More controversies on the treatment of psychogenic pseudoseizures: an addendum

There is no shortage of controversies when it comes to psychogenic pseudoseizures (PPS). In this addendum to the Iriarte et al. paper [Epilepsy Behav 4 (2003) 354], I review some controversial issues related to the treatment of PPS. First, I advocate the point that our first goal of therapy is not to attempt to stop the occurrence of PPS, but to ensure that patients and families have accepted that they do not suffer from epilepsy, because the most frequent cause of morbidity and mortality seen in these patients is related to their misdiagnosis as epilepsy patients and the resultant aggressive treatment in intensive care units. Remission of PPS should be our second goal! The second controversial point pertains to how long neurologists should continue to follow up patients after a diagnosis of PPS is reached, and I suggest some parameters to be used in reaching such decision. In the third controversial issue, I review the lack of communication between neurologists and psychiatrists exemplified by the misinterpretation by psychiatrists of the diagnostic value of video-EEG-telemetry studies and resulting mixed messages given to patients and families by neurologists and psychiatrists. The fourth controversial point pertains to the criteria to discontinue antiepileptic drugs after a diagnosis of PPS has been established. Finally, I discuss the timing of introducing a psychogenic cause during the presentation of the diagnosis to patient and family.