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2016 ; 21
(3
): 239-46
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Nonepileptic seizures: an updated review
#MMPMID26996600
Perez DL
; LaFrance WC Jr
CNS Spectr
2016[Jun]; 21
(3
): 239-46
PMID26996600
show ga
Psychogenic nonepileptic seizures (PNES) are a functional neurological
disorder/conversion disorder subtype, which are neurobehavioral conditions at the
interface of neurology and psychiatry. Significant advancements over the past
decade have been made in the diagnosis, management, and neurobiological
understanding of PNES. This article reviews published PNES research focusing on
semiologic features that distinguish PNES from epileptic seizures, consensus
diagnostic criteria, the intersection of PNES and other comorbidities,
neurobiological studies, evidence-based treatment interventions, and outcome
studies. Epidemiology and healthcare utilization studies highlight a continued
unmet medical need in the comprehensive care of PNES. Consensus guidelines for
diagnostic certainty are based on clinical history, semiology of witnessed
typical event(s), and EEG findings. While certain semiologic features may aid in
the diagnosis of PNES, the gold standard remains capturing a typical event on
video electroencephalography (EEG) showing the absence of epileptiform activity
with history and semiology consistent with PNES. Medical-neurologic and
psychiatric comorbidities are prevalent in PNES; these should be assessed in
diagnostic evaluations and integrated into treatment interventions and prognostic
considerations. Several studies, including a pilot, multicenter, randomized
clinical trial, have now demonstrated that a cognitive behavioral
therapy-informed psychotherapy is an efficacious treatment for PNES, and
additional efforts are necessary to evaluate the utility of pharmacologic and
other psychotherapy treatments. Neuroimaging studies, while requiring
replication, suggest that PNES may occur in the context of alterations within and
across sensorimotor, emotion regulation/processing, cognitive control, and
multimodal integration brain systems. Future research could investigate
similarities and differences between PNES and other somatic symptom disorders.
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