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Psychogenic nonepileptic seizures: a concise review

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Abstract

Psychogenic nonepileptic seizures (PNES) are commonly diagnosed and treated at epilepsy centers; however, their neurobiology is still poorly understood. Diagnosis relies on a multidisciplinary evaluation and is usually based on different combinations of data. They are diagnosed most reliably by recording a seizure while under video-EEG monitoring. Treatment includes multiple phases. Fewer than 40% of adults with PNES are expected to become seizure-free within 5 years after diagnosis. This article presents a concise review of the current literature about the definition, diagnosis, epidemiology, clinical characteristics, treatment, and prognosis of PNES.

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References

  1. Asadi-Pooya AA, Emami Y, Emami M (2014) Psychogenic non-epileptic seizures in Iran. Seizure 23(3):175–177

    Article  PubMed  Google Scholar 

  2. Alsaadi TM, Marquez AV (2005) Psychogenic non-epileptic seizures. Am Fam Physician 72:849–856

    PubMed  Google Scholar 

  3. Kerr MP, Mensah S, Besag F et al (2011) International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia 52:2133–2138

    Article  PubMed  Google Scholar 

  4. Brigo F, Igwe SC, Ausserer H et al (2015) Terminology of psychogenic nonepileptic seizures. Epilepsia 56(3):e21–e25

    Article  PubMed  Google Scholar 

  5. O’Sullivan SS, Spillane JE, McMahon EM et al (2007) Clinical characteristics and outcome of patients diagnosed with psychogenic non-epileptic seizures: a 5-year review. Epilepsy Behav 11:77–84

    Article  PubMed  Google Scholar 

  6. Hubsch C, Baumann C, Hingray C et al (2011) Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J Neurol Neurosurg Psychiatry 82:955–960

    Article  PubMed  Google Scholar 

  7. Bodde NM, Brooks JL, Baker GA et al (2009) Psychogenic non-epileptic seizures-definition, etiology, treatment and prognostic issues: a critical review. Seizure 18:543–553

    Article  CAS  PubMed  Google Scholar 

  8. Avbersek A, Sisodiya S (2010) Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 81(7):719–725

    Article  PubMed  Google Scholar 

  9. Bagla R, Skidmore CT (2011) Frontal lobe seizures. Neurologist 17(3):125–135

    Article  PubMed  Google Scholar 

  10. Asadi-Pooya AA, Emami M, Ashjazadeh N et al (2013) Reasons for uncontrolled seizures in adults; the impact of pseudointractability. Seizure 22(4):271–274

    Article  PubMed  Google Scholar 

  11. Asadi-Pooya AA, Emami M (2012) Reasons for uncontrolled seizures in children; the impact of pseudointractability. Epilepsy Behav 25(3):341–344

    Article  PubMed  Google Scholar 

  12. Ricciardi L, Edwards MJ (2014) Treatment of functional (psychogenic) movement disorders. Neurotherapeutics 11(1):201–207

    Article  PubMed  Google Scholar 

  13. Driver-Dunckley E, Stonnington CM, Locke DE et al (2011) Comparison of psychogenic movement disorders and psychogenic non-epileptic seizures: is phenotype clinically important? Psychosomatics 52(4):337–345

    Article  PubMed  Google Scholar 

  14. Hopp JL, Anderson KE, Krumholz A et al (2012) Psychogenic seizures and psychogenic movement disorders: are they the same patients? Epilepsy Behav 25(4):666–669

    Article  CAS  PubMed  Google Scholar 

  15. Voon V, Ekanayake V, Wiggs E et al (2013) Response inhibition in motor conversion disorder. Mov Disord 28(5):612–618

    Article  PubMed  PubMed Central  Google Scholar 

  16. LaFrance WC, Baker GA, Duncan R et al (2013) Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach; a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 54(11):2005–2018

    Article  PubMed  Google Scholar 

  17. Cuthill FM, Espie CA (2005) Sensitivity and specificity of procedures for the differential diagnosis of epileptic and non-epileptic seizures: a systematic review. Seizure 14:293–303

