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

Abstract

Psychogenic non-epileptic seizures (PNES) consist of paroxystic events facilitated by a dysfunction in emotion processing. Models explaining the pathogenic mechanisms leading to these seizure-like episodes are limited. In this article, evidence that supports dysfunction at the level of arousal tolerance, cognitive-emotional information processing and volitional control is reviewed. A hypothetical pathophysiological mechanism is discussed based on functional neuroimaging evidence from PNES-related conditions and traits. This pathophysiological model suggests an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes. Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system. During the episodes, sensorimotor and cognitive processes are modified or not properly integrated, allowing the deployment of autonomous prewired behavioral tendencies. Finally, I elaborate on how therapeutic applications could be modified based on the proposed hypothetical model, potentially improving clinical outcomes.

Towards an integrative theory of psychogenic non-epileptic seizures (PNES)

“…According to this account, PNES reflect the operation of pre-wired behavioural tendencies (e.g., Baslet, 2011;Kretschmer, 1944), such as an intrinsic stress response similar to other defensive reactions (e.g., freeze; startle; Nijenhuis, Vanderlinden, & Spinhoven, 1998). This may arise as an acute response to threat and/or alteration in arousal and is thought to serve a basic biological function, such as protecting the organism, regulating arousal or facilitating recuperation.…”

“…Most recent accounts suggest that various factors can contribute to the onset and maintenance of PNES, with the precise contribution varying from individual to individual (e.g., Baslet, 2011;Bodde et al, 2009;Goldstein, Deale, Mitchell-O'Malley, Toone, & Mellers, 2004;Reuber, 2009). Some theorists (e.g., Baslet, 2011;Goldstein et al, 2004) make specific claims about the nature of PNES; others (e.g., Bodde et al, 2009;Reuber, 2009) speak generally about predisposing, precipitating and perpetuating factors without clearly specifying what they consider PNES to actually be.…”

“…Some theorists (e.g., Baslet, 2011;Goldstein et al, 2004) make specific claims about the nature of PNES; others (e.g., Bodde et al, 2009;Reuber, 2009) speak generally about predisposing, precipitating and perpetuating factors without clearly specifying what they consider PNES to actually be. Often, the focus is more on why PNES have developed rather than how, that is, on etiology rather than mechanism.…”

Psychogenic Pseudoepileptic Seizures – From Ancient Time to the Present

“…In paper of Baslet (2011) presented is a hypothetical pathophysiological model suggesting an alteration in the influence and connection of brain areas involved in emotion processing onto other brain areas responsible for sensorimotor and cognitive processes. Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system.…”

“…Integrating this information, PNES are conceptualized as brief episodes facilitated by an unstable cognitive-emotional attention system. (Baslet 2011). According to Reuber (2009) PNES should be understood based on multifactorial etiologic model.…”