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Management of psychogenic non-epileptic seizures: a multidisciplinary approach

S Gasparini1,2, E Beghi3, E Ferlazzo1,2,4

  • 1Department of Medical and Surgical Sciences, Magna Greacia University of Catanzaro, Catanzaro, Italy.

European Journal of Neurology
|October 10, 2018
PubMed

Insights

Experts reached a consensus on managing psychogenic non-epileptic seizures (PNES), recommending a multidisciplinary approach. Diagnosis should follow ILAE guidelines, with ethical seizure induction and cognitive-behavioral therapy as a first-line psychological treatment.

Area of Science:

  • Neurology
  • Psychiatry
  • Bioethics

Background:

  • The International League against Epilepsy (ILAE) established diagnostic criteria for psychogenic non-epileptic seizures (PNES).
  • Ethical considerations and treatment standardization for PNES remain debated, with potential age-related management differences.
  • A consensus was needed to guide PNES management across disciplines and age groups.

Purpose of the Study:

  • To achieve expert and stakeholder consensus on the management of psychogenic non-epileptic seizures (PNES).
  • To address key aspects including diagnosis, ethical issues, psychiatric comorbidities, and treatment strategies for PNES.

Main Methods:

  • Formation of a multidisciplinary expert board including neurologists, neuropsychologists, psychiatrists, pharmacologists, ethicists, and patient representatives.
  • Systematic literature review followed by a consensus conference and Delphi panel consultations.
  • Evaluation of evidence quality, which was generally low across all topics.

Main Results:

  • The consensus affirmed adherence to ILAE diagnostic recommendations for PNES.
  • Seizure induction was deemed ethical using minimally invasive methods.
  • Recommended screening for mood disorders, personality disorders, and psychic trauma.
  • Cognitive-behavioral therapy (CBT) is suggested as a first-line psychological intervention.
  • Pharmacological treatment should target comorbid anxiety and depression.
  • No significant age-related differences in management were identified between children/adolescents and adults.

Conclusions:

  • Psychogenic non-epileptic seizure management requires a multidisciplinary approach.
  • Ethical diagnostic procedures and psychological interventions like CBT are crucial.
  • Further high-quality, long-term research is necessary to standardize PNES treatment protocols.

Keywords:
EEGconversion disorderepilepsy

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