What is PNES and how is it diagnosed?
Psychogenic nonepileptic seizures (PNES) is a disorder characterized by events that mimic epileptic seizures but are not caused by abnormal brain activity. Events related to PNES have an underlying psychological cause. Other terms for PNES are psychogenic seizures or pseudoseizures. The term pseudoseizure is discouraged as it can unintentionally lead others to believe the seizures are not real. PNES is a serious diagnosis and should be treated as such.
The exact cause of PNES is unknown. It is a subtype of a conversion disorder. For people with PNES, their bodies convert an emotional response into a physical response. It is important to remember that the person does not have control over this response.
As it can be difficult for PNES to be distinguished from epileptic seizures, patients will often see a neurologist, and the doctor will begin by taking a thorough medical history.
Tests such as a routine electroencephalogram (EEG) or magnetic resonance imaging (MRI) may also be ordered.
The Nonepileptic Seizure Task Force of the International League Against Epilepsy indicates that Video-EEG (vEEG) is the gold standard for diagnosis of PNES. During a vEEG, the patient’s brain waves are monitored by the EEG and any events are recorded on video. The video will allow doctors to review any behaviors or sounds that occur during the event. If a person is experiencing multiple seizure types, each type should be captured by vEEG.
However vEEG is not always available, and a doctor with experience in diagnosing seizure disorders may be able to diagnose PNES without vEEG. Psychogenic seizures have different characteristics then epileptic seizures, and an experienced doctor may be able to recognize these differences, particularly if a seizure is witnessed by the doctor or if someone else is able to record a seizure on video.
What is the treatment for PNES?
Antiepileptic drugs will not treat PNES and may even increase events. Once diagnosed, patients with PNES should seek psychiatric and psychological health care for treatment.
Cognitive Behavioral Therapy (CBT) is a psychological treatment that has been shown to be effective in managing many mental health disorders, including PNES. CBT can help a person to identify unhelpful thinking and behaviors and teach helpful coping skills, which may result in symptom relief. Research has been shown that CBT may help control psychogenic seizures, however, other psychological therapies, such as individual therapy or group therapy, may be beneficial as well.
Can you have both epilepsy and PNES?
Yes, a person can have both conditions during his/her life or these conditions may even occur at the same time. This is why each seizure type needs to be documented.
Content provided by Epilepsy Alliance Louisiana