Abstract
Psychogenic nonepileptic seizures (PNES) are events commonly encountered by primary care physicians, neurologists, pediatricians, and emergency medicine physicians in their practices, yet there continues to be significant variability in the way they are evaluated, diagnosed, and treated. Lack of understanding this condition and limited data on long-term outcome from current treatment paradigms have resulted in an environment with iatrogenic injury, morbidity, and significant costs to the patient and healthcare system. This article will review the current state of research addressing PNES treatment both in the adult and pediatric populations.
Highlights
Psychogenic nonepileptic seizures (PNES) are events commonly encountered by primary care physicians, neurologists, pediatricians, and emergency medicine physicians in their practices, yet there continues to be significant variability in the way they are evaluated, diagnosed, and treated
By DSM-V, PNES will be classified with the diagnosis of conversion disorder with a specific symptom type of attacks or seizures, found under a new category called somatic symptom and related disorders
This study suggested seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNES and other measures—including those related to the specific condition, the particular patient group, psychosocial domains, or objective and subjective components—should be considered [16]
Summary
LaFrance et al [9] suggested a formal psychiatric assessment should be arranged and performed before initiating therapy This would be a mental health professional (i.e., neuropsychiatrist, psychiatrist, or psychologist) with previous experience in the field who is part of the team that has assessed and diagnosed the patient, and who is comfortable with that diagnosis and subsequent management of the condition and other somatoform disorders. In May 2005, an international group of researchers gathered for the NINDS/ NIMH/AES-sponsored Nonepileptic Seizures Treatment Workshop to discuss development of treatments for patients with PNES [23] This workshop set the benchmarks for research in PNES and was key to addressing specific areas such as pediatrics, presenting the diagnosis, classification, outcome measures, and design of treatment trials. Prior studies have been conducted that were funded by NINDS, AES, and EF; they are not listed in this article
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