Treatment of Psychogenic Nonepileptic Seizures

Abstract

Psychogenic non-epileptic seizures (PNES) were first described in the medical literature in the 19th century as seizure-like attacks not related to an identified central nervous system lesion and are currently classified as a conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a universally accepted and unifying etiological model does not yet exist, several risk factors have been identified. Management of PNES should be based on interdisciplinary collaboration, targeting modifiable risk factors. The first treatment phase in PNES is patient engagement, which is challenging given the demonstrated low rates of treatment retention. Acute interventions constitute the next phase in treatment and most research studies focus on short-term evidence-based interventions. Randomized controlled pilot trials support cognitive-behavioral therapy. Other psychotherapeutic and psychopharmacological interventions have been less well-studied using controlled and uncontrolled trials. Within the discussion of acute interventions, we present a preliminary evaluation for feasibility of a mindfulness-based psychotherapy protocol in a very small sample of PNES patients. We demonstrated in 6 subjects that this intervention is feasible in real-life clinical scenarios and warrants further investigation in larger scale studies. The final treatment phase is long-term follow-up. Long-term outcome studies in PNES show that a significant proportion of patients remain symptomatic and experience continued impairments in quality of life and functionality. We believe that PNES should be understood as a disease that requires different types of intervention during the various phases of treatment.

Written Accounts of Living With Epilepsy or Psychogenic Nonepileptic Seizures: A Thematic Comparison

“…This supports the use of different psychological therapies for those with PNES. For example, cognitive behavioural therapy (Goldstein et al, 2010), mindfulness (Baslet, Dworetzky, Perez, Dworetzky, & Oser, 2015), and acceptance-commitment therapy (Cope, Poole, & Agrawal, 2017). Individuals with epilepsy may also benefit from such treatments to help manage with the sequelae of their condition (Dewhurst, Novakova, & Reuber, 2015;Thompson et al, 2015).…”

Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

“…[11][12][13] Long-term adherence with behavioral health treatments of PNES has received limited attention, and longterm dropout rates are unknown. We therefore conducted a prospective cohort study, measuring adherence with psychiatric follow-up for up to 17 months after diagnosis of PNES.…”

A case series of Acceptance and Commitment Therapy (ACT) for reducing symptom interference in functional neurological disorders

“…For a range of different reasons, several have advanced that ACT may be particularly useful in the context of FND (Baslet, Dworetzky, Perez, & Oser, 2015;Cope, Poole, & Agrawal, 2017;Baslet, & Hill, 2011;Graham, Stuart, O'Hara, & Kemp, 2017). First, because ACT's target, psychological flexibility, is a transdiagnostic process (Levin et al, 2014), it may have impact across the psychological heterogeneity evident in FND (Graham et al, 2017).…”