Cleveland Clinic Journal of MedicinePsychogenic Nonepileptic Seizure: A Neurologist’s Perspective

Bridging Neurology and Psychiatry: Unveiling the Pathway to Understanding and Treating Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) present a unique clinical challenge, blending the realms of neurology and psychiatry. This article discusses the diagnostic journey and therapeutic approaches for PNES, underscoring the critical role of neurologists in initiating a treatment trajectory that leverages psychiatric intervention for effective management. With a focus on evidence-based practices, the article illuminates the path toward improved patient outcomes in this complex interplay of mind and body.

Key Points:

• PNES represents a condition where patients experience seizure-like episodes without epileptic activity, differentiated through video EEG.
• Swift referral from primary care or emergency physicians to neurologists is crucial for timely and accurate diagnosis using inpatient video EEG.
• Video EEG serves as a definitive diagnostic tool in PNES, distinguishing it from epileptic seizures by showcasing normal cerebral rhythms during episodes.
• Neurologists play a pivotal role in conveying the diagnosis to patients and families, where the approach can significantly influence the therapeutic outcome.
• Empathy and clarity in discussing the diagnosis with patients are vital, aiding in their understanding and acceptance of the condition and its psychological underpinnings.
• Transitioning patients to psychiatric care is a key step, with a focus on addressing the mind-body interaction believed to trigger PNES.
• PNES can also manifest in children, with a potentially better prognosis than in adults, often linked to external stressors or mood disorders.
• The emergence of evidence-based psychotherapy marks a significant advancement in treating PNES, promising better quality of life for affected individuals.

According to Nature Reviews Neurology, 70% of PNES cases develop between the second and fourth decades of life, but this disease can also affect children and the elderly. At least 10% of patients with PNES have concurrent epileptic seizures or have had epileptic seizures before being diagnosed with PNES.

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