Focus On with Dr. Sadek: Understanding Psychogenic Non-Epileptic Seizures
Psychogenic non-epileptic seizures (PNES) are a common and often challenging diagnosis. These events present as symptoms that mimic and often on the surface look like epileptic seizures. They can involve symptoms such as convulsions, limb shaking, loss of consciousness, uncontrolled body movements, and falls. From the outside it can often be difficult to distinguish between non-epileptic and epileptic seizures.
Unlike epilepsy, PNES is not caused by abnormal electrical brain activity, but rather as a manifestation of psychological distress. Underlying psychological issues such as mood disorders, history of abuse, post-traumatic stress disorder, and other psychiatric diagnoses are common in patients with PNES.
Certain features such as excessively frequent seizures, very prolonged seizures, and lack of response to anti-seizure medications can raise the concern for PNES however the diagnosis is best made by an epilepsy specialist. Video-EEG monitoring that captures the events in question with simultaneous analysis of clinical video and brain wave recordings is essential in making a precise diagnosis. It is essential to get an accurate diagnosis as early as possible. Misdiagnosis can lead to unnecessary prescribing of anti-seizure medications and other implications.
PNES can be a challenging diagnosis to understand and accept. The events experienced in PNES are real and are not voluntarily initiated by the patient but rather a response to trauma or other real stressors. Treatment should emphasize on addressing the underlying psychological problems and often centers around different types of psychological therapy, mainly cognitive behavioral therapy. Treatment may take time, but when working with a multi-disciplinary team of specialists familiar with the diagnosis the prognosis can be favorable.