Nonepileptic seizures: an updated review

Area of Science:

• Neurology
• Psychiatry
• Neuroscience

Background:

• Psychogenic nonepileptic seizures (PNES) are a subtype of functional neurological disorder, presenting complex diagnostic and management challenges at the intersection of neurology and psychiatry.
• Recent advancements have improved the understanding of PNES, yet significant unmet needs persist in comprehensive patient care.

Purpose of the Study:

• To review current research on PNES, focusing on diagnostic criteria, semiologic features, comorbidities, neurobiology, and evidence-based treatments.
• To highlight the current state of PNES care and identify areas for future research and clinical attention.

Main Methods:

• Review of published research on PNES, encompassing clinical, neurobiological, and treatment studies.
• Analysis of diagnostic criteria, including semiologic features and video electroencephalography (EEG) findings.
• Examination of comorbidities, treatment interventions (psychotherapy, pharmacotherapy), and outcome studies.

Main Results:

• Consensus diagnostic criteria rely on clinical history, witnessed semiology, and EEG, with video-EEG capturing typical events being the gold standard.
• Psychiatric and neurological comorbidities are common and integral to PNES assessment and management.
• Cognitive behavioral therapy-informed psychotherapy has demonstrated efficacy in treating PNES, though further research into other treatments is needed.

Conclusions:

• PNES diagnosis requires integrating clinical, semiologic, and EEG data, with a recognition of prevalent comorbidities.
• Evidence-based psychotherapies, particularly CBT-informed approaches, offer effective treatment options for PNES.
• Future research should explore neurobiological underpinnings and the relationship between PNES and other somatic symptom disorders.