Exploring the Association Between Psychogenic Non-epileptic Seizures and Mild Traumatic Brain Injury: A Systematic Review

Abstract

Context: This systematic review explores the intersection between mild traumatic brain injury (mTBI) and psychogenic nonepileptic seizures (PNES). Evidence Acquisition: This review examines the prevalence, risk factors, and diagnostic challenges of PNES in the context of mTBI, while also exploring potential underlying mechanisms and clinical implications. Results: From the initial 1,354 studies, 7 were included in the final analysis. La France et al. reported a 44.6% prevalence of traumatic brain injury (TBI) in PNES, with 73% being mTBI (P < 0.001). Mokleby et al. found that 83% of PNES patients had minor head trauma, significantly associated with depression and post-traumatic stress disorder (PTSD) (P < 0.01). Salinsky et al. highlighted a strong link between mTBI, PTSD, and PNES in veterans (P = 0.002). The studies consistently reported high psychiatric comorbidity rates, including major depression and conversion disorder (P < 0.001). These findings emphasize the need for an integrated neurological and psychiatric approach to PNES in mTBI patients. Conclusions: The review concludes with an emphasis on the need for comprehensive care in managing PNES, especially considering the prominent role of psychiatric comorbidities. Future research directions include prospective studies, a focus on pediatric populations, and enhanced treatment strategies integrating neurological and psychiatric care.