What is the treatment for psychogenic seizures?

Treatment for Psychogenic Seizures

The most effective treatment for psychogenic seizures is a multidisciplinary approach centered on cognitive behavioral therapy (CBT), which has shown to result in seizure reduction of over 50% in 81% of patients, with half becoming seizure-free after treatment. 1

Understanding Psychogenic Seizures

Psychogenic seizures, also known as psychogenic non-epileptic seizures (PNES), are episodes that resemble epileptic seizures but are not associated with abnormal electrical activity in the brain. They are considered a type of functional neurological disorder or conversion disorder.

Key diagnostic features:

• Normal EEG during events (no epileptiform activity) 2
• Preservation of consciousness during events
• Lack of response to antiepileptic medications 3

Treatment Algorithm

Step 1: Proper Diagnosis and Communication

• Ensure accurate diagnosis through video-EEG monitoring to differentiate from epileptic seizures 2
• Carefully explain the diagnosis to the patient, which is a necessary first therapeutic step 4
• Use clear, non-stigmatizing language when discussing the condition with patients 2

Step 2: Psychological Interventions

• First-line treatment: Cognitive Behavioral Therapy (CBT) 1, 3

  • Focuses on identifying triggers and developing coping strategies
  • Addresses underlying psychological factors
  • Typically requires 12-16 sessions

• Adjunctive psychological approaches:

  • Relaxation techniques and stress management 5
  • Family therapy to address interpersonal dynamics 5
  • Psychoeducational programs about the condition 6

Step 3: Psychiatric Assessment and Management

• Evaluate and treat comorbid psychiatric conditions 2
  • Depression and anxiety are common in PNES patients 4
  • Address any trauma history or PTSD symptoms

Step 4: Follow-up and Monitoring

• Regular follow-up to assess:
  • Seizure frequency and severity
  • Quality of life improvements
  • Psychological functioning 1

Evidence for Treatment Effectiveness

• CBT-based interventions show the strongest evidence for effectiveness 1, 3
• In outcome studies, 81% of patients showed >50% reduction in seizures after CBT treatment 1
• Half of treated patients may become seizure-free with appropriate psychological treatment 1
• Patients who achieve seizure freedom show greater improvement in psychological functioning 1

Important Considerations and Caveats

• Avoid antiepileptic drugs as they do not treat the underlying cause and may cloud cognitive skills needed for psychological treatment 5
• Prognosis varies: approximately 25-33% of patients may develop chronic PNES despite treatment 4
• A heterogeneous set of psychological factors may contribute to PNES, requiring individualized psychological assessment 4
• Treatment should address not only seizure reduction but also quality of life improvements 3
• Self-control relaxation paradigms have shown success where pharmacological interventions have failed 5

Special Populations

• For patients with comorbid epilepsy and PNES (approximately 20% of cases), both conditions must be addressed 5
• For patients with communication difficulties (e.g., aphasia), modified approaches using gesture and prosody may be effective 5
• For patients with intellectual disabilities, treatment should be adapted to cognitive level 6

The evidence strongly supports that psychological interventions, particularly CBT, should be the cornerstone of PNES treatment, with careful attention to comorbid psychiatric conditions and quality of life outcomes.