Short Communication Are psychogenic nonepileptic seizures risk factors for a worse outcome in patients with refractory mesial temporal epilepsy submitted to surgery? Results of a retrospective cohort study Ana Eliza Romano Furlan a , Sebastião Carlos da Silva Junior b , Lucia Helena Neves Marques b , Gerardo Maria de Araujo Filho a, ⁎ a Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil b Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil abstract article info Article history: Received 15 October 2018 Revised 24 January 2019 Accepted 27 January 2019 Available online xxxx Objective: The objective of this study was to verify if the presence of psychogenic nonepileptic seizures (PNES) could be a risk factor precluding corticoamygdalohippocampectomy (CAH) in patients with refractory temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) (TLE-MTS). Methods: This retrospective cohort study analyzed medical data of patients with refractory TLE-MTS accompanied in a Brazilian epilepsy surgery center. Presurgical psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Engel's I classification two years after surgery was considered as a favorable outcome. Results: Of the 81 patients initially included (65 females; 56.5%), 49 (60.5%) had TLE-MTS without PNES, 24 (29.7%) with TLE-MTS and PNES, and eight (9.8%) with PNES only, who were excluded from further statistical comparisons. Nine patients with PNES (37.5%) underwent CAH versus 35 (71.4%) without PNES (p = 0.005). Five patients (55.5%) with PNES versus 26 (74.3%) without PNES presented Engel I (p = 0.54). The relative risk (RR) was of 1.90 for patients without PNES to undergo CAH and of 1.33 to be at Engel I. Conclusions: In this study, PNES were associated with less CAH. There were no differences, however, regarding favorable postsurgical outcomes. These results highlight that the sole presence of PNES should not preclude CAH in patients with TLE-MTS, despite the necessity of careful presurgical psychiatric evaluation. © 2019 Elsevier Inc. All rights reserved. Keywords: Temporal lobe epilepsy Mesial temporal sclerosis Psychogenic nonepileptic seizures Epilepsy surgery outcome 1. Introduction Recent data have demonstrated that 30–40% of patients with epilepsy present with medically intractable disease despite treatment with antiep- ileptic drugs (AEDs), and that corticoamygdalohippocampectomy (CAH) is a safe and efficient surgical procedure for patients with refractory epilepsy [1]. Refractory temporal lobe epilepsy (TLE) is one of the most frequent epilepsy syndromes followed up in tertiary epilepsy centers, and mesial temporal sclerosis (MTS) have been the most frequent etiol- ogy of TLE observed among these patients, compromising the primary structures of the limbic system, particularly the hippocampus and amyg- dala. Temporal lobe epilepsy and MTS (TLE-MTS) also have been associ- ated with cognitive deficits, psychiatric disorders (PD) and lower quality of life [2]. Moreover, TLE-MTS is also one of the most common types of surgically remediable epilepsy syndromes [1,2]. Although CAH has be- come an important treatment option for patients with TLE-MTS in tertiary epilepsy centers, authors have highlighted that 20–40% of those patients have PD, which can rise to 70% in patients with refractory forms [2,3]. Ad- ditional evidence has suggested that the presence of presurgical PD has been possibly associated with worse postsurgical seizure outcomes [4,5]. Psychogenic nonepileptic seizures (PNES) are paroxysmal episodes superficially resembling epileptic seizures but are not associated with any electrical abnormalities [6,7]. Most patients with PNES, although their clinical heterogeneity, fulfill the diagnostic criteria of a functional neurological symptom disorder (FNSD) (Diagnostic and Statistical Manual of Mental Disorders [DSM-5]) or of dissociative convulsions (International Classification of Diseases 10th revision [ICD-10]) [8,9]. There is a scarcity of studies investigating such outcomes on specific subgroups of patients with dual diagnoses of TLE-MTS and PNES [10,11]. Apart from the severity of the comorbid TLE-MTS and/or the possibility to achieve seizure freedom, the presence of PNES has been considered a relative contraindication for CAH due to the possibility of pre- and postsurgical behavioral complications [11,12]. The present study aimed to investigate if the presence of PNES could be a risk factor to preclude CAH in a homogeneous group of patients with TLE-MTS treated in a tertiary epilepsy center, Epilepsy & Behavior 93 (2019) 12–15 ⁎ Corresponding author at: Av. Brigadeiro Faria Lima, 5416 – Nova Redentora, São José do Rio Preto 15090-000, Brazil. E-mail address: filho.gerardo@gmail.com (G.M. de Araujo Filho). https://doi.org/10.1016/j.yebeh.2019.01.036 1525-5050/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh