From the Guidelines
The best treatment for Psychogenic Non-Epileptic Seizures (PNES) is psychological therapy, delivered by specially trained clinicians, with a focus on identifying triggers, developing coping strategies, and addressing underlying psychological issues. Unlike epileptic seizures, PNES does not respond to antiepileptic medications since these events are not caused by abnormal electrical activity in the brain but rather by psychological factors 1. A comprehensive treatment approach typically begins with clear communication about the diagnosis to help patients understand that their seizures are real but have a psychological origin.
Some key elements of treatment include:
- Helping the person to a safe space where they are unlikely to injure themselves during an episode
- Letting them know they are safe but avoiding constant reassurance and physical contact or restraint
- Advising others to behave as they would if someone is having a panic attack
- Asking about triggers and warning signs of an imminent episode
- Teaching strategies such as Sensory Grounding Techniques to try and avert an event at the point of a warning sign 1
While medication is not the primary treatment, selective serotonin reuptake inhibitors (SSRIs) or other psychiatric medications may be prescribed if comorbid conditions like depression or anxiety are present. Treatment outcomes improve with early diagnosis, patient acceptance of the diagnosis, and a multidisciplinary approach involving neurologists, psychiatrists, psychologists, and social workers working together to address both the seizures and underlying psychological factors. Accurate diagnosis and appropriate referrals for these patients may be important, as studies have found that on follow-up, a significant percentage of patients’ PNES had resolved after psychiatric treatment 1.
From the Research
Treatment Options for Psychogenic Non-Epileptic Seizures (PNES)
- Psychological interventions, such as cognitive behavioral therapy (CBT), have been shown to be effective in reducing the frequency of PNES 2, 3.
- A meta-analysis of 13 studies found that 47% of people with PNES were seizure-free after completing a psychological intervention, and 82% experienced a reduction in seizures of at least 50% 2.
- CBT has been consistently demonstrated to have positive effects on enhancing well-being and reducing PNES frequency 4, 5, 3.
- Other therapies, such as psychodynamic therapy and group therapy, may be considered in some patients, although high-level evidence to support their use is lacking 5.
- Selective serotonin reuptake inhibitors (SSRIs) may be beneficial in reducing PNES frequency, especially in patients with psychiatric comorbidities, but the evidence is limited and more research is needed 6.
Key Findings
- Psychological interventions, particularly CBT, are a favorable alternative to the current lack of treatment options for PNES 2.
- A therapeutic approach to PNES should include a thorough discussion of the diagnosis, a psychiatric evaluation, and CBT 5.
- Treatment trials for PNES are few, and more research is needed to fully understand the effectiveness of different treatment options 3, 6.