Psychogenic Nonepileptic Seizures (PNES)

Lekhjung Thapa, Nikhil Gaurishankar, Suman Bhattarai, Abhisekh Man Shrestha, DN Gongal, UP Devkota

ABSTRACT

Psychogenic nonepileptic seizures (PNES), or pseudoseizures are involuntary seizure-like attacks that not related to electroencephalographic epileptiform discharges. It can significantly affect the quality of life. PNES is commonly misdiagnosed as epileptic seizures and the real diagnosis is delayed by an average of 7 years. PNES occur in 20% of patients with conversion syndromes. Patients with PNES do not respond to anticonvulsants, may display paradoxical reactions to prescribed treatment regimens, and may develop anticonvulsant toxicity. Interestingly, both the epileptic and non-epileptic patients may suffer pseudoseizures, which should be suspected when seizure is unpredictable or difficult to be controlled, or when ictal or post-ictal electroencephalogram (EEG) are normal and psychopathology is present. Video-EEG monitoring usually establishes the diagnosis of PNES.

Although etiological understanding and evidence-based treatment availability remain limited, cognitive behavioral therapy (CBT) has the highest efficacy evidence in patients with PNES. Both selective and dual selective serotonin reuptake inhibitors (SSRIs) have been investigated as potential useful pharmacologic interventions.

Clinical trials exploring psychological and medical treatment in PNES deserves exploration.

Keywords: pseudoseizures, PNES, conversion disorder