Identification of three distinct groups of patients with both epilepsy and psychogenic nonepileptic seizures

PNES around the world: Where we are now and how we can close the diagnosis and treatment gaps—an ILAE PNES Task Force report

“…In the group with ID, there was a trend toward a male preponderance, relative paucity of antecedent sexual abuse, frequent episodes of psychogenic nonepileptic status, as well as a greater proportion of patients in whom situational or emotional triggers immediately preceding individual PNES were reported . Gates and Erdahlproposed “a reinforced behavior pattern” as a particularly important pathogenetic factor leading to PNES in patients with comorbid ID, an idea reemphasized in the study by Magaudda et al In view of the somewhat different etiology of PNES in this patient subgroup, treatment may need to be different as well. A therapeutic approach combining the modification of the patient's environment and mind‐set may be particularly useful …”

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

“…It should be noted that all types of psychological trauma (job loss, divorce, relational problems, a dysfunctional family, and chronic diseases such as epilepsy, multiple sclerosis, and rheumatoid arthritis) can trigger the pathogenic mechanism which brings on histrionic symptoms [41]. One could discuss the reasons why the resulting histrionic symptom is PNES rather than, for instance, hemiparesis or mutism.…”

“…Nevertheless, in patients with moderate to severe intellectual disabilities, the pathogenic mechanism of PNES is not conversion but rather a "reinforced behavioral pattern" [41]. In these patients, PNES occur when there is an improvement in or the disappearance of a particular medical pathology which until then had led to significant attention on the patient by family members (e.g., the reduction in frequency or the disappearance of ES).…”

Comorbid epilepsy and psychogenic non-epileptic seizures: How well do patients and caregivers distinguish between the two

“…Higher prevalence of intellectual disability among patients with PNES and comorbid epilepsy has already been recognized. 10 Cognitive impairment may interfere with the patient's ability to make such distinction in several ways. Inability to understand and to retain information regarding the diagnosis may be involved.…”

“…2,7 Five to 60 percent of PNES patients have comorbid epilepsy. [8][9][10] Studies focusing on PNES outcome and treatment generally exclude cases with confirmed or suspected comorbid epilepsy, [11][12][13] since these conditions are not easily discernible. 14 One study included patients with comorbid epilepsy if patients reliably distinguished both events, not specifying how this distinction was made.…”