PNES Epidemiology: What is known, what is new?

Case report on psychogenic nonepileptic seizures: A series of unfortunate events

“…While not elicited during this presentation, the patient would benefit from a detailed, systematic psychiatric evaluation assessing family, social, financial, and employment challenges. 1,11,16 Psychotherapy remains a validated treatment modality in PNES. 10 In a large, multicenter randomized controlled trial in the UK (CODES, 2020) 29 , researchers observed more favorable clinically relevant secondary outcomes in patients receiving cognitive-behavioral therapy (CBT), such as coping with PNES diagnosis and overall quality of life in addition to specialist care.…”

“…Encouraging self-guided learning by providing tools such as leaflets and reliable health websites and introducing patients to a community of others dealing with PNES may decrease truancy to care. 11 Occasionally, family members and even health professionals may accuse patients with PNES of faking their symptoms. 21 In these instances, physicians thereby embark on rebuilding trust following a breakdown in communication, disappointment, and delays in treatment.…”

“…In these instances, physicians thereby embark on rebuilding trust following a breakdown in communication, disappointment, and delays in treatment. While not elicited during this presentation, the patient would benefit from a detailed, systematic psychiatric evaluation assessing family, social, financial, and employment challenges 1,11,16 . Psychotherapy remains a validated treatment modality in PNES 10 .…”

“…The prevalence range of PNES is 2-33 cases per 100,000/ year. 11,12 In 2017, it was ranked among the top three neuropsychiatric problems by the ILAE. 6,13 The risk factors described in PNES include, but are not limited to, sexual abuse, anxiety disorder, physical abuse or neglect, traumatic brain injury, and psychiatric comorbidities, with high post-traumatic stress disorder (PTSD) rates.…”

“…For instance, in a controlled study, researchers observed asynchronous jerks in 96% of PNES cases versus 5% in ES, suggesting this is an important sign and discriminating feature of PNES 4,8,9 . The International League Against Epilepsy (ILAE) Task Force (2013) suggests that in settings with video electroencephalography (vEEG), this, in combination with direct observation of abnormal signals, offers a diagnostic “gold standard.” 10,11 …”