Psychogenic nonepileptic seizures (PNES) cause significant suffering, and most patients with undiagnosed and/or untreated PNES continue to have seizures and remain on disability.
The correct answer is B.
PNES are transient and paroxysmal, often triggered by a stressor. The majority of patients have a history of emotional, physical, or sexual trauma, as well as one or more psychiatric comorbidities, including depression, anxiety, PTSD, and personality disorders.
Unlike factitious disorder and malingering, patients with PNES and other functional neurological disorders do not consciously produce symptoms and may experience symptoms even when there is no possibility of primary or secondary gain.
The gold standard for diagnosis of PNES entails capture of all habitual episode types on vEEG, with normal brain activity before, during, and following the event as well as semiology (signs and symptoms) consistent with PNES.1 While vEEG capture of all typical events is necessary to make a diagnosis of PNES, the diagnosis may be made with lower levels of certainty as possible or probable PNES based on interictal EEGs and verbal descriptions or video recordings of typical seizures.
A growing body of evidence demonstrates that weekly CBT-informed regimens are effective in reducing PNES frequency and improving quality of life. Goldstein and colleagues2 draws primarily on standard CBT principles and techniques. Research by LaFrance and colleagues3 incorporates psychoeducation, mindfulness, and interpersonal therapy theory and techniques into the CBT.
SSRIs have not shown a consistent benefit for PNES. Psychopharmacologic therapy is therefore recommended for treatment of psychiatric comorbidities but not for PNES itself. Rapid titration off all anti-seizure medications under vEEG monitoring at the time of diagnosis has been shown to result in improved seizure frequency and a greater internal locus of control for patients.
For more on this topic, see Addressing Psychogenic Nonepileptic Seizures: Clinical Challenges, on which this quiz is based.
From our archives:
Psychogenic Non-Epileptic Seizures: Clinical Issues for Psychiatrists
The authors offer insights on how to develop an appropriate treatment plan.
Comorbid Medical Illnesses in Children With Psychogenic Nonepileptic Seizures
In children, the characteristics of PNES closely resemble actual seizure symptoms.
1. LaFrance WC, Jr, Baker GA, et al. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013;54:2005-2018.
2. Goldstein LH, Chalder T, Chigwedere C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology. 2010;74:1986-1994.
3. LaFrance Jr WC, Baird GL, Barry JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997-1005.
Image credit: ©dizain/AdobeStock