Treatment of Patients With Psychogenic Nonepileptic Attacks

Abstract

Psychogenic nonepileptic attacks (PNEA), also known as psychogenic nonepileptic seizures, dissociative seizures, or pseudoseizures (a term now widely considered pejorative), can be terrifying and frustrating for patients and their families. PNEA are transient episodes of involuntary movements or altered consciousness caused by psychological mechanisms, often involving intense stress. They are the most common form of functional neurological disorder, the preferred term for what was previously known as conversion disorder. Unlike factitious disorder or malingering, PNEA are not consciously produced or controlled by the patient, ie, they are not "faked." Individuals with PNEA may thrash and jerk their limbs, fall to the floor, roll back and forth, or simply close their eyes and become unresponsive as if asleep. PNEA can appear very much like epileptic seizures, in which abnormal electrical discharges in the brain cause similar episodes of involuntary movements and altered consciousness.The criterion standard for diagnosis of PNEA entails the capture of all typical episodes on videoelectroencephalogram (vEEG), demonstrating normal brain activity before, during, and following the event, and semiology (signs and symptoms) consistent with PNEA as determined on video review by an experienced

Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty

“…During these episodes, patients manifest complex partial seizure activity, but seizure activity is not demonstrated on electroencephalograms (EEG). It is therefore, considered a diagnosis by exclusion [89]. These episodes may be accompanied by myoclonic jerks.…”

Myths and truths about pediatric psychogenic nonepileptic seizures

“…Benbadis said it best when he wrote, “PNES are a real condition that arises in response to real stressors. These seizures are not consciously produced and are not the patient’s fault.” [ 3 , 9 ] PNES and factitious disorder/malingering are completely different disorders: symptoms of the former are not consciously produced and do respond to psychotherapy, whereas those of the latter are consciously produced and do not respond well to psychotherapy [ 10 ].…”

“…Neither of these professionals is willing or prepared to assume treating this complex condition [ 20 ]. Psychiatrists tend to be skeptical of the diagnosis of PNES and question the accuracy of vEEG [ 10 , 21 ]. Neurologists are primarily focused on ruling out epilepsy, and many feel that any aspect of the treatment of PNES is not their responsibility [ 5 , 10 ].…”

“…Psychiatrists tend to be skeptical of the diagnosis of PNES and question the accuracy of vEEG [ 10 , 21 ]. Neurologists are primarily focused on ruling out epilepsy, and many feel that any aspect of the treatment of PNES is not their responsibility [ 5 , 10 ]. Because of the gaps in diagnostic and therapeutic services, many patients feel left in limbo [ 5 ].…”

Intubation for Psychogenic Non-Epileptic Attacks: Frequency, Risk Factors, and Impact on Outcome

“…Results: Of 80 patients who were admitted via the ED and had PNEA documented by vEEG, 12 (15%) were intubated. Compared with non-intubated PNEA patients, intubated patients had longer duration of convulsive symptoms vs 2 [IQR 1-9] minutes, P = 0.01), were less likely to have a normal Glasgow Coma Scale score of 15 (33% vs 94%, P < 0.001), received higher doses of benzodiazepines (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) vs 10 [IQR 5-20] mg of diazepam equivalents, P = 0.004), and were treated with more antiepileptic drugs (AEDs, 2 [IQR 1-3] vs 1 [IQR 1-2], P = 0.01). Hospital length of stay was longer (3)(4)(5) vs 2 [IQR 2-3], P = 0.001), and the rate of complications (25% vs 4%, P = 0.04) and re-hospitalization from a recurrent episode of PNEA within 30 days was higher among intubated PNEA patients (17% vs 0%, P = 0.02).…”