From the Research
The prevalence of non-epileptic seizures in patients with epilepsy is estimated to be around 5-20%, with some studies suggesting up to 30% of patients with epilepsy may experience both epileptic and non-epileptic seizures. This comorbidity creates significant diagnostic challenges for clinicians. Non-epileptic seizures, also called psychogenic non-epileptic seizures (PNES) or functional seizures, are episodes that resemble epileptic seizures but lack the characteristic electrical discharges in the brain that define epilepsy.
Key Points
- The gold standard for differentiating between these conditions is video-EEG monitoring, which allows clinicians to observe seizure events while simultaneously recording brain activity 1.
- However, a recent study suggests that video alone can be used to differentiate epileptic seizures from non-epileptic spells with a high degree of accuracy, with a sensitivity of 82.2% and specificity of 84.7% 1.
- Patients with both conditions often require a multidisciplinary approach to treatment, including antiseizure medications for epileptic seizures and psychological interventions such as cognitive behavioral therapy for non-epileptic seizures.
- This dual diagnosis is particularly common in specialized epilepsy centers where more complex cases are referred, and recognition of this overlap is essential for appropriate management and improved patient outcomes.
Diagnosis and Treatment
- The diagnosis of PNES typically begins with a clinical suspicion and then is confirmed with EEG-video monitoring or video alone 1.
- Provocative techniques, activation procedures, or "inductions" can also be useful for the diagnosis of PNES 2.
- Treatment of patients with both epileptic and non-epileptic seizures requires a comprehensive approach that addresses both conditions, including medication management and psychological therapy.