Etiology, diagnosis, and treatment of nonepileptic seizures

Abstract

Psychogenic nonepileptic seizures (NES) can be classified into five categories. This review focuses on NES associated with emotional conflict, by far the most common and important group. Etiology is speculative, but the background histories of these patients are often similar. The presence of a trauma history, depression, post-traumatic stress symptoms, and the use of dissociation plus cognitive dysfunction possibly point to an organic etiology. The presentation of NES in children and adults is discussed, along with the differential diagnosis. The diagnostic differential is lengthy, with epileptic seizures of frontal lobe origin presenting a unique challenge. Diagnostic procedures are reviewed with an emphasis on the utility of hypnosis with seizure induction. Presenting the diagnosis to the patient, the role of the neurologist, and the role of the mental health consultant are reviewed. Issues in the doctor-patient relationship are also addressed, as well as the overall prognosis.

A Seizure by Any Other Name: Challenges and Long-Term Implications of Psychogenic Nonepileptic Seizures

“…This overlap makes clinical distinction more challenging. Several differences in presentation between epileptic and nonepileptic seizures have been noted across the literature (21,22). These findings are summarized in Table 1.…”

Psychogenic Nonepileptic Seizures: What a Neurologist Should Know

“…Typical PNES features include a gradual onset, long duration, waxing and waning course, and disorganized, asymmetrical motor activity [15]. PNES also lack the stereotypy of epileptic seizures; that is, the pattern of symptoms and sequence of events vary between seizures.…”

“…Frontal lobe seizures are often mistaken for nonepileptic seizures because of their dramatic motor and vocal outbursts, possible retained consciousness and short post-ictal period. They may be distinguished from PNES by their brief duration, stereotypical nature, and tendency to begin during sleep [15].…”

Nonepileptic Seizures: An Overview

“…38 The mental health consultant can provide an assessment of the patient and the family milieu and help the treatment team with the "difficult patient." 39 It has been suggested that it is important for the mental health consultant to hold a family meeting, presenting the diagnosis and treatment options. 40 NES have also been visualized as similar to the compulsive behaviors of people with addictions.…”