Psychogenic Non-Epileptic Seizures (PNES)

Psychogenic non-epileptic seizures (PNES) are a common presentation to the emergency rooms and neurology departments, and they are difficult to discriminate from epileptic seizures (ES). PNES present as paroxysmal time-limited, alterations in motor, sensory, autonomic, and/or cognitive signs and symptoms, but unlike epilepsy, PNES are not caused by ictal epileptiform activity. There is no exact known etiology or mechanism for PNES so far. The most recognized factors discussed in the literature include trauma and child adversity, dissociation, somatization, emotional processing, psychiatric comorbidities, coping styles, and family dysfunction. The use of a comprehensive assessment model may ease the transition of patient care from the diagnosing team to the outpatient treatment provider. Recognition of the characteristic clinical features of PNES and utilization of video-EEG to confirm the diagnosis are critical. Communicating the diagnosis, discontinuation of treatment for epilepsy (unless comorbid PNES and epilepsy are present), and implementing proper liaison with a multidisciplinary team with clinical psychologists, neurologists, and psychiatrists improve patient and healthcare outcome.