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Orbitofrontal cortex dysfunction in psychogenic non-epileptic seizures. A proposal for a two-factor model.

Jagan A Pillai1, Sheryl R Haut2, David Masur2

  • 1Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, United States.

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|February 17, 2015
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Psychogenic nonepileptic seizures (PNES) may stem from both orbitofrontal dysfunction and psychological stress. This two-factor model offers new insights into PNES causes and potential treatments.

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Area of Science:

  • Neurology
  • Psychiatry
  • Neuroscience

Background:

  • Psychogenic nonepileptic seizures (PNES) present diagnostic challenges due to their similarity to epileptic seizures.
  • The pathophysiology of PNES and other conversion disorders remains poorly understood.
  • Psychological, psychiatric, and environmental factors are linked to PNES, but a unifying model is lacking.

Purpose of the Study:

  • To propose a novel two-factor model for the pathogenesis of PNES.
  • To investigate the combined role of orbitofrontal cortical dysfunction and psychological stressors in PNES.
  • To explore the therapeutic implications of this proposed model.

Main Methods:

  • Review of clinical signs differentiating PNES from frontal lobe epilepsy.
  • Analysis of the correlation between orbitofrontal cortex dysfunction, psychological stressors, and PNES.
  • Development of a hypothetical two-factor model for PNES pathogenesis.

Main Results:

  • Clinical signs of PNES can overlap with those of frontal epileptic seizures.
  • Orbitofrontal cortex dysfunction and psychological stressors are independently associated with PNES.
  • A two-factor model suggests a combined predisposition to PNES.

Conclusions:

  • PNES may arise from the interplay of orbitofrontal cortical dysfunction and a history of psychological stressors.
  • This model provides a framework for understanding PNES etiology.
  • Further research into this two-factor model could guide novel therapeutic strategies for PNES.