    Article  PubMed  Google Scholar 

  18. Asadi-Pooya AA, Sperling MR (2015) Epidemiology of psychogenic nonepileptic seizures. Epilepsy Behav 46:60–65

    Article  PubMed  Google Scholar 

  19. Duncan R, Razvi S, Mulhern S (2011) Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 20:308–311

    Article  PubMed  Google Scholar 

  20. Sigurdardottir KR, Olafsson E (1998) Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia 39:749–752

    Article  CAS  PubMed  Google Scholar 

  21. Szaflarski JP, Ficker DM, Cahill WT et al (2000) Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. Neurology 55(10):1561–1563

    Article  CAS  PubMed  Google Scholar 

  22. Benbadis SR, Allen-Hauser W (2000) An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 9(4):280–281

    Article  CAS  PubMed  Google Scholar 

  23. Asadi-Pooya AA, Emami M (2013) Juvenile and adult-onset psychogenic non-epileptic seizures. Clin Neurol Neurosurg 115(9):1697–1700

    Article  PubMed  Google Scholar 

  24. Szabó L, Siegler Z, Zubek L et al (2012) A detailed semiologic analysis of childhood psychogenic non-epileptic seizures. Epilepsia 53:565–570

    Article  PubMed  Google Scholar 

  25. Duncan R, Oto M, Martin E, Pelosi A (2006) Late onset psychogenic non-epileptic attacks. Neurology 66:1644–1647

    Article  PubMed  Google Scholar 

  26. Alessi R, Valente KD (2013) Psychogenic non-epileptic seizures at a tertiary care center in Brazil. Epilepsy Behav 26(1):91–95

    Article  PubMed  Google Scholar 

  27. Scévola L, Teitelbaum J, Oddo S et al (2013) Psychiatric disorders in patients with psychogenic non-epileptic seizures and drug-resistant epilepsy: a study of an Argentine population. Epilepsy Behav 29(1):155–160

    Article  PubMed  Google Scholar 

  28. Oto M, Conway P, McGonigal A et al (2005) Gender differences in psychogenic non-epileptic seizures. Seizure 14(1):33–39

    Article  CAS  PubMed  Google Scholar 

  29. Dhiman V, Sinha S, Rawat VS et al (2013) Semiological characteristics of adults with psychogenic non-epileptic seizures (PNESs): an attempt towards a new classification. Epilepsy Behav 27(3):427–432

    Article  PubMed  Google Scholar 

  30. Cronje G, Pretorius C (2013) The coping styles and health-related quality of life of South African patients with psychogenic non-epileptic seizures. Epilepsy Behav 29(3):581–584

    Article  PubMed  Google Scholar 

  31. Jones SG, O’ Brien TJ, Adams SJ et al (2010) Clinical characteristics and outcome in patients with psychogenic non-epileptic seizures. Psychosom Med 72(5):487–497

    Article  PubMed  Google Scholar 

  32. Abubakr A, Wambacq I (2005) Seizures in the elderly: Video/EEG monitoring analysis. Epilepsy Behav 7(3):447–450

    Article  PubMed  Google Scholar 

  33. Thomas AA, Preston J, Scott RC, Bujarski KA (2013) Diagnosis of probable psychogenic nonepileptic seizures in the outpatient clinic: does gender matter? Epilepsy Behav 29(2):295–297

    Article  PubMed  Google Scholar 

  34. Noe KH, Grade M, Stonnington CM et al (2012) Confirming psychogenic non-epileptic seizures with video-EEG: sex matters. Epilepsy Behav 23(3):220–223

    Article  PubMed  Google Scholar 

  35. Asadi-Pooya AA (2016) Psychogenic nonepileptic seizures are predominantly seen in women: potential neurobiological reasons. Neurol Sci 37(6):851–855

