging studies. Epilepsy Behav 52:256–259

    Article  Google Scholar 

  3. 3.

    Asadi-Pooya AA, Emami Y, Emami M (2014) Psychogenic non-epileptic seizures in Iran. Seizure 23(3):175–177

    Article  Google Scholar 

  4. 4.

    Asadi-Pooya AA, Tinker J, Fletman EW (2017) How variable are psychogenic nonepileptic seizures? A retrospective semiological study. J Neurol Sci 377:85–87

    Article  Google Scholar 

  5. 5.

    Asadi-Pooya AA, Tinker J (2017) Delay in diagnosis of psychogenic nonepileptic seizures in adults: a post hoc study. Epilepsy Behav 75:143–145

    Article  Google Scholar 

  6. 6.

    Wei D, Garlinghouse M, Li W, Swingle N, Samson KK, Taraschenko O (2018) Utilization of brain imaging in evaluating patients with psychogenic nonepileptic spells. Epilepsy Behav 85:177–182

    Article  Google Scholar 

  7. 7.

    Bolen RD, Koontz EH, Pritchard PB 3rd. (2016) Prevalence and distribution of MRI abnormalities in patients with psychogenic nonepileptic events. Epilepsy Behav 59:73–76

    Article  Google Scholar 

  8. 8.

    Reuber M, Fernandez G, Helmstaedter C, Qurishi A, Elger CE (2002) Evidence of brain abnormality in patients with psychogenic nonepileptic seizures. Epilepsy Behav 3:249–254

    CAS  Article  Google Scholar 

  9. 9.

    Mcsweeney M, Reuber M, Levita L (2017) Neuroimaging studies in patients with psychogenic non-epileptic seizures: a systematic meta-review. Neuroimage Clin 16:210–221

    Article  Google Scholar 

  10. 10.

    Jones SG, O’Brien TJ, Adams SJ et al (2010) Clinical characteristics and outcome in patients with psychogenic nonepileptic seizures. Psychosom Med 72:487–497

    Article  Google Scholar 

  11. 11.

    Katzman GL, Dagher AP, Patronas NJ (1999) Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 282:36–39

    CAS  Article  Google Scholar 

  12. 12.

    Kanner AM (2004) Structural MRI changes of the brain in depression. Clin EEG Neurosci 35:46–52

    Article  Google Scholar 

  13. 13.

    Coloigner J, Batail JM, Commowick O et al (2019) White matter abnormalities in depression: a categorical and phenotypic diffusion MRI study. Neuroimage Clin 22:101710

    Article  Google Scholar 

  14. 14.

    Andreescu C, Butters MA, Begley A, Rajji T, Wu M, Meltzer CC, Reynolds CF 3rd, Aizenstein H (2008) Gray matter changes in late life depression—a structural MRI analysis. Neuropsychopharmacology 33:2566–2572

  15. 15.

    Asadi-Pooya AA (2016) Biological underpinnings of psychogenic nonepileptic seizures: directions for future research. Neurol Sci 37:1033–1038

    Article  Google Scholar 

  16. 16.

    Asadi-Pooya AA (2017) Psychogenic nonepileptic seizures: a concise review. Neurol Sci 38:935–940

    Article  Google Scholar 

  17. 17.

    Devinsky O, Mesad S, Alper K (2001) Nondominant hemisphere lesions and conversion nonepileptic seizures. J Neuropsychiatr Clin Neurosci 13:367–373

    CAS  Article  Google Scholar 

Download references


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

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The authors conducted the statistical analyses.

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Correspondence to Ali A. Asadi-Pooya.

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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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Asadi-Pooya, A.A., Homayoun, M. Structural brain abnormalities in patients with psychogenic nonepileptic seizures. Neurol Sci 41, 555–559 (2020).

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  • Epilepsy
  • Imaging
  • PNES
  • Psychogenic
  • Seizure