From the Guidelines
Psychogenic nonepileptic seizures (PNES) and pseudo seizures are essentially the same condition, though "pseudo seizures" is now considered an outdated and potentially stigmatizing term. PNES are episodes that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they have psychological origins and are classified as a functional neurological disorder. These events are real and involuntary, often developing as a response to psychological distress, trauma, or other emotional factors. The term "pseudo" implies something fake or intentionally fabricated, which mischaracterizes the genuine nature of these episodes, similar to how "psychogenic pseudosyncope" is described as having a psychological origin rather than a physical one 1.
The diagnosis and management of PNES require a comprehensive approach, including video-EEG monitoring to distinguish PNES from epileptic seizures, as they can appear very similar. Treatment generally involves psychotherapy approaches such as cognitive behavioral therapy (CBT), often with involvement from both neurologists and mental health professionals. It's crucial to understand that patients with PNES are not faking their symptoms and require compassionate care addressing the underlying psychological factors contributing to their condition.
Key aspects of PNES include:
- Psychological origins rather than abnormal electrical brain activity
- Real and involuntary episodes
- Often a response to psychological distress, trauma, or emotional factors
- Require video-EEG monitoring for diagnosis
- Treatment involves psychotherapy, such as CBT
- Compassionate care is essential, recognizing the genuine nature of the condition, as implied by the distinction between psychogenic pseudosyncope and actual syncope 1.
In clinical practice, using the term PNES instead of "pseudo seizures" is preferred to avoid stigmatization and to emphasize the psychological basis of the condition, aligning with the understanding of psychogenic pseudosyncope as having a psychological origin 1.
From the Research
Definition and Classification
- Psychogenic nonepileptic seizures (PNES) are defined as altered movement, sensation, or experience similar to epilepsy, but caused by a psychological process 2.
- PNES are classified as somatoform disorders in the DSM-IV, but belong to the group of dissociative disorders in the ICD-10 2.
- PNES are also referred to as pseudo seizures, as they resemble epileptic seizures but are not caused by abnormal electrical activity in the brain 3, 4.
Diagnosis and Differentiation
- The diagnosis of PNES can be challenging, and clinical features alone are not sufficient to distinguish PNES from epileptic seizures 4.
- Video-EEG monitoring is the gold standard for diagnosing PNES, as it can record typical seizures and confirm the absence of epileptiform activity 2, 4.
- A thorough neurological and psychiatric history can also be used to confirm the diagnosis of PNES 4.
Relationship between PNES and Pseudo Seizures
- PNES and pseudo seizures are often used interchangeably, as they refer to seizure-like episodes that are not caused by abnormal electrical activity in the brain 2, 3.
- However, pseudo seizures can also refer to other types of nonepileptic seizures, such as those caused by physical or metabolic factors 3.
- In the context of PNES, pseudo seizures refer specifically to seizure-like episodes that are caused by psychological factors 2, 4.
Treatment and Management
- Treatment of PNES typically involves psychotherapeutic modalities, such as cognitive behavioral therapy (CBT), which can help empower patients and reduce seizures 5, 6.
- A multidisciplinary approach, involving both neurologists and psychiatrists, is often necessary to manage PNES effectively 2, 3.
- While seizure freedom may not always be achievable, treatment can improve quality of life and reduce symptoms of psychopathology 5, 6.