    Article  PubMed  Google Scholar 

  36. Lesser RP (1996) Psychogenic seizures. Neurology 46(6):1499–1507

    Article  CAS  PubMed  Google Scholar 

  37. Asadi-Pooya AA, Emami M, Emami Y (2013) Gender differences in manifestations of psychogenic non-epileptic seizures in Iran. J Neurol Sci 332(1–2):66–68

    Article  CAS  PubMed  Google Scholar 

  38. Asadi-Pooya AA, Emami M (2013) Demographic and clinical manifestations of psychogenic non-epileptic seizures: the impact of co-existing epilepsy in patients or their family members. Epilepsy Behav 27(1):1–3

    Article  PubMed  Google Scholar 

  39. Benbadis SR, Agrawal V, Tatum WO (2001) How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 57:915–917

    Article  CAS  PubMed  Google Scholar 

  40. Marchetti RL, Kurcgant D, Gallucci-Neto J et al (2010) Epilepsy in patients with psychogenic non-epileptic seizures. Arq Neuropsiquiatr 68(2):168–173

    Article  PubMed  Google Scholar 

  41. Martin R, Burneo JG, Prasad A et al (2003) Frequency of epilepsy in patients with psychogenic seizures monitored by video-EEG. Neurology 61(12):1791–1792

    Article  CAS  PubMed  Google Scholar 

  42. Kollar B, Carnicka Z, Siarnik P et al (2014) The importance of interictal electroencephalography in paroxysmal states. Bratisl Lek Listy 115(3):168–170

    CAS  PubMed  Google Scholar 

  43. Binnie CD, Stefan H (1999) Modern electroencephalography: its role in epilepsy management. Clin Neurophysiol 110:1671–1697

    Article  CAS  PubMed  Google Scholar 

  44. Reuber M (2009) The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. Neurol Clin 27:909–924

    Article  PubMed  Google Scholar 

  45. Selkirk M, Duncan R, Oto M, Pelosi A (2008) Clinical differences between patients with nonepileptic seizures who report antecedent sexual abuse and those who do not. Epilepsia 49(8):1446–1450

    Article  PubMed  Google Scholar 

  46. Duncan R, Oto M (2008) Predictors of antecedent factors in psychogenic nonepileptic attacks: multivariate analysis. Neurology 71(13):1000–1005

    Article  CAS  PubMed  Google Scholar 

  47. LaFrance WC Jr, Deluca M, Machan JT, Fava JL (2013) Traumatic brain injury and psychogenic nonepileptic seizures yield worse outcomes. Epilepsia 54(4):718–725

    Article  PubMed  Google Scholar 

  48. Bowman ES, Markand ON (1996) Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry 153(1):57–63

    Article  CAS  PubMed  Google Scholar 

  49. Westbrook LE, Devinsky O, Geocadin R (1998) Nonepileptic seizures after head injury. Epilepsia 39(9):978–982

    Article  CAS  PubMed  Google Scholar 

  50. Barry E, Krumholz A, Bergey GK et al (1998) Nonepileptic posttraumatic seizures. Epilepsia 39(4):427–431

    Article  CAS  PubMed  Google Scholar 

  51. Baslet G (2011) Psychogenic non-epileptic seizures: a model of their pathogenic mechanism. Seizure 20:1–13

    Article  PubMed  Google Scholar 

  52. Alper K, Devinsky O, Perrine K et al (1993) Nonepileptic seizures and childhood sexual and physical abuse. Neurology 43(10):1950–1953

    Article  CAS  PubMed  Google Scholar 

  53. Elliott JO, Charyton C (2014) Biopsychosocial predictors of psychogenic non-epileptic seizures. Epilepsy Res 108(9):1543–1553

    Article  PubMed  Google Scholar 

  54. Xue Q, Wang ZY, Xiong XC et al (2013) Altered brain connectivity in patients with psychogenic non-epileptic seizures: a scalp electroencephalography study. J Int Med Res 41(5):1682–1690

