Nonepileptic Seizures

The primary goal of treatment in nonepileptic seizures (NES) is to improve the patient's quality of life by terminating seizure production or reducing seizure frequency. Initial treatment consists of explaining the diagnosis and its psychological nature to patients without judging them or giving the NES excessive attention. Next, help patients identify stresses and refer them for mental health treatment. Neurologists should continue to see patients intermittently to wean anticonvulsants, and encourage compliance with mental health care. Psychiatric treatment of NES has the following three aims: 1) Help patients identify and eliminate contributing stresses. 2) Teach better coping mechanisms and increased expression of suppressed feelings that are being communicated somatically. 3) Diagnose and treat comorbid psychiatric conditions such as depression, anxiety, dissociation, or post-traumatic symptoms. The mainstay of psychiatric treatment for NES is some kind of individual or family psychotherapy or hypnosis. Selective serotonin reuptake inhibitor antidepressant medications (first-line drugs) or tricyclic antidepressants (second-line drugs) may be needed to treat comorbid depression, panic, or post-traumatic stress disorder (PTSD), but medications should nearly always be combined with psychotherapeutic approaches. Benzodiazepines should be used only with psychotherapy to teach better coping. Families or caregivers may need to learn behavior modification to minimize covert environmental rewards for NES. With proper diagnosis and treatment, about 45% of patients will become seizure-free, and another one third of patients will show reduced seizure frequency.