An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management
THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES INC
The diagnosis and management of Psychogenic non-epileptic seizures (PNES) can be very challenging. This article proposes a diagnostic and treatment algorithm suggesting a multidisciplinary approach to probably improve the outcomes of patients suffering from PNES. The coexistence of epilepsy and PNES poses special challenges, which require the coordinated efforts of family physicians, psychiatrists, psychologists, neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes.
Psychogenic non-epileptic seizures (PNES) is a condition that mimics epileptic seizures but originates from psychological rather than neurological dysfunction. Psychogenic nonepileptic seizures are most likely to be misdiagnosed as epilepsy and may go undiagnosed for several years. The estimated prevalence of PNES is about 15 per 100,000 people. PNES can be very disabling and may result in significant personal, social, and occupational impairment. These seizures are more common in women than men and typically occur between the ages of 20 to 40 years old. Psychogenic nonepileptic seizures have a wide variety of symptoms, but typically include loss of bladder or bowel control and/or unconsciousness. Psychogenic nonepileptic seizures are usually shorter than epileptic seizures (typically less than 30 seconds).
Psychogenic nonepileptic seizures are more likely to occur in clusters. Psychogenic non-epileptic seizures can have a wide range of associations, including psychological factors such as anxiety or depression and physical factors such as head injury or metabolic disorders. Psychogenic non-epileptic seizures often coexist with epilepsy. Diagnosis is based on history, electroencephalography (EEG), neuroimaging results, video EEG monitoring, electromyography (EMG) and/or polysomnography where available. Treatment for PNES is directed at the underlying psychiatric disorder(s). Antiepileptic drugs should not be used except in patients who also have true epileptic because they may worsen outcomes and confusion. Psychotherapy, cognitive-behavioral therapy (CBT), and family therapy are the mainstay of treatment for PNES.
This referenced article was written by Dr. Sameer Zuberi, a neurologist with the Hamilton Health Sciences Division of Neurology and Associate Clinical Professor at McMaster University in Hamilton, ON. For more information on Psychogenic non-epileptic seizures please visit the Canadian Epilepsy Alliance website or contact info@epilepsyontario.org.