Psychogenic nonepileptic seizures: review and update
Abstract
The population incidence of psychogenic nonepileptic seizures (PNES) may be only 4% that of epilepsy, but many patients with PNES have a tendency to seek medical attention, and PNES make up a larger share of the workload of neurologists and emergency and general physicians. Although a great number of publications describe how PNES can be distinguished from epileptic seizures, it usually takes several years to arrive at this diagnosis, and three-quarters of patients (with no additional epilepsy) are treated with anticonvulsants initially. However, the management of PNES as epileptic seizures can lead to significant iatrogenic harm. Moreover, the failure to recognize the psychological cause of the disorder detracts from addressing associated psychopathology and enhances secondary somatization processes. This review provides an overview of studies of the diagnosis, etiology, treatment, and prognosis of PNES. Physicians should always consider PNES in the differential diagnosis of a seizure disorder. If a diagnosis of PNES is possible, or a diagnosis of epilepsy in doubt, a clear diagnostic categorization should be sought. This should involve the assessment of the patient by a physician versed in the diagnosis of seizure disorders and, in many cases, the documentation of a typical seizure by video-EEG. Outcome may be improved if the diagnosis is more actively sought, made earlier, and communicated more convincingly.
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Findings are insufficient and unsuitable for the diagnosis of an epileptic event or convulsive syncope in this case.
“findings are insufficient and unsuitable for the diagnosis of an epileptic event or convulsive syncope (55, 95, 96).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [96]
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- Authors
- Reuber, M., & Elger, C. E.
- Affiliations
- Royal Hallamshire Hospital (GB)
- University of Bonn (DE)
- Corresponding author
- Reuber, Markus
- Venue
- Epilepsy & Behavior
- Publisher
- Elsevier BV
- Published
- 2003-06
- Volume
- 4
- Issue
- 3
- Pages
- 205-216
- ISSN
- 1525-5050 (ISSN-L)
- OpenAlex
- W2112340291
- Cited by
- 404
- References
- 188
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 12 · 2023: 15 · 2022: 14 · 2021: 19 · 2020: 21 · 2019: 16 · 2018: 19 · 2017: 15 · 2016: 20 · 2015: 19 · 2014: 30 · 2013: 20 · 2012: 22
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epilepsy & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- psychogenic non-epileptic seizures, anticonvulsant therapy, iatrogenic injury, somatization, psychopathology, etiology, prognosis, delayed diagnosis
- MeSH terms
- Anticonvulsants, Anxiety Disorders, Diagnosis, Differential, Electroencephalography, Epilepsy, Humans, Terminology as Topic, Psychotherapy, Stress Disorders, Post-Traumatic, Neurocognitive Disorders
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