From the Research
Approximately 10-40% of patients with pseudoseizures (also known as psychogenic non-epileptic seizures or PNES) also have epileptic seizures. This comorbidity creates significant diagnostic challenges for clinicians, as distinguishing between the two conditions often requires video-EEG monitoring 1. The overlap occurs because patients with epilepsy may develop psychological mechanisms that trigger pseudoseizures as a response to stress, trauma, or as a learned behavior. Key factors to consider in diagnosis include:
- Clinical features that can help distinguish PNES from epileptic seizures, such as psychological stress preceding PNES 2
- The importance of video-EEG monitoring as the diagnostic gold standard for PNES 3, 2
- The need for a thorough neurological and psychiatric history to confirm the diagnosis of PNES 2
- The potential for patients with PNES to have concurrent epileptic seizures or a history of epileptic seizures 2, 1 When treating patients with both conditions, it's essential to address both the epileptic seizures with appropriate antiseizure medications and the pseudoseizures with psychological interventions such as cognitive behavioral therapy. Accurate diagnosis is crucial because inappropriate treatment with antiseizure medications for pseudoseizures alone can lead to unnecessary side effects without therapeutic benefit, while failing to treat actual epileptic seizures can result in serious neurological consequences. A multi-disciplinary team approach, involving neurology, psychiatry, psychology, social work, and nursing, is ideal for managing patients with PNES 1, 4.