From the Guidelines
Yes, patients can become unresponsive during psychogenic non-epileptic seizures (PNES). During PNES episodes, some patients may appear to lose consciousness or become unresponsive to external stimuli, though this unresponsiveness differs from the true loss of consciousness seen in epileptic seizures. This apparent unresponsiveness is part of the clinical presentation of PNES, which involves seizure-like symptoms without the corresponding epileptiform brain activity, as noted in the study by 1. The unresponsiveness in PNES is typically not associated with the post-ictal confusion commonly seen after true epileptic seizures, and patients often recover more quickly. PNES is understood to be a manifestation of psychological distress, often related to past trauma, anxiety, or other psychological factors, rather than abnormal electrical activity in the brain.
Key Considerations
- PNES episodes may resemble epilepsy or syncope but are not associated with abnormal electroencephalography changes, as highlighted in 1.
- Management focuses on psychological interventions such as cognitive behavioral therapy, rather than antiepileptic medications, which are generally ineffective for PNES, a point supported by the study 1.
- It's crucial to approach patients with PNES with a plan that includes moving them to a safe space, avoiding constant reassurance and physical contact or restraint, and sometimes using sensory grounding techniques to help prevent dissociation, as suggested in 1.
- Relatives or colleagues should be informed about what to do during a typical attack, including not calling an ambulance unless necessary and providing comfort after the attack, as advised in 1.
Clinical Implications
- Diagnosis typically requires video-EEG monitoring to distinguish PNES from epileptic seizures, as treatment approaches differ significantly.
- Accurate diagnosis and appropriate referrals for these patients are important, as noted in 1, where it was found that 72% of patients’ PNES had resolved after psychiatric treatment.
- Clinicians should be aware that some patients may have both a true seizure disorder and PNES, making management complex, as discussed in 1.
From the Research
Characteristics of Psychogenic Non-Epileptic Seizures (PNES)
- PNES are defined as changes in behavior or consciousness resembling epileptic seizures but have a psychological origin 2.
- They are categorized as a manifestation of dissociative or somatoform (conversion) disorders 2.
- PNES represent a symptom, not the underlying disease, and the mechanism of dissociation is pivotal in the pathophysiology 2.
Diagnosis and Presentation of PNES
- The diagnosis of PNES is usually confirmed by recording spells using video EEG 3.
- PNES can present emergently and are often mistaken for epileptic seizures 4.
- Patients with PNES may become unresponsive during episodes, which can be mistaken for epileptic seizures or status epilepticus 4.
Patient Outcomes and Response to PNES
- PNES can cease or significantly decrease in most patients after diagnosis, but occupational status does not improve as often 5.
- Earlier diagnosis may improve outcome, and persisting PNES are associated with longer duration of PNES before diagnosis and presence of additional psychiatric disease 5.
- Patients with PNES may experience serious morbidities, including self-harm and suicide attempts, particularly when misdiagnosed in an emergency setting 4.
Clinical Implications and Management
- Increased awareness of PNES is necessary to prevent iatrogenic harm and to identify underlying psychiatric illnesses that carry their own risks 4.
- The process of communicating the diagnosis using a multidisciplinary approach is an important and effective therapeutic step 2.
- PNES may be associated with various comorbid disorders, including other dissociative and functional disorders, post-traumatic stress disorder, depressive and anxiety disorders, and personality disorders 6.