Diagnosis and Treatment of Nonepileptic Seizures

David K. Chen, MD;; W. Curt LaFrance, Jr, MD, MPH, FAAN, FANPA, DFAPA Epilepsy p. 116-131 February 2016, Vol.22, No.1 doi: 10.1212/CON.0000000000000282
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Purpose of Review: This article details the evaluation process involved in the diagnosis of psychogenic nonepileptic seizures (PNES). The psychological underpinnings, prognostic factors, and recent treatment advances of PNES are also reviewed.

Recent Findings: The diagnosis of PNES is determined based on concordance of the composite evidence available, including historical and physical examination findings, seizure symptoms and signs, and ictal/interictal EEG. No single clinical data point is definitively diagnostic of PNES. The diagnosis of PNES can be challenging at times, such as when seizure documentation on video-EEG cannot be readily obtained. Yet, delayed diagnosis of PNES portends poor outcome. A multicomponent approach to the diagnosis of PNES, with use of an aggregate of available evidence, may facilitate diagnosis and then care of patients with PNES. Emerging evidence supports the effectiveness of cognitive-behavioral–based therapy in the treatment of these patients.

Summary: The diagnosis of PNES can be made reliably, and evidence-based treatment now exists. Continued efforts remain necessary to enhance prompt recognition and interdisciplinary management for patients with PNES.

Address correspondence to Dr W. Curt LaFrance Jr, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903, [email protected].

Relationship Disclosure: Dr Chen reports no disclosure. Dr LaFrance serves on the Epilepsy Foundation Professional Advisory Board; has served as a clinic development consultant for the Cleveland Clinic, Emory University, Spectrum Health, and the University of Colorado Denver; and has provided expert medicolegal testimony. Dr LaFrance receives royalties from Cambridge University Press and Oxford University Press and has received research support from the American Epilepsy Society, the Epilepsy Foundation, the Matthew Siravo Memorial Foundation Inc, the National Institutes of Health, and Rhode Island Hospital.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Chen and LaFrance report no disclosures.

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 app versions of this article; the URLs are provided in the print version. Video legends begin on page 128.

© 2016 American Academy of Neurology