Diagnostic perspective in psychogenic nonepileptic seizures: An overview

Abstract

Psychogenic nonepileptic seizures (PNESs) are the episodes altered movement, sensation, or experience similar to epilepsy but caused by psychological process and not associated with abnormal discharges in the neurons. Diagnosing PNES is extremely a tough work for a neurologist because of its psychological etiology and somatic manifestation. The patients with PNES are frequently misdiagnosed for epilepsy and exposed to antiepileptic drugs for several years which risk their life and put unnecessary economic burden on them. Majorly, while diagnosing PNES, the neurologist has to rule out several neurological and psychological disorders. PNES multiple etiologies and lack of quantifiable biomarkers make its diagnosis more difficult and inaccurate. Although the gold standard measure to diagnosis PNES is video-encephalography, it is always not available for the assessment and is too costly. Therefore, neurologists go for other diagnostic procedures to distinguish PNES from epilepsy. Psychological assessment of the patients; semiological and historical details of the patients; postictal observation; and provocation techniques such as saline injection, verbal suggestion, moist swab application, tuning fork application, and compressed temple region are being used in a substantial way to diagnose PNES. Besides, these neuroimaging techniques such as electroencephalography and magnetic resonance imaging and chemical biomarker such as serum prolactin are also being measured to be sure for PNES diagnosis. Further, it must be understood that above assessment procedures are not independent but are complementary to each other, and hence, PNES etiology is still going through elucidation process. Therefore, diagnosing PNES is a cumbersome task. However, if diagnosis of PNES is made with joint efforts of neurologist, psychologist, and psychiatrist, although usually not practiced, only then one can arrive at a definite conclusion.