    Article  PubMed  Google Scholar 

  55. Ding JR, An D, Liao W et al (2013) Altered functional and structural connectivity networks in psychogenic non-epileptic seizures. PLoS One 8(5):e63850

    Article  PubMed  PubMed Central  Google Scholar 

  56. Ding J, An D, Liao W et al (2014) Abnormal functional connectivity density in psychogenic non-epileptic seizures. Epilepsy Res 108(7):1184–1194

    Article  PubMed  Google Scholar 

  57. Arthuis M, Micoulaud-Franchi JA, Bartolomei F et al (2015) Resting cortical PET metabolic changes in psychogenic non-epileptic seizures (PNES). J Neurol Neurosurg Psychiatry 86(10):1106–1112

    Article  CAS  PubMed  Google Scholar 

  58. van der Kruijs SJ, Bodde NM, Vaessen MJ et al (2012) Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry 83(3):239–247

    Article  PubMed  Google Scholar 

  59. Asadi-Pooya AA (2015) Neurobiological origin of psychogenic nonepileptic seizures: a review of imaging studies. Epilepsy Behav 52(Pt A):256–259

    Article  PubMed  Google Scholar 

  60. LaFrance W, Rusch M, Machan J (2008) What is “treatment as usual” for nonepileptic seizures? Epilepsy Behav 12:388–394

    Article  PubMed  Google Scholar 

  61. Kanner AM (2008) Is the neurologist’s role over once the diagnosis of psychogenic nonepileptic seizures is made? No! Epilepsy Behav 12:1–2

    Article  PubMed  Google Scholar 

  62. Baslet G, Dworetzky B, Perez DL, Oser M (2015) Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clin EEG Neurosci 46(1):54–64

    Article  PubMed  Google Scholar 

  63. LaFrance WC Jr, Reuber M, Goldstein LH (2013) Management of psychogenic nonepileptic seizures. Epilepsia 54(Suppl 1):53–67

    Article  PubMed  Google Scholar 

  64. LaFrance WC Jr, Baird GL, Barry JJ et al NES Treatment Trial (NEST-T) Consortium (2014) Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 71(9):997–1005

  65. Farias ST, Thieman C, Alsaadi TM (2003) Psychogenic nonepileptic seizures: acute change in event frequency after presentation of the diagnosis. Epilepsy Behav 4(4):424–429

    Article  PubMed  Google Scholar 

  66. Reuber M, Pukrop R, Bauer J et al (2003) Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 53:305–311

    Article  PubMed  Google Scholar 

  67. Durrant J, Rickards H, Cavanna AE (2011) Prognosis and outcome predictors in psychogenic nonepileptic seizures. Epilepsy Res Treat 2011:274736

    PubMed  PubMed Central  Google Scholar 

  68. Asadi-Pooya AA (2016) An fMRI study to identify the neurobiological link between sex abuse and psychogenic nonepileptic seizures. Epilepsy Behav 57(pt A):222

    Article  PubMed  Google Scholar 

  69. Asadi-Pooya AA (2016) Biological underpinnings of psychogenic nonepileptic seizures: directions for future research. Neurol Sci 37(7):1033–1038

    Article  PubMed  Google Scholar 

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Acknowledgements

This was a non-funded study. I thank Jennifer Fisher Wilson for editorial assistance.

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Authors and Affiliations

  1. Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, 901 Walnut Street, Suite 435, Philadelphia, PA, 19107, USA

    Ali A. Asadi-Pooya

  2. Neurosciences Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

    Ali A. Asadi-Pooya

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Correspondence to Ali A. Asadi-Pooya.

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Conflict of interest

Ali A. Asadi-Pooya, M.D., consultant: Cerebral Therapeutics, LLC and UCB Pharma; Honorarium: Hospital Physician Board Review Manual; Royalty: Oxford University Press (Book publication).

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Asadi-Pooya, A.A. Psychogenic nonepileptic seizures: a concise review. Neurol Sci 38, 935–940 (2017). https://doi.org/10.1007/s10072-017-2887-8

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