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Cleveland Clinic Journal of MedicinePsychogenic Nonepileptic Seizure: An Empathetic, Practical Approach

Unraveling Psychogenic Nonepileptic Seizures: A Deep Dive into Psychological Underpinnings and Diagnostic Pathways

Psychogenic nonepileptic seizures (PNES) represent a complex intersection between neurology and psychiatry, often leading to misdiagnosis and mistreatment. Essential for physicians is an understanding of the diagnostic process, the role of psychological factors in PNES, and the nuanced approach required for effective patient communication and treatment. This article digs deep into the critical aspects of PNES, offering a comprehensive guide to aid in the accurate diagnosis and empathetic management of this condition.

Key Points:

  • PNES is often misdiagnosed as epilepsy, which can result in unnecessary medical interventions and overlook the necessary psychological care.
  • Inpatient video EEG in an epilepsy monitoring unit is the gold standard for diagnosing PNES, distinguishing it from epileptic seizures.
  • PNES patients frequently experience a sense of being misunderstood or accused of feigning their symptoms, exacerbating their psychological distress.
  • The pathophysiology of PNES suggests a network disorder involving areas of the brain associated with sensorimotor processing and emotional regulation.
  • PNES prevalence is notable, particularly among women and individuals with a history of abuse, pointing to a strong correlation with psychological trauma.
  • Effective communication of the diagnosis, emphasizing the legitimacy of the patient’s symptoms and the non-epileptic nature of their condition, is crucial for patient engagement in treatment.
  • Psychotherapy, tailored to address individual psychological triggers and coping mechanisms, has shown efficacy in PNES treatment, with cognitive behavioral therapy being particularly beneficial.
  • Antiseizure medications are not recommended for PNES management and should be discontinued to avoid potential side effects and improve outcomes.
  • Understanding and addressing comorbid psychiatric conditions, such as PTSD and depression, are vital components of effective PNES management.
  • PNES treatment adherence can be challenging due to various factors, including patient acceptance of the diagnosis and access to specialized psychological care.

Epilepsy Currents reports the prevalence of PNES in the United States has been estimated to be 2 to 33 per 100,000 people, with a mean incidence of 3 per 100,000 people per year in those over age 18.

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