Conceptualization and Treatment of Psychogenic Non-Epileptic Seizures

Abstract

Psychogenic non-epileptic seizures (PNES) frequently present co-morbidly with a range of somatic and psychiatric conditions. This review discusses the relationship between PNES, a number of co-morbid psychiatric symptoms, early attachment trauma, and disruption of neurological development. We suggest that it may be clinically useful to understand PNES with reference to three patterns of co-morbidity and trauma history. In the first group, PNES are one symptom of a response to severe, chronic trauma and invalidation in attachment relationships, or a response to a recent event that overwhelms an emotion regulation system shaped by attachment trauma. For a second group, PNES occur in the context of ongoing interruptions to self and memory with or without a history of attachment trauma. For a third group, PNES occur in the absence of extensive co-morbidity and apparent trauma, primarily as a panic reaction, in a population with under-developed emotion regulation skills. Treatment approaches consistent with these conceptualizations are suggested.

Childhood trauma and psychogenic nonepileptic seizures: A review of findings with speculations on the underlying mechanisms

“…It is also important to investigate the characteristics and the circumstances of the traumatic event in patients with PNES in order to determine the best type of psychotherapy [51]. Currently, there are no guidelines regarding treatment of PNES because the symptoms reflect a variety of different defense mechanisms which can give rise to the symptoms [12].…”

Psychogenic non-epileptic seizures: A model of their pathogenic mechanism

“…PNES constitute a heterogeneous population with varying degrees of psychiatric background and somatic complaints. 22,23 It is unlikely that one single model can explain PNES for all subgroups of patients. Certain traits that describe cognitive and emotion processing styles have been identified in PNES.…”

Heterogeneity of patients with functional/dissociative seizures: Three multidimensional profiles

“…A previous study by our team 21 compared FDS patients according to trauma history and found that those who reported a history of trauma had significantly more psychiatric comorbidities and stronger dissociative tendencies. Likewise, Quinn et al 43 divided patients with FDS into three groups according to their trauma experience backgrounds and psychiatric comorbidities on the basis of a literature review. In their first group, the seizures appeared to be a response to severe and chronic trauma.…”