Chapter 12 - Nonepileptic seizures

Summary

Psychogenic nonepileptic seizures (PNES) are paroxysms of altered bodily/mental function. Careful history-taking can elicit most risk factors for PNES. Comorbid psychiatric diagnoses including depression, anxiety, and personality disorder, and family history of psychiatric disorders are also PNES risk factors. Seizure semiology is crucial for raising the clinician's suspicion of PNES, and is often the first step towards making the correct diagnosis. Most studies that assess seizure semiology are structured as retrospective analyses of long-term video EEG. Various prognostic indicators have been reported including clinical and psychological factors. Poorer prognosis is associated with the presence of chronic depression, an Axis II personality disorder, and a history of abuse or trauma. Clinical experience and prior-published treatment reports reveal that coordination between neurologists and psychiatrists/psychologists, with accurate diagnosis and prompt initiation of psychotherapy and communication between care providers, patient and family, yields higher treatment success.