Closing the Major Gap in PNES Research

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.

A Therapeutic Approach to Psychogenic Nonepileptic Seizures

“…This could be due to the limited understanding of mechanisms underlying PNES and the lack of sufficiently powered randomized controlled trials (RCTs) evaluating the efficacy of different treatment modalities [17,9]. A major barrier to performing RCTs for PNES treatment is the limited funding [9].…”

“…Prolonged video-EEG monitoring (usually performed in a SMU) should document habitual seizure types and investigate whether the patient has PNES alone or with co-existent epilepsy, which can be present in up to 9.5 % of cases [10]. Misdiagnosis may occur when based on history alone or observation of a singular event [9].…”

“…This could be due to the limited understanding of mechanisms underlying PNES and the lack of sufficiently powered randomized controlled trials (RCTs) evaluating the efficacy of different treatment modalities [17,9]. A major barrier to performing RCTs for PNES treatment is the limited funding [9]. Nevertheless, the recent publication of the results of three pilot RCTs [18, 19, 20••], including a well-conducted study with high-quality evidence for cognitive behavioral therapy (CBT) [20••], is quite promising.…”

“…The diagnosis of PNES is usually based on clinical history and video-EEG monitoring, which is considered the gold standard for diagnosing the condition [9]. Prolonged video-EEG monitoring (usually performed in a SMU) should document habitual seizure types and investigate whether the patient has PNES alone or with co-existent epilepsy, which can be present in up to 9.5 % of cases [10].…”

Ethical dilemmas in pediatric and adolescent psychogenic nonepileptic seizures

“…Even the terminology used to refer to the diagnosis has sparked substantial debate and can negatively impact the patient’s treatment course [4, 16 – 19]. 1 While the literature to date has discussed a small sampling of these issues across patient populations [4–22], it has not examined the unique moral dilemmas involved in the diagnosis and treatment of pediatric and adolescent patients with PNES [3, 22]. Awareness of these ethical challenges can help clinicians address some of the obstacles in the care of young patients with PNES.…”