Exploring Sleep Quality, Quality of Life, and Seizure Frequency in Patients with Psychogenic Nonepileptic Seizures

Patients with psychogenic nonepileptic seizures (PNES) experience episodes of transient neurological dysfunction that mimic epileptic seizures. Because PNES is caused by problems with how the nervous system is functioning rather than a structural problem, it is often described as a problem with the brain’s software as opposed to hardware. Patients with PNES are part of a medically complex group who historically have been difficult to treat in part because of their array of symptoms caused by PNES or their comorbidities. Therapeutic goals in this patient population often include improving quality of life (QOL) and reducing seizure frequency. To achieve these goals, therapies must be comprehensive and address multiple domains of the patient experience.

The overall objective of this dissertation research was threefold: to generate a conceptual definition of QOL in PNES; to evaluate current nonpharmacologic PNES treatments and effects on seizure frequency and QOL; and to explore the relationship between sleep quality, QOL, and seizure frequency in patients with PNES. To meet the first objective, an evolutionary concept analysis was performed to clarify concepts and define QOL in the context of PNES. To meet the second objective, an integrative literature review was completed, and it was found that sleep was not a primary topic in PNES therapies. There were also research gaps in how sleep quality relates to QOL and seizure frequency in patients with PNES. To meet the third objective, a cross-sectional exploratory study was conducted on a sample of patients with PNES exploring the relationships between sleep quality, QOL, and seizure frequency, and possible influencing factors.

The findings from this dissertation research showed that sleep quality was associated with the physical but not the mental domain of QOL. It also showed that only the use of sleep medications was associated with increased seizure frequency. There was no significant association between sleep quality and seizure frequency. Psychological distress was significantly related to mental QOL; and employment status, psychological distress, and total number of years with PNES were significantly related to seizure frequency. These findings suggest the importance of screening for and treating sleep problems in patients with PNES.