Nonepileptic Episodic Events

Jennifer L. Hopp, MD, FAAN p. 492-507 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000711
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PURPOSE OF REVIEW: This review addresses the scope, evaluation, treatments, and outcomes of patients with nonepileptic episodic events with a focus on psychogenic nonepileptic seizures. Differentiation of the types of events, including a review of terminology, is included, as well as a brief review of special patient populations with these disorders.

RECENT FINDINGS: There are continued efforts to develop tools to improve the diagnosis of these disorders. A thorough evaluation with trained personnel and physicians knowledgeable in the assessment and treatment of these disorders is important. Although inpatient video-EEG monitoring in an epilepsy monitoring unit remains the gold standard for diagnosis, the assessment of clinical and historical factors is critical and can be useful in expediting the process and improving diagnostic certainty. International efforts have recently assisted in providing guidelines for the evaluation of the psychogenic disorders and may help target educational and other resources to underserved areas.

SUMMARY: The prompt and accurate diagnosis of nonepileptic episodic events and psychogenic nonepileptic seizures is possible with current technology, and the appropriate and targeted use of evidence-based treatments may help improve patient quality of life and avoid unnecessary disability in patients with these disorders.

Address correspondence to Dr Jennifer L. Hopp, Department of Neurology, University of Maryland School of Medicine, 110 S Paca St, 3S-131, Baltimore, MD 21201, JHopp@som.umaryland.edu.

RELATIONSHIP DISCLOSURE: Dr Hopp has received grant/research support as a site principal investigator of the Established Status Epilepticus Treatment Trial from the National Institute of Neurological Disorders and Stroke and from SAGE Therapeutics. Dr Hopp has received personal compensation as a speaker for J. Kiffin Penry Epilepsy MiniFellow Network’s Epilepsy MiniFellowship and Residents Epilepsy Program. Dr Hopp receives publishing royalties from UpToDate, Inc and has given expert medical testimony for Venable LLP.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Hopp discusses the unlabeled/investigational use of sertraline for the treatment of psychogenic nonepileptic seizures.

© 2019 American Academy of Neurology.