Multicenter Pilot Treatment Trial for Psychogenic Nonepileptic Seizures

Abstract

Psychogenic nonepileptic seizures (PNES) are a somatoform conversion disorder manifesting as paroxysmal events not associated with electroencephalographic (EEG) epileptiform correlates, and they have psychological underpinnings.¹ They are not responsive to treatment with, and may be worsened by, antiepileptic drugs.^2,3 They occur worldwide, and in the United States up to 20% of civilians and up to 25% of veterans diagnosed as having epilepsy actually have PNES,⁴ making PNES as common as multiple sclerosis and Parkinson disease⁵ and as disabling as epilepsy.⁶ The phenomenology and psychological underpinnings of PNES are well delineated, including an understanding of risk factors and prognostic features.⁷ Much less is known, however, about effective treatments for PNES, resulting in many patients returning to neurology offices and emergency departments because of recurrent seizures. Surveys administered to American Epilepsy Society members and UK clinicians described standard medical care (treatment as usual [TAU]) for PNES as a neurologist sharing the diagnosis with the patient and family, if present, while continuing to follow up with the patient, tapering the antiepileptic drug in lone PNES, and the majority not initiating psychotropic treatment but making a referral to a psychiatrist or psychologist.^8,9 Many times after diagnosis, patients with PNES do not pursue mental health care follow-up or they receive only supportive psychotherapy, which is not effective for PNES¹⁰ or for depression.^11,12