From the Research
Definition and Characteristics of PNES
- Psychogenic nonepileptic seizures (PNES) are a functional neurological disorder/conversion disorder subtype, which are neurobehavioral conditions at the interface of neurology and psychiatry 1
- PNES are episodes of movement, sensation, or behaviors that are similar to epileptic seizures but do not have a neurologic origin; rather, they are somatic manifestations of psychologic distress 2
- PNES constitute one of the most important differential diagnoses of epilepsy, but despite their recognition as a distinctive clinical phenomenon, our understanding of the etiology, underlying mental processes, and treatment remains limited 3
Diagnosis of PNES
- The diagnosis of PNES is usually confirmed by recording spells using video EEG 4
- Clinical features of the history and spells allow the diagnosis of PNES to be suspected, and the diagnosis can be confirmed by capturing a typical event on video electroencephalography (EEG) showing the absence of epileptiform activity with history and semiology consistent with PNES 1
- Consensus guidelines for diagnostic certainty are based on clinical history, semiology of witnessed typical event(s), and EEG findings 1
Treatment and Management of PNES
- Treatment involves discontinuation of antiepileptic drugs in patients without concurrent epilepsy and referral for appropriate psychiatric care 2
- Cognitive-behavioral therapy-informed psychotherapy is an efficacious treatment for PNES, and additional efforts are necessary to evaluate the utility of pharmacologic and other psychotherapy treatments 1, 5
- A mindfulness-based psychotherapy protocol has been shown to be feasible in real-life clinical scenarios and warrants further investigation in larger scale studies 5
Epidemiology and Comorbidities
- From 5 to 10 percent of outpatient epilepsy patients and 20 to 40 percent of inpatient epilepsy patients have PNES 2
- Patients with PNES frequently have comorbid psychiatric illnesses, most commonly depression, posttraumatic stress disorder, other dissociative and somatoform disorders, and personality pathology, especially borderline personality type 2
- Many patients have a history of sexual or physical abuse, and between 75 and 85 percent of patients with PNES are women 2