From the Guidelines
Psychogenic non-epileptic seizures (PNES) are best treated with psychotherapy, particularly cognitive behavioral therapy (CBT), as it has been shown to significantly reduce or eliminate seizures in 60-80% of patients. When treating PNES, it is essential to prioritize a multidisciplinary approach, including a neurologist, psychiatrist, and psychologist working together to address the complex psychological factors underlying the condition 1.
Key Considerations in PNES Treatment
- Accurate diagnosis is crucial, as PNES is often unrecognized and underdiagnosed, leading to unnecessary medical testing and treatments 1.
- Antiepileptic medications are not effective for PNES and should be avoided or tapered off if previously prescribed, as they do not address the underlying psychological causes of the seizures.
- A clear and empathetic communication about the diagnosis is vital, emphasizing that the seizures are real and not deliberately fabricated, to help patients understand and cope with their condition.
- Additional treatments may include stress management techniques, mindfulness practices, and addressing comorbid conditions like depression or anxiety with appropriate medications such as SSRIs.
- Physical therapy may also be beneficial for patients who experience physical symptoms between events, helping to improve their overall quality of life.
Importance of Early Intervention
Early recognition and treatment of PNES can significantly improve patient outcomes, with studies showing that 72% of patients' PNES had resolved after psychiatric treatment 1. Therefore, it is crucial to prioritize psychotherapy and a multidisciplinary approach in the treatment of PNES, rather than relying solely on medical interventions. By doing so, healthcare providers can help patients achieve significant reductions or elimination of seizures, improving their quality of life and reducing the risk of unnecessary medical interventions.
From the Research
Treatment Options for PNES
- Cognitive Behavioral Therapy (CBT) is a known effective intervention for treating PNES and underlying psychiatric symptoms 2, 3, 4
- A multidisciplinary, holistic approach to treatment is beneficial for patients with PNES 3, 5
- Mindfulness-based intervention has shown promise as a feasible treatment option for PNES, although further research is needed 6
Effectiveness of Treatment
- Studies have shown significant improvements in seizure frequency, depression, anxiety, and quality of life in patients treated with CBT 2, 4
- Attending at least 7 sessions of CBT-informed psychotherapy in longer than 3 months was effective for seizure control, depression, and anxiety 2
- Psychotherapeutic modalities remain a powerful instrument to empower patients and reduce seizures, although evidence is mixed for the treatment of PNES 3