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Nonepileptic Behavioral Disorders: Diagnosis and Treatment

Benbadis, Selim R. MD

CONTINUUM: Lifelong Learning in Neurology: June 2013 - Volume 19 - Issue 3, Epilepsy - p 715–729
doi: 10.1212/01.CON.0000431399.69594.de
Review Articles

Purpose of Review: This article will review the important steps in making an accurate diagnosis of psychogenic nonepileptic events or episodes (PNEE), and recent developments in diagnosis and treatment.

Recent Findings: Several clues can be obtained from the history to help the clinician suspect the diagnosis of PNEE. While none of these clues are diagnostic on their own, each is valuable, and there are often multiple clues in a given patient. Clinical clues have limitations, and once PNEE is suspected, video-EEG monitoring remains the gold standard and the only way to make a definite diagnosis of PNEE. Like most tests, video EEG has its limitations, but in most cases the diagnosis can be made and is not difficult. Regarding treatment, growing evidence exists that psychotherapy, especially cognitive behavior therapy, is effective, and a recent finding is that pharmacotherapy may have a role.

Summary: The diagnosis of PNEE can be made reliably, but the management of PNEE remains problematic, in large part because of the insufficient involvement of mental health professionals.

Supplemental Digital Content is available in the text.

Address correspondence to Dr Selim R. Benbadis, University of South Florida and Tampa General Hospital. 2 Tampa General Circle, Floor 6, Tampa, Florida 33606, sbenbadi@health.usf.edu.

Relationship Disclosure: Dr Benbadis is a member of the speakers bureau and serves as a consultant for Cyberonics, Inc, GlaxoSmithKline, Lundbeck, Supernus Pharmaceuticals, Inc, and UCB; serves as an editor for Medscape-WebMD, LLC; and receives research support from Lundbeck, Sunovion Pharmaceuticals, Inc, Supernus Pharmaceuticals, Inc, and UCB.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Benbadis reports no disclosure.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 48.

© 2013 American Academy of Neurology
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