Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders

LANZILLOTTI, ALEJANDRA INÉS; SARUDIANSKY, MERCEDES; LOMBARDI, NICOLÁS ROBERTINO; KORMAN, GUIDO PABLO; D´ALESSIO, LUCIANA

Neuropsychiatric Disease and Treatment

Dovepress

Lugar: London; Año: 2021 vol. Volume 17 p. 1825 - 1838

Abstract: Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic eventsassociated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and30% of patients attending at epilepsy centers and constitute a serious mental health problem.PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, andpsychological mechanisms are involved in their genesis and perpetuation. For psychiatry,there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversionand dissociative disorders, and the DSM-5 describes the functional neurological disorders.However, patients with PNES also have a high frequency of other comorbidities likedepression, particularly trauma and post-traumatic stress disorder. It has been postulatedthat PNES are essentially dissociations that operate as a defensive psychological mechanismthat use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, therecognition of PNES has significantly increased, and several psychological treatments havebeen developed. In this manuscript, we carried out a state-of-the-art review, with the aim toprovide a critical approach to the extensive literature about PNES, focusing on diagnosticaspects, the primary management, and the available treatments that have been shown to beeffective for the improvement of PNES.