From the Guidelines
The best treatment for psychogenic nonepileptic seizures (PNES) in children is psychological therapy, delivered by specially trained clinicians 1.
Key Components of Treatment
- The treatment plan should include a DS plan, which helps put clinicians at ease and makes the person feel safer, preventing escalation and reducing the duration of the episode.
- Identifying triggers and warning signs of an imminent episode is crucial, as it allows for the implementation of strategies to avert the event.
- Sensory Grounding Techniques can be helpful in keeping people present in the moment and focusing attention to prevent dissociation, examples include:
- Noticing the detail in the environment (e.g., colors, textures, and sounds)
- Cognitive distractions (e.g., word games and counting backwards)
- Sensory-based distractors (e.g., flicking a rubber band on the wrist and feeling a textured item)
Approach to Treatment
When a person is having a PNES episode, it is essential to:
- Help them to a safe space where they are unlikely to injure themselves
- Let them know they are safe, but avoid constant reassurance and physical contact or restraint
- Advise others to behave as they would if someone is having a panic attack It is also important to note that people can sometimes hear and understand what you say during a PNES episode, even if they are unable to respond 1.
From the Research
Treatment Options for PNES in Children
- The current standard for therapy is psychotherapy that utilizes principles of cognitive behavioral therapy 2
- Treatment may also include education around diagnosis, individual psychological treatment, and additional mental health services such as psychiatric medication, family therapy, and admission to day or inpatient treatment 3
- Accurate diagnosis and referral to psychology can lead to high rates of full remission (no new events) and partial remission (50% or greater reduction in events) as self-reported at discharge 3
Importance of Accurate Diagnosis
- Accurate diagnosis is crucial to avoid unnecessary medical investigation and therapy, and to expedite rates of remission 3
- Diagnosis can be supported using video electroencephalography recording, and communication of the diagnosis to patients and families in a compassionate way is of paramount importance 2
Challenges in Diagnosis and Treatment
- PNES can be difficult to diagnose, especially in children who have both epileptic and nonepileptic seizures 4
- Video EEG and home video can help clinicians in diagnosis, but more studies are needed to better classify PNES in children and facilitate diagnosis and treatment 4
- Management consists of making the patient and relatives aware about the causation and diagnosis, and treatment may include psychotherapy, behavior therapy, drugs, hypnosis, and placebo 5