What is the prognosis of phantom seizures?

From the Guidelines

The prognosis of phantom seizures, also known as psychogenic non-epileptic seizures (PNES) or functional seizures, is generally favorable with appropriate treatment. Most patients can achieve significant reduction or complete resolution of symptoms with proper psychological interventions. The primary treatment approach involves psychotherapy, particularly cognitive behavioral therapy (CBT) or specialized psychotherapy focused on addressing underlying psychological factors. Many patients benefit from a 12-16 session course of CBT with a therapist experienced in treating functional neurological disorders. Unlike epileptic seizures, antiepileptic medications are not effective for phantom seizures and should be avoided or discontinued under medical supervision if previously prescribed.

Some key points to consider in the management of phantom seizures include:

• Early diagnosis and intervention lead to better outcomes, with studies showing that approximately 60-70% of patients experience substantial improvement or remission within a few years of appropriate treatment 1.
• The condition is caused by the brain's response to psychological distress rather than abnormal electrical activity, which explains why traditional seizure medications are ineffective while psychological approaches yield positive results.
• Prognosis improves significantly when patients accept the psychological nature of their condition and actively engage in treatment.
• It is essential to differentiate phantom seizures from epileptic seizures, as the treatment approaches and outcomes differ significantly.

In terms of specific treatment strategies, some studies suggest that:

• Cognitive behavioral therapy (CBT) is an effective treatment approach for phantom seizures, with many patients experiencing significant reduction or complete resolution of symptoms 1.
• Specialized psychotherapy focused on addressing underlying psychological factors can also be beneficial in managing phantom seizures.
• Antiepileptic medications should be avoided or discontinued under medical supervision if previously prescribed, as they are not effective for phantom seizures and may even exacerbate symptoms.

Overall, the prognosis of phantom seizures is generally favorable with appropriate treatment, and early diagnosis and intervention are critical in achieving better outcomes. By prioritizing psychological interventions and avoiding unnecessary medication, patients with phantom seizures can experience significant improvement or remission of symptoms.

From the Research

Prognosis of Phantom Seizures

The prognosis of phantom seizures is a complex topic, and there are limited studies that specifically address this condition. However, based on the available evidence, here are some key points to consider:

• Phantom absences, a type of phantom seizure, are usually accompanied by infrequent generalized tonic-clonic seizures and absence status, and do not typically impair individual neurological functions 2.
• Idiopathic generalized epilepsy with phantom absences, absence status, and generalized tonic-clonic seizures is an extremely rare condition, and EEG is the exclusive method for diagnosis 2.
• Antiepileptic drugs are effective for controlling epileptic seizures in this disease, and the frequency of absence seizures can be significantly reduced with treatment 2.
• The prognosis for patients with epilepsy, in general, is influenced by several factors, including the type of seizures, the presence of comorbidities, and the response to treatment 3, 4.
• Studies have shown that the risk of seizures recurring after a period of remission is influenced by factors such as the type of seizures, the duration of remission, and the presence of abnormal electroencephalogram results 5.
• If a first antiepileptic drug fails to control a child's epilepsy, the chances of success with the next drug are lower, and the outcome is less favorable 6.

Factors Influencing Prognosis

Several factors can influence the prognosis of phantom seizures, including:

• The type of seizures and epilepsy syndrome
• The presence of comorbidities, such as neurologic deficits or psychiatric disorders
• The response to treatment, including the effectiveness of antiepileptic drugs
• The duration of remission and the risk of seizures recurring
• The presence of abnormal electroencephalogram results

Treatment and Management

The treatment and management of phantom seizures typically involve the use of antiepileptic drugs, which can be effective in controlling epileptic seizures and reducing the frequency of absence seizures 2. The selection of antiepileptic drugs should be based on the type of seizures and epilepsy syndrome, as well as the presence of comorbidities and potential drug interactions 3, 4.